Health Savings Accounts offer one of the best tax advantages available — but many account holders leave money on the table simply because they're unsure how reimbursements work. Here are answers to the questions we hear most often.
What is an HSA reimbursement?
An HSA reimbursement means paying yourself back for a qualified medical expense using pre-tax HSA dollars. You pay for a medical expense out of pocket, keep your receipt, and then transfer money from your HSA to your personal bank account. The key advantage: that money was never taxed going in, it grows tax-free, and it comes out tax-free too.
Who can be reimbursed from my HSA?
You can use your HSA to cover qualified medical expenses for:
- Yourself
- Your spouse (even if they're not on your health plan)
- Any dependent you claim on your taxes
Note: if a dependent is no longer claimed on your return (e.g., they're 26 and filing independently), their expenses no longer qualify.
Is there a time limit to claim a reimbursement?
This is the most underused HSA feature: there is no IRS deadline for reimbursement, as long as the expense occurred after you opened your HSA. You can pay a medical bill today and reimburse yourself five years from now. Many savvy HSA users pay medical bills out-of-pocket, let their HSA balance invest and grow, then reimburse themselves years later — effectively using their HSA as a tax-free investment account.
The catch: you must keep every receipt. If the IRS audits you, you need documentation to prove the expense was qualified.
What expenses qualify for HSA reimbursement?
The IRS defines qualified medical expenses in Publication 502. Broadly, eligible expenses include:
- Doctor, dentist, and vision visits
- Prescription medications
- OTC medications (since the CARES Act of 2020)
- Medical equipment (CPAP, wheelchair, hearing aids, etc.)
- Mental health therapy
- Fertility treatments
- Menstrual care products (since 2020)
- Some transportation costs to receive care
Use our HSA item directory to look up any specific item.
What expenses do NOT qualify?
Common non-eligible expenses include:
- Cosmetic surgery (unless treating a deformity from disease or accident)
- Teeth whitening
- General vitamins and supplements (unless prescribed for a deficiency)
- Gym memberships (unless you have a Letter of Medical Necessity)
- Toothpaste, soap, and other personal hygiene products
- Baby formula (except medically prescribed specialty formula)
- Insurance premiums (with limited exceptions)
What records do I need to keep?
For every HSA reimbursement you must be able to prove:
- The expense was a qualified medical expense
- The expense occurred after you established your HSA
- You haven't already deducted it or been reimbursed elsewhere
Best practice: keep itemized receipts showing the date, provider, service description, and amount. The IRS recommends retaining records for at least three years after the tax year in which you made the HSA withdrawal. Since you can delay reimbursements indefinitely, keep receipts for the life of the account.
What happens if I use HSA funds for a non-qualified expense?
If you withdraw HSA funds for a non-medical expense before age 65, you'll owe:
- Income tax on the amount withdrawn
- An additional 20% penalty
After age 65, the 20% penalty disappears — you'll still owe income tax, but the HSA effectively becomes like a traditional IRA for non-medical withdrawals.
Can I reimburse myself for insurance premiums?
Generally, no. But there are exceptions. You can use HSA funds for:
- COBRA continuation coverage premiums
- Long-term care insurance premiums (within IRS age-based limits)
- Medicare premiums (Parts A, B, C, D) once you're 65 or enrolled in Medicare
- Health insurance premiums while receiving unemployment compensation
How do I actually make a reimbursement?
The process is simple:
- Pay the medical expense (out of pocket, debit card, credit card — whatever you prefer)
- Save the itemized receipt
- Log into your HSA custodian's portal (Fidelity, HealthEquity, Lively, etc.)
- Request a distribution to your personal bank account equal to the expense amount
- File Form 8889 with your taxes each year you make HSA contributions or distributions
Tools like Reimbursable can automate expense tracking, receipt storage, and Form 8889 preparation — so you always know exactly what you're owed.
Can I contribute to an HSA and claim reimbursements in the same year?
Yes. You can contribute and take distributions in the same tax year. Just be sure your distributions don't exceed the total of your qualified expenses for the year.