An HSA covers far more than doctor visits and prescription refills. IRS Section 213(d) defines the full scope of eligible medical expenses, and the CARES Act expanded that list further, adding most over-the-counter medication and menstrual care without a prescription requirement. Below are the categories where eligible spending most often ends up on a regular debit card instead: drugstore purchases, vision and dental care, home safety equipment, and medical travel. Lively account holders can check any purchase against the What's Eligible catalog before spending, so eligibility doesn't have to be guesswork. This isn't the full IRS list, it's the categories worth knowing before your next pharmacy run or specialist visit.

The Drugstore Aisle

Over-the-counter medication no longer needs a prescription to qualify as an HSA expense. That change opened up most of the pharmacy shelf to eligible spending, not just the items behind the pharmacist's counter. The same rule extends to first aid supplies. Throughout, the test is whether the product treats, manages, or prevents a specific medical condition rather than supporting general wellness.

• Pain relievers like ibuprofen and acetaminophen

• Antihistamines, cough and cold remedies, antacids, and acid reducers

• Anti-diarrheal medication and motion sickness pills

• Antifungal and anti-itch creams, acne treatment, and medicated shampoos

• Nicotine gum and patches

• Broad-spectrum sunscreen at SPF 15 or higher

• Hand sanitizer with at least 60% alcohol

The line to watch is proof of purpose, not the product category. A multivitamin only becomes eligible with a letter of medical necessity tied to a diagnosed deficiency, and that documentation is easier to secure before the purchase than after the receipt is long gone.

Vision and Dental Care

Vision correction is eligible well beyond the annual eye exam. The IRS treats corrective procedures and hardware the same as any other prescribed treatment, as long as an actual vision problem is being corrected. Contact lens supplies and over-the-counter reading glasses qualify without a prescription. Dental care follows a comparably broad standard, covering both preventive visits and corrective procedures.

• Prescription eyeglasses and sunglasses

• Contact lenses and solution

• LASIK, PRK, and cataract surgery

• Over-the-counter reading glasses

The distinguishing line is medical necessity versus appearance. A crown to repair a damaged tooth qualifies; teeth whitening from the same dentist on the same visit does not. Vision follows the identical split: corrective LASIK qualifies, a cosmetic procedure with no vision correction involved does not.

Family Planning and Postpartum Care

Family planning and postpartum expenses make up one of the largest eligible categories on this list. Coverage spans from conception through the months after childbirth. Diagnostic testing and treatment procedures both qualify, and postpartum recovery supplies are included right alongside delivery and prenatal care.

• Pregnancy and ovulation test kits

• Prescription birth control and IUD insertion

• IVF and IUI treatments

• Vasectomy and tubal ligation procedures

• Breast pumps, tubing, and flanges

• Breastmilk storage bags, nursing pads, and nipple creams

• Perineal care supplies and prenatal vitamins

• Childbirth classes and lactation consultant fees

Because many of these purchases repeat on a regular cycle, paying directly with the HSA debit card at checkout is simpler than saving receipts for reimbursement later.

Diagnostic and Monitoring Tech

Home health devices qualify when they serve a diagnostic or monitoring purpose rather than general wellness. That distinction covers most of the equipment used to track a specific condition at home, from blood sugar to blood oxygen levels. At-home test kits fall into this category too, with no doctor's visit required.

• Digital thermometers and blood pressure monitors

• Pulse oximeters

• Blood glucose meters, test strips, and continuous glucose monitors

• At-home COVID and UTI test kits

• Peak flow meters and nebulizers

• Personal ECG monitors like KardiaMobile

What matters for documentation is intent, not the device itself. A blood pressure monitor bought after a hypertension diagnosis is easy to justify if the expense is ever reviewed; the same purchase made purely for general monitoring is harder to defend after the fact.

Mobility and Home Safety

Home modifications made for a documented medical need are eligible, and this is where some of the largest single purchases on this list tend to fall. Both structural changes and portable equipment are covered. What matters is whether the item addresses a specific medical need rather than general home improvement.

• Grab bars, shower chairs, and bath benches

• Wheelchair ramps and vehicle hand controls

• Hospital beds for home use

• Crutches, canes, walkers, wheelchairs, and mobility scooters

• Braces and supports for wrists, ankles, knees, and the back

• Compression socks and orthotic inserts

• CPAP machines and supplies

• Hearing aids and medical alert devices

A stairlift installed as part of an unrelated renovation would not qualify; the same stairlift installed for a documented mobility limitation would. Larger structural projects typically need a letter of medical necessity from a physician, and that's worth arranging before the work starts rather than after the invoice arrives.

Getting To and From Care

The IRS treats transportation that is primarily for medical care as a medical expense in its own right. That covers travel by car, rideshare, or public transit, as well as travel that requires an overnight stay. What determines eligibility is whether the trip's primary purpose is medical care, not incidental to it.

• Mileage, gas, parking, and tolls for driving to appointments

• Rideshare or taxi fare

• Airfare or train fare when treatment requires travel

• Lodging during out-of-town care, up to IRS limits

A drive to a specialist appointment qualifies; a drive to the pharmacy for an unrelated errand does not. Because these costs are easy to lose track of, logging each trip's date, destination, and purpose as it happens is far simpler than reconstructing the record months later.

Less Obvious Eligible Items

A few items sit far enough outside the usual idea of healthcare that they're easy to overlook. What ties them together is the IRS test for diagnosis, treatment, or prevention of a medical condition, a standard that reaches well past traditional medical equipment.

• Guide dogs, including purchase, training, and veterinary care

• Special education tuition or tutoring for a child with a learning disability

• Compression socks, night guards, and orthotic inserts

• Over-the-counter reading glasses

A service animal for someone with a visual impairment meets that test, which is why the full cost of a guide dog's care, training and veterinary visits included, qualifies. The same test is what makes specialized education eligible when it's tied to a diagnosed learning disability rather than general schooling preference.

Premiums, in Four Cases

Health insurance premiums are generally not HSA-eligible. The IRS carves out four specific exceptions, and outside of them, premiums come out of after-tax dollars regardless of the plan. Each exception ties to a particular life circumstance rather than a general premium discount.

• COBRA premiums after leaving a job

• Health insurance premiums while receiving unemployment benefits

• Long-term care insurance premiums, up to age-adjusted limits

• Medicare Part B, Part D, and Advantage premiums once you turn 65

One rule cuts across all four: the premium has to be paid outside of a pretax payroll deduction. A benefit already excluded from taxable income can't also be reimbursed through the HSA without double-claiming the tax advantage.

Keep the Receipts

Some items on this list qualify outright. Others need a prescription or a letter of medical necessity first. The What's Eligible catalog marks the difference for each item, and it's worth a check before a large purchase.

Hold onto documentation regardless of which category the purchase falls into. The IRS enforces eligibility, and an audit can reach back to the day the account was opened. Lively lets you attach a receipt to each expense inside the account, so the record stays with the transaction instead of in a drawer somewhere.

If Something Does Not Qualify

Using HSA funds on an ineligible expense means income tax on the amount plus a 20% penalty. That changes at 65, when non-medical withdrawals are taxed as ordinary income and the penalty drops away. Here is more on what changes at 65.

Every Eligible Dollar Adds Up

Eligibility rules run wide, but the tax advantage only applies to what actually moves through the account. Checking a purchase before it happens, rather than reconstructing it later, is what turns HSA-eligible spending into money that's actually protected from tax. Start with the Lively HSA if you're building that habit for the first time.