Can I Pay a Chiropractor With an HSA?

Health Savings Accounts (HSAs) offer a tax-advantaged way to save and pay for qualified medical expenses. These accounts are for individuals in high-deductible health plans, allowing pre-tax contributions that grow and are withdrawn tax-free for eligible healthcare costs. A common inquiry among account holders involves the eligibility of chiropractic care for HSA payment.

Defining Qualified Medical Expenses

The Internal Revenue Service (IRS) establishes specific guidelines for what constitutes a “qualified medical expense” for HSA purposes. These are costs incurred primarily for the diagnosis, cure, mitigation, treatment, or prevention of disease. This also includes expenses for treatments affecting any structure or function of the body. These expenses are those that would be deductible as medical expenses on Schedule A (Form 1040).

IRS Publication 502 serves as the guide for these definitions, providing an extensive list of eligible medical and dental expenses. It clarifies that expenses merely beneficial to general health, such as vitamins or a vacation, are not considered qualified. Understanding this definition helps determine if specific healthcare services, including chiropractic care, qualify for HSA use.

Chiropractic Care Eligibility

Chiropractic care is a qualified medical expense if it is for the treatment of a specific medical condition or to alleviate a diagnosed ailment. This means services addressing conditions like back pain from an injury, sciatica, or other musculoskeletal issues are eligible. The IRS requires that the care be medically necessary and provided by a licensed healthcare professional, which includes licensed chiropractors.

Conversely, chiropractic services for general wellness, routine maintenance adjustments without a specific medical diagnosis, or massages not prescribed for a medical condition are not covered. For instance, while chiropractic adjustments for pain relief are eligible, treatments solely for general health improvement may not be. Some services, like certain types of massage therapy or herbal remedies, may require a Letter of Medical Necessity (LMN) from a healthcare provider to qualify.

Using Your HSA for Chiropractic Services

Maintaining detailed records is necessary for substantiating expenses when using an HSA for chiropractic services. This record-keeping should include itemized receipts from the chiropractor, a clear description of the services rendered, and documentation, such as a diagnosis or a note, indicating the medical necessity of the treatment. These documents are needed in the event of an IRS audit, as bank statements or estimates are not sufficient.

Account holders can use an HSA-linked debit card directly at the time of service, which offers a convenient way to pay. Alternatively, individuals can pay for services out-of-pocket and then reimburse themselves from their HSA. The reimbursement process involves submitting a claim to the HSA administrator, often through an online portal, with supporting documentation. There is no time limit for requesting reimbursement, provided the expense was incurred after the HSA was established and was not reimbursed by another source or taken as an itemized deduction.