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If you have a high-deductible health insurance plan (HDHP) or are considering getting one, you may be wondering if you can pay for assisted living expenses with a health savings account (HSA). You may also be wondering if this item is eligible or ineligible for reimbursement with your HSA, flexible spending account (FSA), or health reimbursement arrangement (HRA).No, unfortunately you can't use your HSA, FSA, or HRA to pay for assisted living expenses. In fact, if you do pay for assisted living expenses with one of those accounts, you may be subject to a penalty of 20% and income tax on the amount withdrawn or reimbursed.
The same HSA eligibility status for assisted living expenses applies to flexible spending accounts (FSAs) and health reimbursement arrangements (HRAs) as well. However, while a high-deductible health insurance plan is required for an HRA, it is not required for an FSA.
Coming up with accurate eligibility status for the list of HSA eligible expenses can be a challenge at times. The IRS only provides a partial list of eligible expenses, so consumers and even insurance companies are left to wonder exactly what products are eligible.
To help illustrate this point, I had a visitor email me to ask if regenerative medicine such as platelet rich plasma (PRP) and stem cell treatments are HSA eligible. I did extensive research and the answer pointed toward "probably not but check with your provider to see if they'll cover it." So I suggested that he consult them for guidance. His response was that he did and even they didn't know!
In a case like that, I would suggest getting a definitive answer in writing from your provider. If you can't get one, the safe choice is to assume it's not eligible and not expense it.
There are also cases where one source says an expense is eligible and another says it's not. In those cases I do my best to research the expense further and come up with an answer that seems most likely for the greatest number of providers.
At any rate, these are the primary sources I use for expense verification. Keep in mind this is not an exhaustive list, and I will frequently check product manufacturer websites for eligibility statuses, as they often will have done their own due diligence if they suspect people may want to use their HSA or FSA to pay for their products and they fall into the uncertain category.
This page is intended to be an educational reference only. Please check with your HSA administrator or health insurance provider to confirm if you can pay for assisted living expenses with your HSA card before making any purchases.
A good rule of thumb is that if your doctor diagnosed you with a specific medical condition or ordered a treatment, product, or prescription specifically for you, your health savings account should cover it. Sometimes your HSA will even cover items that it normally wouldn't if you have a letter of medical necessity signed by your doctor. Again, you should check with your HSA administrator before any purchase if you have any questions about an item being eligible or ineligible.