Can I Use My HSA on Vitamins and Supplements?

A Health Savings Account (HSA) provides a tax-advantaged way for individuals to save and pay for qualified medical expenses. These accounts are paired with high-deductible health plans (HDHPs), allowing account holders to contribute pre-tax dollars, which can grow tax-free, and be withdrawn tax-free for eligible healthcare costs. The primary purpose of an HSA is to help individuals manage healthcare expenditures.

General HSA Eligible Expenses

The Internal Revenue Service (IRS) defines what constitutes a qualified medical expense for HSA purposes. Generally, these are costs primarily for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for treatments affecting any part or function of the body. This broad definition aligns with medical care as described in IRS Section 213(d). Expenses must be for medical care and not merely for general health or personal benefit.

Common eligible expenses include doctor visits, prescription medications, dental care, and vision care. The Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 expanded the list to include over-the-counter medications and menstrual care products without requiring a prescription. However, personal expenses like toothpaste, which are for general health, are not considered medical care.

Specific Rules for Vitamins and Supplements

Vitamins and dietary supplements purchased for general health or nutritional purposes are generally not HSA-eligible expenses. The IRS considers these items as “general wellness” products intended to maintain overall health rather than to treat specific medical conditions. This means that common multivitamins, Vitamin C, D, B-complex, fish oil, probiotics, and herbal supplements are typically not covered by HSA funds.

However, there are specific circumstances where vitamins and supplements can be considered eligible. If a vitamin or supplement is recommended by a licensed medical practitioner to treat a diagnosed medical condition, illness, or disease, it may qualify. For example, if a doctor prescribes an iron supplement for iron-deficiency anemia, it can be an eligible expense. This distinction is crucial: the item must be primarily for the alleviation or prevention of a physical or mental defect or illness, not just for general health maintenance.

To establish eligibility, a Letter of Medical Necessity (LMN) is often required. This letter, written by a healthcare professional, must specify the diagnosed medical condition and state that the vitamin or supplement is necessary to treat or prevent that condition. The LMN should also indicate the length of treatment required. Without this documentation, most vitamins and supplements remain ineligible.

A notable exception is prenatal vitamins, which are typically HSA-eligible without requiring a prescription or LMN. Prenatal vitamins address the specific medical condition of pregnancy and are widely recognized as standard care, providing essential nutrients like folic acid and iron. Similarly, certain other supplements, such as glucosamine used for joint pain, may also be eligible.

Maintaining Records for Reimbursement

Account holders are responsible for maintaining thorough records to substantiate all HSA expenditures. The IRS considers any spending from HSAs as equivalent to a tax deduction, necessitating proper documentation. While HSA administrators do not require substantiation for every transaction, individuals must be prepared to provide proof of eligibility if audited by the IRS.

Essential documentation includes a prescription or a Letter of Medical Necessity, linking the expense to a diagnosed medical condition. Detailed receipts are also necessary. These records serve as proof that the distributions were exclusively used for qualified medical expenses and were not reimbursed from another source.

It is prudent to retain these records for several years, often aligning with the tax return’s audit period. Electronic records are generally acceptable, though the IRS has not issued official guidance on digital storage. Keeping organized documentation helps avoid potential penalties, such as a 20% penalty on distributions that cannot be proven to be for qualified medical expenses, in addition to income tax.