Can You Pay for a Doula With an HSA?

A Health Savings Account (HSA) is a tax-advantaged savings account designed to help individuals save for qualified medical expenses. These accounts are typically available to those enrolled in a high-deductible health plan (HDHP), offering a way to manage healthcare costs with tax benefits. Many individuals wonder if services provided by a doula qualify as an eligible expense for HSA reimbursement. Doula services can be considered HSA eligible under specific conditions.

HSA Eligibility for Medical Expenses

The Internal Revenue Service (IRS) defines “medical care” for HSA eligibility as costs incurred for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for affecting any structure or function of the body. This definition is crucial when determining if a doula’s services qualify. Doulas are non-medical professionals who provide continuous physical, emotional, and informational support. Their services are not automatically classified as medical care under IRS Code Section 213(d).

However, portions of a doula’s services may be eligible if they are medically necessary and directly support medical care. If a doula’s support helps alleviate or prevent a physical or mental defect or illness, such as reducing stress or complications during pregnancy and childbirth, it could be considered an eligible expense. This applies when their services assist with labor pain management or postnatal recovery related to a diagnosed medical condition. General health or wellness services, emotional support, or basic parenting education provided by a doula are typically not eligible.

Substantiating Doula Expenses

To prove doula services meet HSA eligibility criteria, specific documentation is required. An itemized receipt from the doula is a foundational document, detailing the date of service, a description of the services provided, and the associated cost. This receipt helps establish the expense and its connection to the medical care received.

A Letter of Medical Necessity (LMN) from a healthcare provider, such as an obstetrician or midwife, is crucial for doula services to be deemed HSA eligible. This letter should explicitly outline the medical condition being treated and explain how the doula’s support is necessary for the individual’s health or pregnancy. The LMN should specify the services recommended and how they address a medical need, rather than general wellness support. For example, it might describe how physical labor support or postpartum recovery assistance is medically necessary. Obtain this letter before incurring expenses to ensure compliance.

Accessing Your HSA Funds

Once eligibility is determined and all necessary documentation, including itemized receipts and a Letter of Medical Necessity, is gathered, individuals can access their HSA funds. One common method is using an HSA debit card for direct payment at the time of service. Many HSA providers also allow online payments directly from the account or offer options for ordering checks.

Alternatively, individuals can pay for doula services out-of-pocket and then seek reimbursement from their HSA. This involves submitting a claim to the HSA administrator, often through their online portal, mobile app, or by mail. The claim typically requires the date of service, the expense amount, and a description of the service. Retain all receipts and supporting documentation, like the LMN, for tax purposes and in case of an IRS audit, as HSA funds used for non-qualified expenses are subject to income tax and a penalty. There is generally no time limit for requesting reimbursement, allowing you to pay out-of-pocket and reimburse yourself years later, as long as the HSA was established before the expense was incurred.