Can I Use an HSA Card for a Massage?

A Health Savings Account (HSA) offers a tax-advantaged way to save and pay for healthcare costs. These accounts are designed for individuals enrolled in high-deductible health plans (HDHPs). A common question arises regarding the use of HSA funds for non-traditional medical expenses, such as massage therapy. The Internal Revenue Service (IRS) defines “qualified medical expenses” for HSA purposes, guiding whether treatments like massage can be covered using these tax-free funds.

Understanding HSA-Eligible Medical Expenses

The IRS outlines specific criteria for expenses to be considered “qualified medical expenses.” These expenses must be for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for affecting any structure or function of the body. Costs associated with general health or cosmetic purposes, such as vitamins or a vacation, do not qualify.

Common eligible expenses include doctor visits, prescription medications, dental care, and vision care. Other examples are chiropractic services, physical therapy, and certain mental health treatments. These expenses must not be reimbursed by another insurance plan to maintain their qualified status for HSA use.

Qualifying Massage Therapy Expenses

Massage therapy can be an HSA-eligible expense, but only under specific conditions. It is covered if prescribed by a medical professional, such as a physician, chiropractor, or physical therapist, to treat a specific medical condition. This requirement emphasizes “medical necessity,” meaning the massage must alleviate or prevent a physical or mental defect or illness. General wellness or relaxation massages, not intended to treat a diagnosed condition, are not eligible for HSA funds.

Examples of conditions for which massage therapy might be prescribed include chronic pain disorders like fibromyalgia or chronic back pain, muscle injuries, or post-surgical rehabilitation. The treatment should be performed by a licensed professional. The massage must be therapeutic, addressing a diagnosed health issue.

Essential Documentation for Massage Therapy

To substantiate massage therapy as a qualified medical expense for HSA purposes, documentation is required. A “Letter of Medical Necessity” (LMN) or a prescription from a qualified healthcare provider is necessary. This document should clearly state the diagnosis, outline the recommended treatment plan including frequency and duration of massage, and bear the medical professional’s signature. The LMN confirms that the massage therapy is not for general wellness but to treat a particular medical condition.

Retain detailed receipts from the massage therapist. These receipts should include the date of service, a description of the service, the amount paid, and the therapist’s credentials. Maintaining these records, along with documentation of the medical condition, is necessary for substantiating the expense in case of an IRS audit. An LMN is valid for one year, and a new one may be needed for ongoing treatment.

Using Your HSA Card for Payment or Reimbursement

Once eligibility criteria are met and documentation is secured, there are two primary methods for using HSA funds for qualifying massage therapy expenses. The first method involves direct payment using an HSA debit card at the time of service. Even when paying directly with the card, keep supporting documentation, such as the Letter of Medical Necessity and detailed receipts, in your personal records for potential IRS substantiation.

The second method is reimbursement, where you pay for the service out-of-pocket and then submit a claim to your HSA administrator. The reimbursement process involves logging into your HSA account online, entering expense details, and sometimes uploading supporting documents. There is no time limit to request HSA reimbursements, provided the expense was incurred after the HSA was established and not reimbursed by another source. This allows flexibility to pay for services and seek reimbursement later, while letting HSA funds potentially grow tax-free.