Can You Use an HSA for Fertility Treatment?

A Health Savings Account (HSA) offers a tax-advantaged way to save and pay for healthcare expenses. These accounts are designed to help individuals cover medical costs with pre-tax dollars, and the funds can grow tax-free over time. For those navigating fertility journeys, a common question arises about using HSA funds for related treatments. Generally, many fertility treatments can be covered by an HSA, provided they meet specific criteria established by the Internal Revenue Service (IRS). This allows individuals to leverage the financial benefits of an HSA to manage the costs associated with fertility care.

General HSA Eligibility and Qualified Expenses

To establish and contribute to an HSA, an individual must be covered by a High-Deductible Health Plan (HDHP). For 2025, an HDHP is defined by the IRS as a health plan with a minimum annual deductible of $1,650 for self-only coverage or $3,300 for family coverage. Additionally, these plans have a maximum limit on annual out-of-pocket expenses, which for 2025 is $8,300 for self-only coverage and $16,600 for family coverage. An individual cannot be enrolled in Medicare or claimed as a dependent on someone else’s tax return to be eligible for an HSA.

Once eligible, contributions to an HSA are typically made on a pre-tax basis, and the funds can be invested, growing tax-free. Distributions from an HSA are tax-free when used for “qualified medical expenses” as defined by Internal Revenue Code Section 213. This section broadly defines medical care as amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body. These expenses must be primarily for the alleviation of a physical or mental defect or illness, excluding expenses that are merely beneficial to general health.

Specific Fertility Treatments Covered by HSAs

Many fertility treatments and associated expenses are recognized as qualified medical expenses under IRS guidelines, making them eligible for HSA reimbursement. In Vitro Fertilization (IVF) procedures, including egg retrieval, embryo transfer, sperm washing, monitoring, and associated laboratory services, generally qualify. Intrauterine Insemination (IUI), which involves placing sperm directly into the uterus, is also typically covered.

Fertility medications, such as injectables, suppositories, and oral medications prescribed by a doctor, are eligible expenses. Diagnostic procedures include testing, ultrasounds, and blood work related to fertility. Costs for obtaining sperm or ova, whether through a donor or a fertility clinic, are considered eligible. The storage of reproductive materials, such as eggs, sperm, or embryos, also qualifies if directly related to current or future medical treatment for the individual or their spouse. Acupuncture or other complementary therapies may be covered if prescribed by a medical professional for a specific medical condition, such as infertility. Cosmetic procedures or general health improvements not directly treating infertility are typically not covered.

Documentation and Record-Keeping for HSA Use

Maintaining thorough records is important for all HSA transactions, particularly in case of an IRS audit. Since individuals own their HSAs, they are responsible for proving that distributions were used for qualified medical expenses. Failure to provide proper documentation can result in a 20% penalty on the distributions, in addition to income tax.

Key records to retain include receipts from healthcare providers, Explanation of Benefits (EOB) statements from insurance companies, and prescription details. For less common treatments or therapies, a doctor’s note or medical diagnosis letter is important to demonstrate medical necessity. It is advisable to keep these records for at least as long as your income tax return is subject to audit, which is typically three years, or longer if the account remains open.

Accessing and Using Your HSA Funds

There are several practical methods for using or reimbursing yourself from an HSA for qualified fertility treatment expenses. One common approach is direct payment using an HSA debit card or checks provided by the HSA administrator. This allows for immediate payment at the point of service, such as a fertility clinic or pharmacy. Many HSA providers also offer online portals for direct payments to healthcare providers.

Alternatively, individuals can pay for expenses out-of-pocket and then reimburse themselves from their HSA account. This reimbursement can occur at any time after the expense is incurred, even years later, as long as proper documentation is maintained from the year the expense was made. Reimbursement methods include online transfers from the HSA to a personal bank account or writing a check from the HSA. HSA administrators typically provide online portals or specific forms for submitting these reimbursement requests.