Can I Use My HSA for Medical Spa Treatments?

Many spa guests often wonder if they can use their health savings account (HSA) to pay for services. The short answer is that, unless prescribed by a doctor, no. To use your HSA to pay for massage, you must provide a medical necessity letter from your doctor stating that a therapeutic message is really needed. Talk to your doctor if you think this situation might apply to you.

Many HSA-eligible expenses are those that are not normally covered by regular insurance. You can use your HSA to fund copayments and pay for eligible expenses for yourself and also for your spouse and dependents. Expenses incurred by adult dependents are eligible as long as the beneficiary is covered by an HDHP and is not otherwise insured. Spending money on healthcare isn't fun, but there's a way many of us can get a good price cut from triple tax breaks in health savings accounts.

Stephen Neeleman, founder of HealthEquity, a group that serves 2.3 million such accounts in more than 33,000 companies, sheds some light on how to reap the benefits. If you lose your job or transition to a new one, HSA funds can be used to pay for Cobra coverage. Members can include the amount paid for acupuncture in medical expenses. What members pay for dental disease prevention and relief is a covered expense.

Preventive treatment includes the services of a dental hygienist or dentist for procedures such as cleaning teeth, applying sealants, and fluoride treatments to prevent tooth decay. Treatments to relieve dental diseases include the services of a dentist for procedures such as x-rays, fillings, braces, extractions, dentures and other dental ailments. Eye exams are covered, as are glasses and contact lenses needed for medical reasons. In addition, eye surgery to treat poor vision, such as laser eye surgery or radial keratotomy, is a covered expense.

Inpatient treatment at a therapeutic center for alcohol or drug addiction, including meals and accommodations, is covered. Members can also include in medical expenses the amounts paid for transportation to and from Alcoholics Anonymous meetings in the community if assistance is necessary for treatment. Massages to improve overall health and well-being don't qualify. Massage therapy can be classified as a medical need by the HSA, provided the patient has a medical need letter from a doctor.

A doctor may prescribe massage therapy for a specific injury or trauma, or to treat high levels of stress caused by other diagnosed medical conditions. Many medical expenses clearly qualify for HSA spending or reimbursement, but when it comes to cosmetic procedures and treatments, the line isn't always as clear. So here are some frequently asked questions about HSA and cosmetic surgery: A health savings account (HSA) is a personal bank account with significant tax advantages that a person can use to pay for qualified medical expenses under a compatible high-deductible health plan (HDHP). Unlike most flexible spending accounts (FSAs), HSA funds transfer automatically from year to year and can be used indefinitely as long as the purchase is a qualifying medical expense.

This is particularly attractive to younger, healthier people who don't usually use the balance of their annual contributions by the time the deadline is reset. Given the IRS definition, most cosmetic surgeries do not qualify as an eligible HSA expense, including “any procedure that is aimed at improving a patient's appearance and that does not significantly promote proper body function or prevent or treat a disease or illness”. However, some cosmetic surgeries may meet the definition of qualified medical expense if “there is a need to improve a deformity that arises from, or is directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease”. These HSA-eligible expenses include dental implant surgery and laser eye surgery.

Given this distinction, most plastic surgeries, such as breast reconstruction surgery, would qualify as an eligible expense for HSA since it “seeks to correct dysfunctional areas of the body”.Cosmetic problems such as wrinkles or dark spots usually don't qualify but treatments for skin cancer and acne do even if insurance doesn't cover them. HSA funds can also be used to purchase dermatological prescriptions. Botox treatments that are not medically necessary are not eligible for HSA. However there are some cases where Botox may qualify such as treatment for migraines or dental procedures.

A medical necessity letter from a doctor or dentist may be required to use HSA funds for Botox. However some major insurers such as Cigna will reimburse the removal of defective or medically hazardous breast implants. Breast reconstruction surgery is also a qualified medical expense. Similarly eye exams glasses and contact lenses also qualify as medically necessary expenses. While liposuction is generally not an eligible expense for HSA weight-loss programs used as treatment for specific diseases diagnosed by the doctor such as obesity hypertension and heart disease may qualify However the IRS notes that weight loss programs do not qualify if “the purpose of weight loss is to improve appearance overall health or sense of well-being”.It depends If a doctor or dentist deems necessary medications or supplies related to a procedure not covered by health insurance they may be eligible for HSA A medical necessity letter may be required However if “overdraft” refers to a procedure outside the IRS definition of a qualified medical expense then HSA funds cannot be used for drugs or supplies related to that procedure.

Pauline Kasa
Pauline Kasa

Total travel advocate. Twitter enthusiast. Typical coffee geek. Incurable zombie fanatic. Passionate tvaholic. Infuriatingly humble food practitioner.

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