Are Pillows HSA Eligible? Requirements & Documentation

A Health Savings Account (HSA) offers a tax-advantaged way to save and pay for qualified medical expenses. While many healthcare costs, such as doctor visits and prescription medications, are clearly eligible, questions often arise regarding everyday items like pillows. Understanding the specific criteria for what constitutes a qualified medical expense is important for proper HSA utilization.

Understanding HSA-Eligible Medical Expenses

The Internal Revenue Service (IRS) defines a qualified medical expense as costs paid for the diagnosis, cure, mitigation, treatment, or prevention of disease. This definition also extends to expenses for treatments affecting any structure or function of the body. This broad guideline aims to ensure that HSA funds are used for genuine healthcare needs rather than general wellness or cosmetic purposes.

Commonly eligible expenses include professional medical services, hospital care, and prescription drugs. However, items considered beneficial for general health, such as vitamins or some over-the-counter products, are not eligible unless prescribed for a specific medical condition. The guiding principle is that the expense must primarily alleviate or prevent a physical or mental disability or illness.

Specific Requirements for Pillow Eligibility

A pillow is not considered an HSA-eligible expense if purchased for general comfort or personal use. However, a pillow can qualify if it is specifically intended to treat or mitigate a diagnosed medical condition, such as chronic back pain, neck issues, or sleep apnea. The key distinction lies in the medical necessity of the item.

To establish medical necessity, a Letter of Medical Necessity (LOMN) from a qualified healthcare professional is required. This document, provided by a doctor, chiropractor, or physical therapist, must clearly state the patient’s diagnosis and explain how the specific pillow will alleviate or treat the condition. The LOMN should also include the recommended duration of use for the pillow.

Examples of pillows that may receive LOMNs include orthopedic pillows designed for spinal alignment, cervical pillows for neck support, wedge pillows for acid reflux or respiratory issues, and specialized pillows used with sleep apnea devices. These items are distinct from standard pillows because they address a specific medical need. The LOMN serves as official documentation, linking the pillow purchase directly to a medical treatment plan.

Submitting HSA Claims and Maintaining Records

Using HSA funds for an eligible pillow can be done in a couple of ways. If the vendor accepts HSA debit cards, the card can be used directly at the point of purchase.

Alternatively, an individual can pay out-of-pocket for the pillow and then seek reimbursement from their HSA administrator. This process involves submitting a claim along with the purchase receipt and the Letter of Medical Necessity. Many HSA providers offer online portals for submitting these reimbursement requests, often allowing direct transfer of funds to a linked bank account.

Maintaining thorough records is important for all HSA transactions. Individuals should retain all receipts for purchases, copies of the LOMN, and any supporting documentation from their healthcare provider. These records are essential for tax purposes and for IRS audits. While there is no time limit to request HSA reimbursements for past qualified expenses, the records should be kept for at least seven years, aligning with tax record retention guidelines.