HSA and FSA Usage at Retailers: What to Know to Spend Smart

• Generally, you can use your HSA card at many big box retailers both online and in-store, but it depends on the store and what’s eligible under your plan. You can also typically use your HSA card at the doctor’s office, hospital, or pharmacy.
• Where you can use your HSA card depends on your plan administrator’s rules, the merchant category, and the retailer’s checkout system.
• Your HSA or FSA card may go through even if the item is not eligible, and could decline for an eligible item—check eligibility rules before buying and keep receipts to fix any checkout mishaps.
• Common places where your HSA card can often work include pharmacies, big-box retailers with pharmacy sections, optical stores, and certain online stores.
• However, your card can sometimes fail or decline because of merchant coding, the item being flagged as “not eligible”, mixed carts, or issues with the billing address or other info online.
• It’s helpful to check your plan’s list of eligible purchases before shopping to ensure a smoother process, but be aware that checkout success does not always prove an item is eligible and might require extra documentation or clarifying with your plan administrator.

There are a variety of items you can buy with your HSA/FSA card online and in-store, provided they are eligible under your plan. Here are a few common categories:

• Everyday OTC items and supplies: OTC medicines such as pain relievers and allergy medicines, first aid, menstrual care, sunscreen, acne and skincare products, and certain medical devices and supplies.
• Vision and dental care: Contact lenses and solution, prescription glasses, eye exams, dental cleanings and exams, Invisalign, fillings and root canals, dental supplies. Note: Eligible vision/dental expenses depend on what is eligible under your plan.
• “Surprising” items: Sometimes you may be able to use your HSA/FSA funds on products and services beyond what you would find at a typical retailer when used to treat or manage a specific condition with documentation such as an LMN. This can include items such as adaptive footwear, mattresses, or a gym membership.
• “Usually not” items: Items that are more general like body lotion, cosmetics, and everyday vitamins without a specific, documented, medical need are usually not HSA/FSA eligible.
• Eligibility depends on the plan and product: Make sure you save your receipts and any documentation, because eligibility ultimately depends on your plan and the product.

You can generally use your FSA card to spend on health-related expenses such as OTC medications, prescriptions, therapy, and more, if your plan allows it. But FSA cards can sometimes feel stricter—here’s what to watch for when using your FSA card:

• Since FSAs are generally “use it or lose it” meaning the funds don’t rollover from year to year, you may be more tempted to use your FSA card at checkout to quickly use up your funds before they expire.
• Using your FSA card can certainly be more convenient, as some items may be auto-verified and you often don’t need to submit receipts or additional documentation when you pay directly with your card.
• However, this isn’t always the case, and some FSAs may require proof more often for purchases made with your FSA card. That’s why it’s a good idea to always hold on to receipts even when paying with your FSA card in case you need to submit them for further proof.
• Common reasons your FSA card may decline: Mixed carts with items that are FSA eligible and non-eligible, unrecognized items, and your billing address not matching when shopping online.
• Keep it simple: Keep an “FSA-only” cart with items that are clearly eligible under your plan to avoid confusion later.
• If you’re unsure about using your FSA card for an item, you can always pay out-of-pocket and then submit receipts for reimbursement depending on what your plan covers.

You can generally use your HSA card on eligible purchases in-store and online, but there can be differences depending on where you shop, and things to look out for.

• In-store: Some items may register as HSA-eligible at checkout and the system may auto-split eligible and non-eligible items, but others may not.
• Online: The online store’s checkout process, item coding, and shipping and billing address matching can affect approval when using your HSA card to pay for eligible purchases online.
• Subscriptions and memberships: Paying for subscriptions and memberships directly with your HSA card can often be tricky—check your plan for eligibility first, and get any documentation you need to support the purchase.
• Marketplaces: If qualified, shopping with your HSA card at an HSA/FSA marketplace online can be a good way to shop a variety of health and wellness products beyond what you would typically find at a store or online retailer. A marketplace may also provide additional documentation such as a Letter of Medical Necessity, when required. Check your plan’s rules before shopping at a marketplace, and be sure to keep clear receipts and documentation for your records.
• Regardless of where you shop with your HSA card, check to see if you can get an itemized receipt or invoice first.

Ask yourself these questions before spending your HSA/FSA funds on eligible items to make the process smoother.

• Step 1: Is the item clearly eligible according to your plan’s rules?
• Step 2: Can you get an itemized receipt that clearly describes the item?
• Step 3: Is it a mixed cart? If yes, split it.
• Step 4: If the card declines, can you pay another way and submit a claim?
• Step 5: Save documentation in one place (folder/app) for taxes and proof.

• Save your receipts: Keep itemized receipts and invoices, as these will be your best bet to provide your HSA/FSA plan administrator for tax purposes or proof if/when asked to do so for purchases, even if you paid for it with your HSA/FSA card.
• Eligibility: Whether you shop in-store or online, remember that eligibility rules ultimately depend on your plan administrator, even if items are tagged as “eligible” in store/online.

Avoid double-dipping: Make sure you don’t reimburse yourself twice or or mix benefits if you have both an HSA and an FSA.

Shopping on Truemed’s HSA/FSA marketplace can help you spend your funds on a wide variety of health products and services that you may not find at traditional HSA/FSA stores, if eligible. Here’s how Truemed* can help:

• Customers can complete a clinical intake form for an item that is potentially eligible to treat or manage a diagnosed medical condition. An independent licensed practitioner may issue a Letter of Medical Necessity (LMN) based on the customer’s responses when clinically appropriate.
• Customers can browse thousands of potential HSA and FSA-eligible products and services tied to managing a diagnosed health condition such as adaptive footwear, wearable health tech, gym memberships and fitness equipment, mattresses, saunas and cold plunges, and more. You can buy qualifying products or services directly from the brand’s site, which ensures you’re getting the best price.
• While you may be able to use your HSA or FSA funds for these items, your plan administrator may have different rules for eligibility and still makes final decisions on reimbursement.
• How to spend smart: When possible, do the initial intake and documentation steps before you buy and be sure to keep itemized receipts for your plan administrator.

*Truemed is for qualified customers. See terms at truemed.com/disclosures.