How To Get a Doctor's Note for Health Savings


Justin Mares

Published Date:

January 31, 2024


Your HSA account can be a lifesaver — literally. HSA accounts exist to make healthcare needs more affordable by allowing you to set aside pre-tax money specifically for that purpose. The list of what an HSA covers is fairly extensive, but the HSA rules have a pretty rigid idea of what constitutes medicine. 

True medicine is the choices you make, from the foods you eat to the way you choose to improve your body’s ability to recover from a workout or an injury. An HSA doesn’t have your unique needs in mind, but your doctor does. Here’s how to get a Letter of Medical Necessity from your doctor to expand your HSA-eligible purchases for your personal wellness.

What Is a Letter of Medical Necessity?

A Letter of Medical Necessity (LMN) is a letter from your doctor stating that something is medically necessary for you. Medically necessary doesn’t have to mean “life-saving,” and it doesn’t have to indicate an emergency. The phrase “medical necessity” only has to mean that your doctor believes that your health would significantly benefit from something. 

Everyone’s needs are different, and therefore, different treatment approaches will work best when tailored to someone’s needs. For example: exercise is vital for human health. A healthy person with a lot of lean muscle who runs twice a week and does light yoga every day wouldn’t benefit from a gym membership as much as someone who is overweight with low to average muscle development. 

A Letter of Medical Necessity can be used to expand what offerings are considered medical or health-related expenses for a patient depending on their unique needs. A Letter of Medical Necessity can help someone use HSA funds for things like workout equipment or a gym membership.

A doctor could easily make a case that a gym membership would be a medical necessity for someone who needs to prioritize exercise and weight management as part of a healthy lifestyle plan, while a person who already has an effective workout routine wouldn’t benefit as much. 

What Can You Get Without a Letter of Medical Necessity?

HSA funds can be used for a wealth of items without a letter of medical necessity. An HSA account will cover most of your daily medical needs and plenty of commonly used over-the-counter medical or health products. The list of what an HSA covers is impressively large. These are just a few common products that many people buy with their HSA funds. 

Direct Medical and Prescription Costs

An HSA typically covers direct medical and prescription costs, such as the following:

  • Doctor and hospital visit costs
  • Co-pays for prescriptions
  • Medical devices like wheelchairs, crutches, or mobility scooters
  • Disability devices like hearing aids
  • Dental care costs, including false teeth and braces
  • Eyeglasses and prescription sunglasses
  • Contact lenses and contact lens care supplies
  • Custom orthotics and prescription therapeutic shoes
  • Artificial limbs
  • Glucose meters, test strips, and insulin syringes 

Over-the-Counter Medicine

Some over-the-counter medicines are also covered by HSA funds, including:

  • Pain relievers (like ibuprofen, acetaminophen, and naproxen)
  • Allergy medications and antihistamines
  • Antacids and anti-nausea meds
  • Cold and sinus medication
  • Cold sore treatments
  • Vapor rub
  • Cough drops and throat sprays
  • Electrolyte solutions and powders
  • Sleep aids

Reproductive Health and Pregnancy Products

The following reproductive health and pregnancy products can also be purchased using HSA funds:

  • Pregnancy tests
  • Ovulation tests
  • Condoms
  • Birth control
  • Emergency contraceptives
  • Pads, tampons, and menstrual cups
  • Over the counter medicated ointments
  • Lactation supplies and consulting, including breast pumps

Medicated Skincare

Medicated skincare aimed at treating or preventing skin conditions can be purchased using your HSA. These include:

  • Medicated acne wash, wipes, spot treatments, and face pads
  • Sunscreen and sunburn relief products
  • Lotion or treatments for specific skin concerns, like eczema or rosacea 
  • Hydrocortisone cream
  • Anti-fungal cream
  • Topical medicated pain relief balms and roll-ons

First Aid Supplies 

First aid supplies is also covered by HSA funds — eligible items include the following:

  • First aid kits
  • Bandages and gauze
  • Antibiotic ointments
  • Alcohol, peroxide, and betadine
  • Hand sanitizer 
  • Burn relief gel or cream
  • Fabric bandages, wraps, and braces
  • Cold packs
  • Topical lidocaine products
  • Liquid bandage sprays

What Can You Get With a Letter of Medical Necessity?

You can get almost anything health or wellness related with a Letter of Medical Necessity, even if it isn’t on the list. As long as your doctor can justify the purchase as medically necessary for you, your HSA should be able to cover at least part of the cost of your purchase. 

Therapeutic and Recovery Tools

If your doctor has prescribed a specific therapeutic or recovery tool for the treatment of a health concern, like arthritis, you can use your HSA funds for the purchase. 

Examples include:

  • Hot tubs
  • Saunas
  • Cold plunges
  • Alternative wellness practitioner services
  • Aromatherapeutic tools (like essential oils and diffusers)

Wellness Technology 

Certain wellness technology is also HSA eligible if your doctor has prescribed it, such as:

  • Wellness-tracking smart tech (like bracelets or watches)
  • Pedometers
  • Sleep tracking devices

Nutritional Health Products

Nutritional health products can also be HSA eligible if your doctor has prescribed them for the sake of a health condition — like if you have a vitamin deficiency, for example:

  • Vitamins
  • Supplements
  • Protein powders and shakes
  • Bone broth

Physical Fitness

Fitness memberships and equipment can also be HSA eligible with a doctor’s prescription:

How To Get a Letter of Medical Necessity

There are two ways to get a Letter of Medical Necessity for an HSA purchase. The first way is to ask your doctor or specialist at your next appointment, and the second way is to shop with a Truemed integrated retailer.

Ask Your Doctor for a Letter of Medical Necessity 

If you believe that something like a gym membership or a home sauna would have a substantial benefit to your health, talk to your doctor about it. Your doctor will likely agree with anything safe and proven to be a net benefit to human health. 

Your doctor can write you a Letter of Medical Necessity for a specific type of purchase or service that shows your medical need for something that isn’t ordinarily covered by HSA. You’ll have clearance to buy whatever was described in the letter while remaining compliant with your HSA.

Fill Out a Truemed Survey to Determine Eligibility

When you shop with a retailer or service provider that uses Truemed for HSA/FSA payments, you can choose “Pay With Truemed” at checkout and take a two-minute HSA/FSA evaluation survey. You’ll be matched with a provider to determine eligibility. If you qualify, you’ll receive a Letter of Medical Necessity to complete your purchase using your HSA/FSA debit card.

Once you have your Letter of Medical Necessity, you can place all future purchases for the qualified product, service, or membership on your HSA/FSA debit card. You can also pay for them out of your personal funds and reimburse yourself from your HSA account.

What To Do When You Make a Purchase with a Letter of Medical Necessity

Whenever you make a purchase with HSA/FSA funds, you need to save your receipt. Your receipt proves that you spent your HSA/FSA funds appropriately and that your purchases were truly tax-exempt. 

When you make a purchase with a Letter of Medical Necessity, all you need to do is take one extra step. Keep your Letter of Medical Necessity with your receipts for all purchases your letter covers. For example, if you got your gym membership through your LMN, keep your monthly membership due receipts with your letter. They work in tandem to complete the big picture of your eligibility. 

Getting an LMN When You Need One 

The term “medicine” can mean a lot of things. Sometimes, medicine is things like bone broth or a wellness tracker that helps you meet your doctor’s recommended exercise goals. It’s easy to get a Letter of Medical Necessity that will allow you to purchase different types of medicine with your HSA account.

If you’re a retailer that offers wellness goods that don’t fit the standard HSA guidelines, you may be able to allow your customers to shop with you using their HSA funds by helping them obtain a Letter of Medical Necessity. That’s why Truemed is here. 


How HSA-eligible plans work |

Benefits of Physical Activity | Centers for Disease Control and Prevention

2022 Publication 969 Health Savings Accounts and Other Tax-Favored Health Plans | Internal Revenue Service

What's a Health Savings Account? | Centers for Medicare & Medicaid Services