Employee Benefits

How to Make the Most of Your HSA: From Massages to Investments 

3 min read
Jan 31, 2024

Have you ever wondered, Can you use my HSA for massage Or maybe you’ve questioned whether you can use it for cold medicine, eyeglasses, or renovations to make your house more accessible.

If you have a health savings account (HSA), you may be aware that you can use it for more than just covering copays, deductibles, and prescriptions.1 You can use it for massage therapy, holistic healthcare, mental healthcare, over-the-counter (OTC) medications, and more.2,3 You can even invest the balance to save for medical costs after retirement. Read on to learn more about putting your HSA funds to good use.

HSA Basics

An HSA is a pre-tax savings account that allows individuals with eligible high-deductible health plans (HDHPs) to pay for qualified medical expenses.1

Qualified medical expenses that you can spend your HSA money on include everything from doctors’ office visits to holistic treatments to accessibility products.1,4 You can use your HSA dollars on qualified expenses for you, your dependents, or your spouse.5

Using your HSA for massage therapy and holistic care

Your HSA can pay for massage therapy, though you’ll likely need a letter of medical necessity (LMN) from your doctor.7 An LMN states what condition the treatment is for, how many sessions you need, and any other relevant details. An HSA may also be used on alternative or holistic treatments, such as:4,6

  • Massage therapy
  • Acupressure (may require an LMN)
  • Chiropractic services (may require an LMN)
  • Daith piercings (may be eligible with an LMN)
  • Essential oils (may be eligible with an LMN)
  • Yoga (may be eligible with an LMN)

Your HSA must be used for expenses related to medical conditions, which is why some HSA providers require LMNs to explain what condition is being treated.4,6 If you use your HSA funds on non-eligible expenses, you may be subject to penalties.5

Using your HSA for OTC products

You can use your HSA to pay for over-the-counter (OTC) medications and other readily available healthcare products.3 You generally won’t need to get an LMN for these categories, since the 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act expanded the list of products you can use your HSA for.3 Some of the qualifying OTC products include:6,7

Some of the qualifying OTC products include:

  • OTC medication: You can use your HSA to purchase OTC medications ranging from allergy relief to cold and flu medications (cough drops, suppressants, and syrups). However, supplements and vitamins generally don’t qualify.
  • Feminine care: In 2020, HSA-eligible products expanded to include feminine hygiene products. This includes pads, tampons, menstrual pain relievers, and more.
  • Family planning: You can use HSA funds to pay for condoms, birth control, pregnancy tests, and more.
  • Nursing products: If you have a new baby, many breastfeeding supplies are HSA-eligible.
  • Acne medicine and skincare: Acne is a medical condition and isn’t considered cosmetic, so you can use your HSA to purchase several acne-fighting products.

Using your HSA for accessibility

Your HSA also provides tax benefits on accessibility products and services. This can help people with limited mobility, vision, and hearing problems, or other disabilities afford the services they need. Some of the qualifying accessibility products include:6

  • Hearing aids: Your HSA can help cover hearing aids, hearing aid batteries, and repair costs.
  • Glasses or contacts: This includes all kinds of lenses, even prescription goggles (with an LMN) and prescription sunglasses, as well as repair costs.
  • Mobility aids: Your HSA can help purchase walkers, canes, crutches, mobility scooters, and other mobility aids you may need.
  • Home improvements: Home improvements for accessibility — such as a ramp, rails, or a stairs chair lift — may be HSA eligible. You’ll likely need an LMN from your doctor.
  • Service dogs: Service dogs can help you navigate the world, feel safer, and communicate your needs. With an LMN, you can use your HSA to pay for a seeing-eye dog or other service dog costs.
  • Transportation and travel for medical care: No matter your mode of transportation, you can use your HSA to pay a portion of your travel expenses.8 This may include gas mileage, parking, tolls, bus or train tickets, and more. You can even use your HSA to help pay an ambulance bill.

Using your HSA for mental health treatment

Your mental health is just as important as your physical health. HSA accounts let you spend funds on mental health treatments, like in-patient programs, therapy, and prescription medications.6 This can help by giving you a tax break on already expensive treatment bills.

Using your HSA for addiction treatment

If you or someone on your insurance needs treatment for an addiction, you can likely pay those bills with your HSA.6 A drug or alcohol treatment and counseling, a smoking cessation program, and costs associated with quitting — like nicotine gum or patches — are all HSA-eligible expenses. Some may require an LMN.6

Using your HSA for weight loss treatment

If your doctor recommends a weight loss program to treat a medical condition, like heart disease or obesity, they can write an LMN for the associated costs.6 This often won’t cover gym fees or special food. But it will cover other weight loss treatment costs — such as a dietitian, weight loss programs, or weight loss surgery.

Using your HSA to invest

Did you know you can use HSAs for current medical costs and future medical costs? Your HSA allows you to invest your funds!

HSA funds roll over from year to year, so you can save them for when you really need them. Your funds should earn interest in the account, but you can also grow them through investments. You may be able to invest your HSA dollars in stocks, bonds, mutual funds, and more.

An HSA offers a triple tax benefit: Your HSA contributions are tax-deductible; any earnings are tax-free; and when you withdraw for any qualified medical expenses, that’s tax-free, too.

Considering an HSA?

Open enrollment is the perfect time for eligible high-deductible health plan (HDHP) policyholders to set up an HSA. Whether you want to set aside money for general healthcare costs, massage therapy, or OTC products, an HSA may be right for you.

Time To Enroll in a New Benefit Plan?

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1 “Understanding HSA-eligible plans,” HealthCare.gov
2 “Holistic Healers: HSA Eligibility,” HSA Store
3 “IRS outlines changes to health care spending available under CARES Act,” IRS, 2023
4 “Publication 502 (2022), Medical and Dental Expenses,” IRS
5 “Publication 969 (2022), Health Savings Accounts and Other Tax-Favored Health Plans,” IRS
6 “The Complete HSA Eligibility List,” HSA Store
7 “Over-The-Counter Items: HSA Eligibility,” HSA Store
“Travel or Transportation for Medical Care: HSA Eligibility,” HSA Store