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Can you pay for counseling with an HSA?
Are you wondering if you can pay for counseling with a health savings account (HSA), flexible spending account (FSA), or health reimbursement arrangement (HRA)? You may also be wondering if this item is eligible or ineligible for reimbursement with your HSA, FSA, or HRA.
HSA fast facts
- Health savings accounts (HSAs) were created as part of the Medicare Prescription Drug, Improvement, and Modernization Act, or MMA, signed into law by President George W. Bush on December 8, 2003. The MMA was the largest overhaul to Medicare in the program's history.
- HSAs are only available as part of a high-deductible health insurance plan (HDHP).
- As part of the 2020 CARES Act, over-the-counter medications and menstrual care products became eligible for purchase with an HSA.
- Contributions to an HSA can be made by an employer and/or employee on a pre-tax basis. You can find current and historical HSA contribution limits on this site.
- Funds in a health savings account can be invested in a similar way as other retirement accounts and are a rare example of an account that's triple tax advantaged. That is, funds are contributed pre-tax, can be withdrawn for eligible medical expenses without taxation, and if you invest the funds within your HSA the earnings or interest are tax free. There are also many other benefits of HSAs that you may not know about.
- Funds can be withdrawn at any time for any reason, but funds withdrawn for non-approved medical expenses before the age of 65 are subject to income taxes and an additional penalty.
- You can no longer contribute to an HSA once you're enrolled in Medicare.
Explore HSA eligibility for other products and services
Common HSA providers
- Bank of America
- Blue Cross Blue Shield
- Fifth Third
- HealthSavings Administrators
- HSA Authority
- HSA Bank
- Optum Bank
What about FSA and HRA eligibility?
The same HSA eligibility status for counseling applies to flexible spending accounts (FSAs) and health reimbursement arrangements (HRAs) as well.
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.
- Publication 502 - IRS
- Publication 969 - IRS
- H.R.748 (CARES Act) - U.S. Congress
- Health savings accounts - Wikipedia
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 counseling 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.