The Benefits of a Letter of Medical Necessity


Justin Mares

Published Date:

January 31, 2024


The term “medicine” is generally used to refer to visits with a doctor and items that a doctor prescribes for you. In reality, medicine is so much more. Every decision you make to improve or maintain your overall wellness is medicine. The things you put on your plate and the 30 minutes you spend at the gym are absolutely medicine — so why doesn’t your HSA feel the same way?

You can expand your HSA’s eligible offerings with something called a Letter of Medical Necessity (LMN). A Letter of Medical Necessity states that your doctor feels that something would have medicinal value to you and, therefore, should be covered by HSA funds. Here’s how it works.

What Is Generally Covered By an HSA?

Your HSA (health savings account) is designed to make health and wellness costs more affordable. It can be used for obvious medical expenses, like co-pays on medical visits and prescriptions. HSAs also extend to things you can purchase over the counter. 

You can use your HSA for over-the-counter medicines, first aid supplies, reproductive health supplies, and necessary medical devices. Anything that would obviously be considered medicine or a wound care product is typically covered by an HSA.

The only issue is that there are plenty of things necessary for our health and wellness that aren’t typically considered medicine. Supplements and vitamins, healthy food, exercise, and high-quality sleep all have a significant value to human health, but your HSA doesn’t immediately recognize that value. That’s where a Letter of Medical Necessity comes into play.

What Is a Letter of Medical Necessity?

A Letter of Medical Necessity is a letter written by a doctor stating that their patient would experience a significant benefit to their health or wellness by using a specific product or service. These letters come in handy when your unique medical needs fall outside of the normal scope of HSA-eligible purchases.

A Letter of Medical Necessity can be written for any health or wellness need. You won’t need a Letter of Medical Necessity for things like prescription medicine, necessary medical devices, or doctor-prescribed medical treatment. 

Why Do You Need a Letter of Medical Necessity?

Some people benefit from vitamin supplements, which aren’t ordinarily covered by HSA funds. Things like gym membership and workout equipment also aren’t HSA eligible by default. Vitamins and exercise can both be crucial to maintaining your health, and your doctor knows that. 

However, default HSA rules don’t automatically agree with this — a Letter of Medical Necessity overrules default HSA eligibility guidelines by expanding what’s made available to you via HSA funds. There’s an entire secondary list of products and services that are available with a Letter of Medical Necessity.

You’ll need a Letter of Medical Necessity for each category of products or services you want to purchase. For example, you can’t use a Letter of Medical Necessity for workout equipment to purchase bone broth — your doctor will need to write separate notes for each category of need and specifically mention what the LMN is intended to be used for. 

What Can You Get With a Letter of Medical Necessity?

Your Letter of Medical Necessity acts like a key to unlock new doors along your wellness journey. With a Letter of Medical Necessity, an expanded range of health and wellness goods and services are made available to you. 

Fitness Goods and Services

Exercise is essential for both your mental and physical health. A Letter of Medical Necessity can make it more affordable to work out at a gym or from your home.

Sleep Support Items and Tech

The human body needs 7 to 9 hours of sleep each night in order to recover from the day and function properly. Bedtime gear can be a starting point for getting better sleep — examples include:

  • Special pillows, mattresses, and mattress pads
  • Sleep tracking tech

Healthy Foods, Vitamins, and Supplements

Health starts with what we eat. Everything you put on your plate fuels your body, and a healthy diet can go a long way in preventing or reducing your risk for disease.

  • Bone broth
  • Vitamins
  • Supplements
  • Healthy meal delivery services 
  • Foods for specific dietary needs 

Mental Wellness

Mental health and physical health are closely tied together. Taking care of your mind is just as important as taking care of your body.

  • Meditation devices
  • Mental health coaching or mentoring

Alternative Health and Homeopathy 

Sometimes, less conventional health solutions can offer promising results. If your doctor agrees, you may be able to use your HSA to try alternative or complementary medicine.

  • Essential oils and diffusers
  • Homeopathic medicine
  • Alternative health practitioners

How To Get a Letter of Medical Necessity

There are two ways you can obtain a Letter of Medical Necessity. The first is by speaking with your doctor about changes to your health and wellness routine you’d like to make. The second way is to shop with a Truemed merchant and use our simple survey solution for a quick medical evaluation. 

Getting a Letter of Medical Necessity From Your Doctor

Doctors generally encourage their patients to make beneficial life choices that keep them on a healthy path. Your doctor may even outright recommend that you begin a workout regimen, take a specific supplement, or practice aromatherapy for your mental health. If your doctor doesn’t directly make that recommendation, it never hurts to ask for their opinion.

If your doctor agrees that something that isn’t ordinarily HSA eligible would be the right choice for you, they can provide you with a Letter of Medical Necessity that will allow you to buy a specific product or service with your HSA money.

Getting a Letter of Medical Necessity Through Truemed

Doctors are very busy, and you might want to start making healthy changes today. You may have to wait a long time for an appointment with your doctor to discuss your Letter of Medical Necessity. 

When you buy products or services from a Truemed integrated retailer, you can use a simple survey process for a quick medical evaluation by choosing “Pay With Truemed” at checkout and entering your payment details. We’ll match you with a provider, and if you’re eligible, they’ll issue you a Letter of Medical Necessity for the purchase you want to make with your HSA. 

How To Use Your Letter of Medical Necessity

Once you’ve received your Letter of Medical Necessity, it’s important to use it exactly as intended. A single letter doesn’t give you full permission to make purchases outside of normal HSA eligibility. Letters are highly specific. They need to be followed accurately and stored with the appropriate documentation to prove your eligibility for certain purchases. 

Follow Your Letter of Medical Necessity Specifically

If your Letter of Medical Necessity specifically says that your doctor wants you to purchase liquid vitamin B12, a purchase of vitamin B12 capsules wouldn’t be covered. It also wouldn’t cover a multivitamin supplement that contains vitamin B12 — a vague note leaves too much room for error, so there’s value in specificity.

If you know specifically what you’d like to purchase, mention that to your doctor. If your Letter of Medical Necessity is purely based on your doctor’s suggestion, make sure they’re as specific as possible when naming what you’re supposed to purchase in the letter. 

Keep Your Receipts or Invoices With Your Letter of Medical Necessity

Your Letter of Medical Necessity is only half of the big picture. It acts as proof that a doctor agreed that you should be able to make specific purchases with your HSA. It doesn’t prove that you spent your HSA money on those purchases.

Keep your Letter of Medical Necessity with the receipts for every purchase you made based on the Letter. You need to be able to prove how and why you spent your HSA funds and verify that your purchases were eligible in order to enjoy the tax-free status of your HSA money.

Don’t Go Without the Benefits of a Letter of Medical Necessity

A Letter of Medical Necessity helps you make the most out of your HSA. By expanding your eligibility to purchase things outside the normal scope of what’s considered “medicine,” you’re taking a proactive approach to a healthy lifestyle.

Truemed makes it easy to obtain a Letter of Medical Necessity and shop directly with your HSA/FSA debit card. We partner with health and wellness businesses to make it easier for HSA holders to save money and focus on staying healthy. Shop our integrated retailers and feel empowered to control your wellness. 


Health Savings Accounts (HSAs) | Congressional Research Service

Healthy Eating for a Healthy Weight | Healthy Weight, Nutrition, and Physical Activity | CDC

Physical Activity and Mental Health: What is the Connection? | Mass General Hospital

How HSA-eligible plans work |