Can You Pay for Plastic Surgery With an HSA?

Health Savings Accounts (HSAs) offer a tax-advantaged way to save and pay for healthcare expenses. The use of these funds for plastic surgery procedures is a common question. Eligibility involves understanding Internal Revenue Service (IRS) guidelines, which differentiate between medically necessary and purely cosmetic procedures.

Understanding Health Savings Accounts

An HSA is a tax-advantaged savings account for healthcare expenses. Individuals, employers, or both can contribute. Contributions are tax-deductible, and earnings grow tax-free. Withdrawals for qualified medical expenses are also tax-free.

To be eligible for an HSA, an individual must be covered by a High-Deductible Health Plan (HDHP). An HDHP is characterized by a higher annual deductible than typical health plans and a maximum limit on out-of-pocket medical expenses. For 2025, an HDHP must have a minimum deductible of at least $1,650 for self-only coverage or $3,300 for family coverage. The maximum out-of-pocket expenses for an HDHP are $8,300 for an individual or $16,600 for a family in 2025. The HSA is owned by the individual, and funds remain in the account year after year, even if employment changes.

Eligible Medical Expenses

Eligible medical expenses are defined by IRS Publication 502. These are costs incurred for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for treatments affecting any structure or function of the body. The expenses must primarily aim to alleviate or prevent a physical or mental disability or illness. They do not include expenses merely beneficial to general health, such as vitamins.

Common examples of eligible expenses include doctor visits, prescription medications, dental care, and vision care. Other qualifying expenses are mental health services, chiropractic care, and certain over-the-counter medicines. Procedures solely for cosmetic purposes are generally not eligible. This distinction is central to understanding HSA eligibility for plastic surgery.

Plastic Surgery and HSA Eligibility

HSA eligibility for plastic surgery hinges on whether the procedure is medically necessary or purely cosmetic. IRS Code Section 213 specifies that “medical care” generally does not include cosmetic surgery. An exception exists if the surgery corrects a deformity from a congenital abnormality, personal injury, or disfiguring disease.

Medically necessary plastic surgery aims to treat a disease, defect, or injury, or to restore normal bodily function. Examples include reconstructive surgery after a mastectomy for cancer, repair of congenital deformities like a cleft palate, or surgery to correct disfigurement resulting from an injury or disease. Procedures to alleviate a specific medical condition, such as eyelid surgery to improve vision impaired by drooping lids or breast reduction surgery to alleviate severe back pain, may also qualify. For such procedures to be eligible, a physician’s diagnosis and a written recommendation stating the medical necessity are crucial.

Purely cosmetic procedures, solely for improving appearance without addressing a medical condition or restoring function, do not qualify for HSA funds. Examples include facelifts, liposuction, or breast augmentation for aesthetic reasons. If a plastic surgery procedure is medically necessary and an eligible expense, individuals can use HSA funds to pay for it via an HSA debit card or reimbursement. Using HSA funds for non-qualified expenses can lead to income tax and a 20% penalty if under 65.