Can You Buy Shoes With an HSA Account?

A Health Savings Account (HSA) is a tax-advantaged savings account specifically designed for healthcare expenses. It allows individuals with high-deductible health plans to save money for medical costs on a pre-tax basis. Contributions to an HSA are tax-deductible, the funds grow tax-free, and withdrawals for qualified medical expenses are also tax-free, offering a triple tax advantage.

General Rules for HSA Eligible Expenses

The Internal Revenue Service (IRS) defines what constitutes an eligible medical expense, primarily outlined in IRS Publication 502. These expenses must be primarily for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for affecting any part or function of the body. This means that expenses for general health improvement or personal enjoyment are not eligible.

For an expense to qualify, it must address a specific physical or mental defect or illness, not just provide general well-being. Common examples of eligible expenses include doctor visits, prescription medications, dental care like fillings and braces, and vision care such as eyeglasses and eye examinations. Conversely, expenses for cosmetic procedures, unless medically necessary to correct a deformity, or general health supplements like most vitamins, are not eligible.

Qualifying Shoes and Footwear

While everyday shoes are not considered HSA-eligible, specific types of footwear can qualify if they are medically necessary and prescribed for a particular condition. Orthopedic shoes, diabetic shoes, custom orthotics, and other therapeutic footwear are eligible expenses. These items must be primarily for medical care, intended to alleviate or prevent a physical disability or illness. For instance, shoes designed to address plantar fasciitis, bunions, heel spurs, or alignment issues qualify.

To confirm eligibility for such items, a Letter of Medical Necessity (LMN) from a licensed healthcare provider is required. This document should detail the patient’s specific medical condition, the recommended footwear, and how it will treat or mitigate the condition. Without this medical justification, even specialized shoes would not be eligible for reimbursement. The LMN helps distinguish medically necessary items from those for general comfort or personal use.

Reimbursement and Record-Keeping

After incurring an eligible medical expense, including qualifying footwear, individuals can seek reimbursement from their HSA. Maintain detailed records for all transactions. These records should include receipts, doctor’s prescriptions, and any Letters of Medical Necessity. These documents are crucial because the individual is ultimately responsible for proving the eligibility of expenses if audited by the IRS.

Many HSA administrators provide online portals for submitting claims, or individuals may need to mail in forms. While an administrator might process a claim, the ultimate responsibility for ensuring the expense is qualified rests with the account holder. For tax purposes, records should be retained for at least as long as the tax return is subject to audit, which can be several years. Failure to provide documentation for non-qualified withdrawals can result in the amount being taxed as income, plus a potential 20% penalty if the individual is under age 65.