Can You Buy a Scale With an HSA Account?

A Health Savings Account (HSA) is a tax-advantaged savings account designed to help individuals save and pay for qualified medical expenses. These accounts are paired with high-deductible health plans (HDHPs), offering a triple tax benefit: contributions are tax-deductible, earnings grow tax-free, and withdrawals for eligible expenses are also tax-free. The primary objective of an HSA is to provide a dedicated fund for healthcare costs, allowing account holders to manage their medical finances effectively over time.

General Rules for HSA Qualified Medical Expenses

Qualified medical expenses, as defined by the Internal Revenue Service (IRS), are costs incurred primarily for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body. The IRS provides detailed guidance on what constitutes a qualified medical expense in Publication 502, “Medical and Dental Expenses.” Expenses must be medically necessary, meaning they are not merely beneficial to general health, such as vitamins or a vacation.

Specific Eligibility for Scales

A weighing scale is generally not considered an HSA-eligible expense if its purpose is for general health or wellness, such as routine weight monitoring for fitness goals. However, a scale can become an eligible expense when it is medically necessary for the diagnosis, treatment, or alleviation of a specific medical condition.

For instance, a scale may qualify if it is used to monitor weight for conditions like heart disease, diabetes, or obesity, particularly when weight management is an integral part of a physician-prescribed treatment plan. In such cases, a Letter of Medical Necessity (LMN) from a healthcare professional supports the expense’s eligibility. This letter explains the medical condition and how the scale is essential for its treatment or monitoring.

Some body composition scales, which measure metrics beyond just weight like body fat percentage and muscle mass, may be considered medical devices and universally eligible due to their diagnostic capabilities, even without an LMN.

Using Your HSA for Purchase and Record Keeping

Many HSA providers offer a debit card, which can be used directly at the point of sale, similar to a regular bank debit card, for qualified medical expenses. Alternatively, you can pay for the expense out-of-pocket using personal funds and then reimburse yourself from your HSA. This method allows you to let your HSA funds grow and be withdrawn later, even years after the expense was incurred, provided the HSA was established at the time of the expense.

Maintaining accurate records for all HSA expenditures is important for tax purposes and in case of an IRS audit. This includes keeping receipts, invoices, and any supporting documentation, such as a doctor’s note or LMN, especially for items requiring medical necessity.

While your HSA administrator may not require receipts for every transaction, you are responsible for proving the eligibility of all withdrawals. These records should be retained for at least as long as your income tax return is subject to audit, typically three years, or longer if the account is still maintained. Failure to provide proper documentation for non-qualified expenses can result in income tax and a 20% penalty on the distribution.