Does an HSA Cover Marriage Counseling?

Health Savings Accounts (HSAs) offer a tax-advantaged way to save and pay for various healthcare expenses. These accounts are designed to help individuals manage medical costs by allowing pre-tax contributions and tax-free withdrawals for qualified expenses. Many people wonder if specific services, such as marriage counseling, fall under the umbrella of eligible expenditures.

General HSA Eligibility Rules

Funds held within a Health Savings Account can be used for “qualified medical expenses” as defined by the Internal Revenue Service (IRS). These expenses must primarily be for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for treatments affecting any part or function of the body. IRS Publication 502, “Medical and Dental Expenses,” details this broad definition. The expense must address a medical condition, not simply promote general health or well-being.

Marriage Counseling and Medical Necessity

Marriage counseling, when focused on general relationship improvement or marital harmony, is not considered a qualified medical expense for HSA purposes. However, if the counseling is provided as a direct treatment for a diagnosed medical condition affecting one or both spouses, it may be eligible. For instance, if a licensed medical professional diagnoses an individual with depression, anxiety, or post-traumatic stress disorder (PTSD) and prescribes counseling as part of their treatment plan, that specific therapy portion could qualify. The counseling must be medically necessary to alleviate or prevent a physical or mental defect or illness, as the IRS requires a direct link between the service and the treatment of a recognized health condition.

Required Documentation for Reimbursement

Specific documentation is necessary to substantiate a claim for marriage counseling. This includes a written diagnosis from a qualified medical professional, such as a psychiatrist or psychologist, for the condition being treated. A prescription or a Letter of Medical Necessity (LMN) from the treating physician or mental health professional is also required. This letter should explicitly state that the counseling is a necessary component of the treatment plan for the diagnosed condition. Itemized bills from the counselor or therapist are required, clearly detailing the services rendered, dates of service, and associated costs.

Submitting Your HSA Claim

Once all necessary documentation has been gathered, you can proceed with submitting your HSA claim. Many HSA providers offer multiple submission methods, including online portals, mobile applications, or traditional mail. If you paid for the counseling out-of-pocket, you can submit a reimbursement request by uploading or attaching the diagnosis, prescription/LMN, and itemized bills. Alternatively, some HSA accounts provide a debit card, which can be used to pay for qualified expenses directly at the time of service. It is important to retain all receipts and supporting documentation for tax purposes and potential IRS audits for at least seven years.