Can You Use HSA for Therapy? Tips & Tricks for Your Mental Health


Justin Mares

Published Date:

January 31, 2024


Mental health used to be a highly stigmatized topic in America, but we’ve grown past most of the stigma. Influential and powerful voices have come forward detailing their own struggles with mental health, and an increasing amount of resources have been made available for people who want to prioritize their own mental well-being.

One in five American adults lives with a mental illness, and nearly 60% of American adults with a mental illness didn’t seek help last year. This is a problem. Mental illness is common and often highly responsive to treatment, and the resources are there. It’s just a matter of taking the first step to find the help you deserve. 

You deserve to put your mental health first — and if you have an HSA, you may be able to use your tax-free funds to pay for therapy and related products and services that will help you maintain good mental health. Here’s how the process works. 

Can Mental Health Impact Physical Health?

Mental health and physical health are inextricably linked. People who experience chronic physical health conditions are more likely to live with mental health conditions like depression or anxiety. It can be hard to feel calm and complacent when chronic physical health problems are impacting your everyday life.

People who experience mental health issues may also experience physical health issues. People with depression and anxiety often find it difficult to properly care for themselves. They often don’t eat proper diets or meet their exercise requirements. Mental health disorders can contribute to insomnia, migraines, stomach problems, muscle tension, and even elevated blood pressure. 

Most people who live with an illness, either physical or mental, benefit from a holistic approach to treatment that benefits both the mind and body. Treating one condition can often help the other, but it’s important to regard both conditions or sets of symptoms as equally important. 

What Is an HSA?

An HSA (health savings account) is a savings account where you can deposit pre-tax money specifically for healthcare-related needs. Anyone with a high deductible insurance plan can have an HSA as long as they aren’t currently contributing to an FSA (flexible spending account) through their employer.

The purpose of an HSA is to make healthcare-related purchases more affordable by covering expenses that insurance won’t cover. The list of HSA-eligible expenses is lengthy. Eligibility extends to purchases and services related directly to mental and physical healthcare. 

Can I Use HSA for Therapy?

HSA funds can be used to cover many types of therapy for people who are living with mental health challenges. You only need a diagnosis by a professional to establish the medical necessity of therapy. You won’t be asked to prove or justify anything beyond written proof of a diagnosis from a qualified professional. 

Ease of access to mental health treatment is a huge step forward for removing the stigma from one of the most common challenges that American adults face. Mental health is recognized to be equally as medically important as physical health and healthcare laws hold them to the same standard.

What Kinds of Therapy Are Covered by HSA Funds?

Any therapy designed or intended to treat a diagnosed mental health condition is covered by HSA funds. You don’t need a Letter of Medical Necessity or a note to prove an exception if you’ve been diagnosed with a mental health condition

Conditions include, but are not limited to:

  • Depression
  • Postpartum depression
  • Anxiety
  • Post traumatic stress
  • Bipolar disorder
  • Addiction
  • Alcoholism
  • Obsessive compulsive disorder
  • Schizophrenia
  • Eating disorders
  • Personality disorders
  • Mood disorders 
  • Severe phobias that impact quality of life (i.e., agoraphobia)

An HSA can also be used to cover the costs of referral to other necessary mental health professionals, inpatient treatment costs, and the costs of prescribed medications for treating a mental health disorder. 

What Kinds of Therapy Aren’t Covered by HSA Funds?

Only therapy to treat an existing mental health condition is covered by HSA funds. Therapy to fix social relationships or familial dynamics is not covered. Marriage counseling, divorce counseling, and grief counseling wouldn’t be covered by HSA. 

Lack of specific coverage doesn’t mean you can’t receive help for issues that fall into situational categories. You can (and should) speak about how your marriage, divorce, or grief are impacting your mental health with your personal therapist. 

Your therapist may not be able to see multiple people or hold group sessions, but they will be able to help you develop coping strategies and communication skills that will empower you to navigate difficult situations in your everyday life. 

Can I Use HSA for Therapy-Related Treatments?

Complementary and holistic medicine have an excellent track record for working to improve mental health when used in conjunction with conventional therapy (and mental health medication when applicable). 

Your mental healthcare professional may recommend the use of certain treatments to help you manage the symptoms of your condition that manifest both physically and mentally. 

These can include:

  • Aromatherapy
  • Massage
  • Sauna
  • Acupuncture

Treatments like aromatherapy work to soothe the mind by distracting from uncomfortable physical or emotional sensations. Massage, sauna, and acupuncture help to release tension throughout the body while supporting the production of positive endorphins.

These treatments aren’t automatically eligible as HSA expenses, but they can become eligible with a Letter of Medical Necessity. If a healthcare professional believes these treatments would significantly impact your health or serve as an efficient treatment for your condition, you may receive a Letter of Medical Necessity that would justify purchasing them with HSA funds. 

What Is a Letter of Medical Necessity?

A Letter of Medical Necessity is a long-form, formal explanation a doctor will write about your diagnosis and treatment plan. Your doctor will address your HSA custodian and formally request that you be able to purchase a specific product or service with HSA funds because it’s necessary for your health. 

This letter gives you official permission to purchase specialized therapies or devices. Store it with your receipt for relevant purchases to prove that you had permission to make a purchase outside of normal HSA eligibility. If you don’t have a Letter of Medical Necessity, you’ll need to pay a tax penalty on purchases you made without one. 

How To Get a Letter of Medical Necessity

You can ask your healthcare provider at your next appointment about how complementary, holistic, or alternative therapies can be a part of your mental healthcare routine. If your doctor agrees, they can write you a Letter of Medical Necessity.

Alternatively, you can utilize Truemed’s two-minute medical evaluation process during checkout with one of our merchants to obtain a Letter of Medical Necessity quickly if you’re eligible to receive one. The small consultation fee for our online survey evaluation is completely covered by your HSA funds. If you’re found eligible after your evaluation, you can use your Letter of Medical Necessity to make special HSA purchases. 

How To Use Your HSA for Therapy

If you have a diagnosed mental health condition and your insurance won’t cover your visits to a therapist that’s a good fit for you, you can use your HSA to pay for therapy. Some therapists accept HSA/FSA as a direct form of payment. 

If your chosen therapist doesn’t accept HSA/FSA debit card payments, you can pay for your appointment out of pocket and reimburse yourself from your HSA account. Just be sure to keep receipts for your bill and reimbursement to prove that your HSA money was spent appropriately. 

Mental Healthcare Is Healthcare

Truemed’s philosophy has always been that a holistic, well-balanced approach to health management is some of the best medicine you can get. Prioritizing your mental health is vastly important, and if you haven’t been doing so, now is the perfect time to start. 

Truemed works with retailers who offer mental health devices and services. If you find a tool you believe will help you when your therapist isn’t around, a Letter of Medical Necessity can empower you to take initiative for your own mental health. 


Physical health and mental health | Mental Health Foundation

Mental Health Facts | National Alliance on Mental Illness

Mental Health Disorder Statistics | Johns Hopkins Medicine

Holistic medicine and mental health practice: toward a new synthesis | National Library of Medicine

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