Can I Use My HSA for Massage Therapy?

A Health Savings Account (HSA) provides a tax-advantaged savings mechanism. This account offers a triple tax advantage: contributions are tax-deductible, earnings grow tax-free, and withdrawals for qualified medical expenses are also tax-free. Understanding which expenses qualify is important for account holders.

Qualified Medical Expenses for HSAs

The Internal Revenue Service (IRS) defines qualified medical expenses as amounts paid primarily for the diagnosis, cure, mitigation, treatment, or prevention of disease. These expenses also include treatments intended to affect any structure or function of the body. The expense must relate to medical care, rather than merely promoting general health or well-being.

For an expense to be considered qualified, it must address a specific physical or mental defect or illness. Costs for general health improvements, such as cosmetic procedures or fitness programs, do not qualify. Qualified medical expenses must not be reimbursed by other sources, such as a health insurance plan. Guidance on eligible expenses can be found in IRS Publication 502.

When Massage Therapy Qualifies

Massage therapy is not considered a qualified medical expense if its purpose is for general relaxation, stress relief, or overall wellness. However, massage therapy can qualify if it is deemed medically necessary to treat a specific, diagnosed medical condition.

Medical necessity requires the massage therapy to be prescribed by a licensed medical practitioner, such as a physician, chiropractor, or physical therapist. This prescription must be for the treatment of a specific condition, like chronic back pain, injury recovery, or other ailments. The medical professional’s recommendation must clearly state the diagnosed medical condition, specify massage therapy as the treatment, and detail the recommended duration and frequency of sessions. Conditions such as chronic pain disorders, muscle injuries, post-surgical rehabilitation, temporomandibular joint disorders (TMJ), certain neurological conditions, lymphedema, and musculoskeletal disorders are examples where massage therapy might be prescribed.

Documentation and Using Your HSA

Proper documentation is essential for massage therapy expenses to qualify for HSA coverage. A written prescription or a Letter of Medical Necessity (LMN) from a qualified medical professional is required. This LMN should explicitly include the specific diagnosis, a clear explanation of why massage therapy is medically necessary for that condition, and the recommended frequency and duration of the treatment. An LMN is valid for one year, justifying expenses incurred within that timeframe.

Original receipts from the massage therapist or clinic are also necessary, detailing the date of service, the specific service provided, the amount paid, and the provider’s name. These records should be kept, as the IRS may request them during an audit to verify medical necessity.

Once documentation is secured, there are two primary methods for using HSA funds. Many HSA providers issue a debit card, which can be used directly at the time of service. When using this method, it is important to retain all supporting documentation for tax purposes.

Alternatively, individuals can pay for the massage therapy out-of-pocket and then seek reimbursement from their HSA. The reimbursement process involves submitting a claim form, along with copies of the LMN and detailed receipts, to the HSA administrator. An advantage of HSAs is that there is no time limit for requesting reimbursement, provided the expense was incurred after the HSA was established.