HSA Eligible Expenses: The Ultimate List for 2026
Your complete reference for IRS-qualified medical expenses, including 2026 updates on telehealth coverage, bronze/catastrophic plan eligibility, direct primary care, and increased contribution limits.
What's New in 2026
Major IRS Updates (Notice 2026-05 & One Big Beautiful Bill Act)
✓ Bronze & Catastrophic Plans Now HSA-Compatible
Starting January 1, 2026, all bronze and catastrophic health plans offered through an Exchange are automatically treated as HSA-eligible HDHPs, even if they don't meet traditional deductible requirements. This significantly expands who can contribute to an HSA.
✓ Direct Primary Care (DPC) Arrangements Allowed
Beginning January 1, 2026, you can now enroll in a Direct Primary Care Service Arrangement and still contribute to your HSA. Monthly DPC fees (up to $150/individual or $300/family) can be paid tax-free with HSA funds.
✓ Telehealth Coverage Made Permanent
HDHPs can now permanently offer telehealth and remote care services before the deductible is met without disqualifying you from HSA contributions. This applies to plan years beginning January 1, 2025 and beyond.
✓ Increased Contribution Limits
2026 HSA contribution limits increased to $4,400 (self-only, up $100) and $8,750 (family, up $200). Catch-up contributions remain at $1,000 for those 55+.
Recently Expanded Eligible Expenses
✓ OTC Contraceptives & Condoms
Over-the-counter oral contraceptives, emergency contraceptives, and male condoms are HSA-eligible without a prescription.
✓ Continuous Glucose Monitors
CGMs for individuals diagnosed with diabetes are treated as preventive care.
✓ All Breast Cancer Screenings
All types of breast cancer screening are considered preventive care for those not diagnosed.
✓ COVID-19 Supplies
Masks, hand sanitizer, sanitizing wipes, and disposable gloves remain HSA-eligible.
Important: Expenses are only qualified if incurred after your HSA was established. The IRS defines qualified medical expenses as amounts paid for "diagnosis, cure, mitigation, treatment, or prevention of disease" (IRS Publication 502).
2026 HSA Contribution Limits & HDHP Requirements
2026 Contribution Limits
2026 HDHP Requirements
Minimum Deductible
$1,700 (self) / $3,400 (family)
Maximum Out-of-Pocket
$8,500 (self) / $17,000 (family)
Medical Services
Doctor & Specialist Visits
- • Primary care physician visits
- • Specialist consultations
- • Copays and coinsurance
- • Telemedicine appointments
- • Second medical opinions
- • Walk-in clinic visits
- • Urgent care visits
Hospital & Procedures
- • Inpatient hospital care
- • Emergency room visits
- • Outpatient surgery
- • Ambulance services
- • Surgical procedures
- • Anesthesia
- • Hospital facility fees
Diagnostic & Lab Tests
- • Blood tests and panels
- • X-rays and imaging (MRI, CT)
- • Ultrasounds
- • Biopsies
- • COVID-19 testing
- • Allergy testing
- • Genetic testing (medical necessity)
Therapy & Rehabilitation
- • Physical therapy
- • Occupational therapy
- • Speech therapy
- • Chiropractic care
- • Mental health counseling
- • Psychiatric care
- • Substance abuse treatment
Dental & Vision Care
Dental Services
Preventive Care
- • Cleanings and exams
- • Fluoride treatments
- • Dental X-rays
- • Sealants
Restorative Work
- • Fillings
- • Crowns and bridges
- • Root canals
- • Tooth extractions
- • Dentures and partials
- • Dental implants
Orthodontics
- • Braces (metal, ceramic)
- • Invisalign/clear aligners
- • Retainers
- • Orthodontic adjustments
Vision Care
Eye Exams & Glasses
- • Comprehensive eye exams
- • Prescription eyeglasses
- • Prescription sunglasses
- • Reading glasses
- • Safety glasses (prescription)
Contact Lenses
- • Contact lens exam
- • Contact lenses (all types)
- • Contact lens solution
- • Lens cases and accessories
Corrective Surgery
- • LASIK surgery
- • PRK surgery
- • Cataract surgery
- • Other vision correction
Medications & Prescriptions
Good News: OTC Medications No Longer Need Prescriptions!
Since January 1, 2020, over-the-counter medications are HSA-eligible without a prescription. This includes pain relievers, cold medicine, allergy medication, and more.
Prescription Drugs
- • All prescription medications
- • Insulin (no Rx needed)
- • Inhalers
- • EpiPens
- • Birth control pills
- • Specialty medications
OTC Medications
- • Pain relievers (Tylenol, Advil)
- • Cold & flu medicine
- • Allergy medication
- • Acid controllers
- • Sleep aids
- • Anti-diarrheal medicine
- • Motion sickness pills
- • Nasal sprays
Topical Treatments
- • Acne medication
- • Anti-fungal cream
- • Hemorrhoid treatment
- • Antibiotic ointments
- • Burn creams
- • Wart removers
- • Hydrocortisone cream
Medical Equipment & Supplies
Durable Medical Equipment
- • Wheelchairs
- • Walkers and canes
- • Crutches
- • Hospital beds
- • Lift chairs
- • CPAP machines
- • Nebulizers
- • Oxygen equipment
- • Hearing aids & batteries
- • Artificial limbs
- • Breast pumps
- • Blood pressure monitors
- • Thermometers
- • Pulse oximeters
- • Glucose monitors (CGMs)
Diabetic Supplies
- • Blood sugar test strips
- • Glucose meters
- • Lancets and lancing devices
- • Insulin pumps and supplies
- • Continuous glucose monitors
- • Insulin syringes
- • Test kits
- • Diabetic shoes (with LMN)
First Aid & Home Care
- • Bandages and gauze
- • First aid kits
- • Medical tape
- • Ice packs
- • Heating pads
- • Braces and supports
- • Compression stockings (with LMN)
- • Medical gloves
Preventive Care
Screenings & Tests
- • Annual physical exams
- • Wellness checkups
- • Cancer screenings (all types)
- • Mammograms
- • Colonoscopies
- • Pap smears
- • Prostate exams
- • Blood pressure checks
- • Cholesterol tests
Vaccines & Immunizations
- • Flu shots
- • COVID-19 vaccines
- • Childhood immunizations
- • Shingles vaccine
- • Pneumonia vaccine
- • HPV vaccine
- • Tetanus boosters
- • Travel vaccines
Special Conditions & Treatments
Pregnancy & Fertility
- • Prenatal care and vitamins
- • Ultrasounds
- • Delivery and hospital costs
- • Lactation consulting
- • Breast pumps & supplies
- • Fertility treatments (IVF, IUI)
- • Egg/sperm storage
- • Birth control (all types)
- • Condoms
Mental Health & Addiction
- • Psychiatric care
- • Psychologist/therapist visits
- • Inpatient mental health treatment
- • Substance abuse programs
- • Smoking cessation programs
- • Prescription medications for mental health
- • Nicotine patches/gum (if prescribed)
Learning & Developmental
- • Special education (if medically necessary)
- • Tutoring for learning disabilities (with LMN)
- • Dyslexia treatment
- • Autism therapy (ABA, speech, OT)
- • ADHD treatment and counseling
Items Requiring Letter of Medical Necessity (LMN)
Some items are eligible only with a Letter of Medical Necessity from your healthcare provider. This letter must explain that the expense is for treating a specific medical condition, not for general health.
Common LMN Items
- • Weight-loss programs (for diagnosed obesity)
- • Gym/health club memberships
- • Massage therapy
- • Compression hosiery/socks
- • Orthopedic shoes (excess cost)
- • Humidifiers
- • Air purifiers
- • Special mattresses
- • Service animals (guide dogs)
- • Home modifications (wheelchair ramps)
How to Get an LMN
- Ask your doctor for a letter stating:
- Your specific medical condition
- Why the expense is medically necessary
- How it treats your condition
- Keep the LMN with your receipt
- Store for at least 7 years (IRS audit period)
Without an LMN, these expenses are NOT HSA-eligible and could trigger a 20% penalty + taxes.
What's NOT Eligible
Using HSA funds for non-qualified expenses results in income tax + 20% penalty if you're under 65.
General Health Items
- × Vitamins/supplements (for general health)
- × Gym memberships (without LMN)
- × Fitness trackers & smartwatches
- × Cosmetics & toiletries
- × Teeth whitening (cosmetic)
- × Hair loss treatments (non-medical)
- × Dietary/herbal supplements (without LMN)
Personal Care
- × Toothpaste & dental floss
- × Shampoo & conditioner
- × Deodorant
- × Lotion & moisturizers
- × Makeup
- × Perfume/cologne
- × Soap & body wash
Insurance Premiums
- × Regular health insurance premiums
- × Medicare supplemental policies
- × Employer-sponsored coverage
- ✓ COBRA premiums (eligible)
- ✓ Medicare Parts B, C, D (eligible after 65)
- ✓ Long-term care insurance (eligible)
- ✓ Unemployment health coverage (eligible)
Other Ineligible
- × Cosmetic surgery (unless medically necessary)
- × Massage (without LMN)
- × Marriage/relationship counseling
- × Maternity clothes
- × Funeral/burial expenses
- × Illegal treatments/medications
- × Already-reimbursed expenses
Documentation Best Practices
Save ALL receipts - The IRS can audit HSA activity up to 7 years after filing.
Include required details - Patient name, provider, date, service description, and cost.
Digital storage is accepted - Scan or photograph receipts and store securely.
Track with software - Tools like HSA Vault automatically extract receipt details including CPT codes, dates, and amounts.
Learn more: Common HSA Receipt Mistakes to Avoid
Automate Your HSA Expense Tracking
Stop manually organizing receipts. HSA Vault uses AI to extract expense details, CPT codes, and provider information automatically from your medical receipts.