Most HSA holders use their account for prescriptions, doctor visits, and dental work — and stop there. The IRS list is much longer. Here are 20 eligible items that surprise people, with notes on which ones need a Letter of Medical Necessity (LMN).
Personal Care
- Sunscreen (SPF 15+) — fully eligible, no LMN. Includes sport sunscreens and tinted moisturizer if SPF 15+ is the primary purpose.
- Period products — tampons, pads, menstrual cups, period underwear. Made permanently eligible by the CARES Act in 2020.
- Acne treatments — both OTC washes and prescription topicals. The whole drugstore acne aisle qualifies.
- Lip balm with SPF — yes, including ChapStick with sun protection.
- Reading glasses — drugstore readers count as a medical device.
Family & Baby
- Breast pumps and accessories — including parts, milk storage bags, and rentals. Lactation consultants count too.
- Pregnancy tests and ovulation kits — fully eligible OTC.
- Baby thermometers and breathing monitors — eligible as medical devices.
- Childbirth classes — eligible to the extent they prepare for delivery (the labor portion, not the parenting portion).
Planning a family? See having a baby with an HSA and fertility treatments and HSAs for the full eligibility picture.
Recovery & Wellness
- Acupuncture — eligible without an LMN when performed for a specific condition.
- Chiropractic care — covered for treatment of back, neck, and spinal issues.
- Smoking cessation — patches, gum, lozenges, and prescription cessation meds.
- Therapy — see our dedicated therapy eligibility post for full details.
Vision & Hearing
- LASIK and corrective surgery — full breakdown in is LASIK HSA-eligible.
- Contact lens solution and cleaning supplies — including travel-size bottles.
- Hearing aids and batteries — fully covered.
Need-an-LMN Items
These are eligible only with a Letter of Medical Necessity linking them to a diagnosed condition:
- Gym memberships — when prescribed for obesity, hypertension, or another condition.
- Massage therapy — for chronic pain or specific orthopedic issues.
- Air purifiers and humidifiers — for severe allergies, asthma, or respiratory illness.
- Vitamins and supplements — for diagnosed deficiencies or specific conditions (vitamin D for documented deficiency, prenatal vitamins, etc.).
Travel and Transportation Counts Too
If you travel for medical care, the costs are HSA-eligible:
- Mileage at the IRS medical rate (about 22¢/mile for 2026)
- Tolls, parking, and public transit fares
- Airfare for treatment not available locally
- Lodging up to $50/night per person while receiving care away from home
Common "Eligible?" Surprises (Spoiler: No)
- Toothpaste, mouthwash, dental floss — general hygiene, not HSA-eligible.
- Cosmetic procedures — Botox for wrinkles is not eligible; Botox for migraines is.
- Vitamins for general health — eligible only with an LMN for a specific condition.
- Funeral expenses, gym memberships without an LMN, health-club fees, marriage counseling without a clinical license.
Browse the Full List
This is just 20 items. Our searchable directory of 890+ items covers everything the IRS includes (plus the borderline cases). When in doubt, search before you spend — and pair the strategy with the shoebox approach so every eligible dollar gets reimbursed tax-free.
The Bottom Line
The HSA covers way more than most people realize. Spend ten minutes browsing the categories and you'll usually find $500+ a year of expenses you've been paying with after-tax dollars. Multiply that by a lifetime — see what it grows to in the HSA ROI calculator — and the case for using your account aggressively becomes obvious.