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First published: February 4, 2026 / Last updated: February 28, 2026
Common expenses that are not HSA eligible
Health savings accounts (HSAs) offer powerful tax advantages, but they are governed by strict IRS rules. One of the most common sources of confusion is whether an expense that feels "health-related" automatically qualifies as an HSA-eligible medical expense.
It does not.
Below is a clear, up-to-date list of commonly searched expenses that are not HSA eligible, along with explanations for why people often assume they qualify and where the IRS draws the line.
Quick "eligibility funnel" for common HSA confusion
If you are unsure whether an expense qualifies, run it through this quick filter. The further down you go, the more likely an expense is HSA eligible.
| Step | Question to ask | What it usually means |
|---|---|---|
| 1 | Is this a general personal, household, or everyday item? | Usually not HSA eligible. |
| 2 | Is this mainly for general health, comfort, cleanliness, or well-being? | Usually not HSA eligible (even if it helps you personally). |
| 3 | Is it primarily to diagnose, treat, or prevent a specific medical condition? | More likely HSA eligible, especially with documentation. |
| 4 | Is it clearly medical in nature (not dual-purpose) and commonly recognized as a medical expense? | Most likely HSA eligible. |
Are mattresses or crib mattresses HSA eligible?
No, mattresses, including crib mattresses and so-called orthopedic or medical mattresses, are not HSA eligible.
This confusion is understandable. Doctors often recommend specific mattresses to help with back pain, sleep apnea, or other conditions. However, the IRS does not consider a mattress to be a medical expense because it is a personal household item that provides general comfort and support.
In extremely rare cases, if an item is required to treat a specific medical condition and is not used for general health, it may be treated as eligible with strong medical documentation (often an LMN), but approval is not guaranteed. However, the IRS maintains a very high bar for "dual-purpose" items like these, and approval is not guaranteed.
In rare scenarios, only a distinct medical device attached to a bed (such as a prescribed medical air system) may qualify. The mattress itself does not.
Is food (including gluten-free or organic food) HSA eligible?
No, food is not an HSA-eligible expense, even if it is gluten-free, organic, sugar-free, or part of a medically recommended diet.
Many people confuse regular food with "medical food" or believe that a prescribed diet changes the eligibility rules. It does not. The IRS excludes food because everyone must eat, regardless of medical condition.
In limited cases, the additional cost of special foods prescribed to treat a specific disease may qualify, but normal food costs do not. Grocery-store foods do not become eligible just because they are organic, gluten-free, or part of a recommended diet.
Are funeral expenses or autopsies HSA eligible?
No, funeral expenses, burial costs, cremation fees, and autopsies are not HSA eligible.
These costs are sometimes associated with healthcare or final medical events, but HSAs legally stop at the point of death. Expenses incurred after death are not considered qualified medical expenses under IRS rules.
This includes autopsies, even when performed to determine a medical cause of death.
Are tuition, daycare, or preschool HSA eligible?
No, education-related expenses such as tuition, daycare, preschool, and after-school programs are not HSA eligible.
This confusion often arises because some childcare-related costs may qualify under a Dependent Care FSA. HSAs follow a completely different set of rules.
HSA vs Dependent Care FSA (quick comparison)
| Expense type | HSA eligible? | Dependent Care FSA eligible? |
|---|---|---|
| Medical co-pays | Yes | No |
| Preschool / daycare | No | Yes |
| Summer day camps (childcare) | No | Yes |
Even if a program promotes health, safety, or supervision, it does not qualify unless the primary purpose is medical care.
Are hygiene items like deodorant, soap, or shampoo HSA eligible?
No, general hygiene items such as deodorant, soap, shampoo, toothpaste, and body wash are not HSA eligible.
These products are used for routine personal care and cleanliness, not for the treatment or diagnosis of a medical condition.
This remains true even if you have a medical condition that makes hygiene especially important.
Are witch hazel, face wash, or lotion HSA eligible?
Most non-medicated skincare products (witch hazel, face wash, moisturizer, lotion) are not HSA eligible.
This is one of the most common gray areas for users. Many skincare products claim therapeutic benefits or are recommended by dermatologists, but the IRS distinguishes between:
- Medical treatment of a diagnosed condition
- General skincare and maintenance
Most over-the-counter skincare products fall into the second category and are therefore ineligible.
To help you decide if an OTC skincare item might be eligible or not, use our HSA eligibility screener.
Are Kleenex, toilet paper, or other household supplies HSA eligible?
No, household paper products such as tissues, toilet paper, paper towels, and wipes are not HSA eligible.
Although these items are often used during illness, they are considered general household supplies rather than medical care.
Only items that meet the IRS definition of first aid or medical treatment qualify.
Is life insurance or auto insurance HSA eligible?
No, life insurance premiums and auto insurance premiums are not HSA eligible.
These expenses are sometimes confused with health insurance premiums, which themselves are only eligible in limited circumstances.
HSAs are designed to pay for medical care, not financial protection products or liability coverage.
How to stay compliant when you are unsure
If you are unsure whether an expense qualifies, ask yourself this question:
Is the primary purpose of this expense to diagnose, treat, or prevent a specific medical condition?
If the answer is no, it is likely not HSA eligible.
To learn how eligibility is determined (and how to document expenses correctly), see what makes an expense HSA eligible.
Sources
- Publication 502 - IRS
- Publication 969 - IRS
- Instructions for Form 8889 (2025) - IRS
Disclaimer
This page is for educational purposes only and is not tax or legal advice. Check with your HSA administrator or a qualified tax or legal professional if you have questions about your specific situation.
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