What should I know about using my FSA or HSA benefits at different retailers?

Items are considered HSA-eligible based on the IRS definition of a qualified medical expense. IRS Publication 502 outlines what counts as a qualified medical expense and includes a complete reference list of what's eligible.

Some HSA-eligible transactions will be pre-approved at checkout, like co-pays and deductibles, prescriptions, and over-the-counter medications and supplies. Other health and wellness items are HSA-eligible but will require documentation, such as medical devices, therapy supplies, and vision, dental, and hearing items.

Some items may be HSA-eligible with appropriate documentation–like a letter of medical necessity (LMN)–when used to treat a specific condition. For example, these items could include fitness equipment and memberships, posture and pain-relief products, sleep-tracking devices, and even saunas or cold plunges when deemed medically necessary.

Cosmetics, general skincare products, vitamins without medical documentation, general tech gadgets, or even paying for gym fees without an LMN will cause your HSA card to decline, as these purchases aren’t usually eligible.

If you’re paying for several different products in one purchase (i.e., mixing HSA-eligible items and non-eligible items at checkout), split the order and pay in separate transactions to avoid a full decline.

Many HSA-eligible products, co-pays, and over-the-counter medications are typically pre-approved at checkout. Specific retailers and pharmacies are designated as approved healthcare merchants based on their merchant category code (MCC). So, HSA card purchases made at these locations will be pre-approved. Products with an eligible SKU (inventory codes) may also be pre-approved at checkout.

HSA cards work just like a debit card (i.e., insert the chip into the card reader, swipe the card, etc.). So you must ensure you have enough funds in your account to complete the transaction.

When shopping online with your HSA card, use HSA-eligible filters on the retailer’s site to search through eligible items and double-check labels. Always download and keep itemized invoices for your records. Remember to split your payments for carts with a mix of HSA-eligible and non-eligible items.

You can make returns and exchanges with items purchased on your HSA card. Always keep your original itemized receipts and make sure refunds are returned to the HSA card. If you paid out-of-pocket for an item that’s HSA-eligible, submit the receipt and LMN, if required, to your HSA/FSA plan administrator for reimbursement.

Always keep an itemized receipt that shows the merchant, product, dollar amount, and date of purchase with your HSA card. For online purchases, save PDFs of the receipt or invoice. Always keep a copy of the prescription or LMN in case your insurance and HSA provider asks for supporting documentation. Store receipts and records for tax season. You may be asked to match bank statements to the receipts on file, so keep them organized for easy retrieval.

• Don’t assume a product is eligible based on a store’s branding—always go by the IRS regulations and eligibility requirements.
• Avoid one-cart checkouts. Separate non-eligible items from HSA-eligible items to prevent your card from declining.
• Don’t forget to get an LMN when purchasing “potentially eligible” items with your HSA.
• Digital receipts from online marketplaces are just as important to keep as physical copies from in-person retailers.

Truemed* simplifies the process so you can maximize your HSA benefits. After you fill out a health intake at checkout in the Truemed marketplace, an independent licensed practitioner reviews it and may issue an LMN if appropriate.

Truemed partners with merchants and retailers to give eligible customers access to shop hundreds of products, paying with your HSA card or getting reimbursed later. Truemed helps you organize your documentation to make eligible purchases.

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