Shoes You Can Buy With an HSA Account

A Health Savings Account (HSA) is a tax-advantaged savings account designed to help individuals pay for qualified healthcare expenses. It serves as a tool for those with high-deductible health plans to manage medical costs while enjoying tax benefits, such as tax-deductible contributions and tax-free withdrawals for eligible expenses. While HSAs cover a range of medical needs, the eligibility of everyday items like footwear involves specific considerations.

Understanding HSA Eligibility for Footwear

For an expense to be considered HSA-eligible, it must primarily be for the “diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.” This definition, provided by the Internal Revenue Service (IRS) in Publication 502, forms the basis for determining eligible medical expenses. Most everyday shoes are not HSA-eligible because they are considered general health items rather than products directly addressing a specific medical condition.

Eligibility for footwear generally hinges on medical necessity, meaning the item must be required to alleviate or prevent a physical illness or disability. A doctor’s prescription or a Letter of Medical Necessity (LMN) is typically required to substantiate this medical necessity. This document from a healthcare provider should clearly outline the specific medical condition, how the footwear will address it, and why it is medically necessary for treatment.

Without such documentation, the expense of specialized footwear is usually not considered eligible for reimbursement. This requirement applies even if the footwear offers some general health benefits, as the IRS classifies such items as “dual-purpose” and typically excludes them without a clear medical directive. The connection between the footwear and a diagnosed medical condition is essential for HSA eligibility.

Specific Types of Eligible Footwear and Related Items

Building upon the necessity of medical justification, certain types of footwear and related items can qualify for HSA use when prescribed by a healthcare professional. Orthopedic shoes are one such category, often designed to accommodate specific foot disorders or medical conditions. These shoes feature characteristics like wider toe boxes, firm heel support, and sometimes removable insoles, differing from general comfort shoes. An LMN is required for reimbursement, stating their necessity for treating a medical condition.

Diabetic shoes also qualify due to their specific design features aimed at preventing complications in individuals with diabetes. These shoes often have extra depth, seamless interiors, and protective elements to reduce pressure points and accommodate foot deformities, minimizing the risk of ulcers and other injuries. A prescription from a qualified healthcare provider is typically required for HSA eligibility.

Custom-made orthotics or inserts are another common eligible item, distinct from over-the-counter insoles. These are specifically molded or designed based on an individual’s foot structure and medical needs to address conditions like plantar fasciitis, arch pain, or alignment issues. A prescription or medical diagnosis from a podiatrist or other healthcare provider is generally necessary to qualify these custom orthotics for HSA reimbursement. Therapeutic shoes, including those for post-operative recovery or conditions causing significant swelling, also fall under eligible expenses when medically necessary.

How to Purchase or Get Reimbursed

When purchasing eligible footwear or related items using your HSA, two methods exist: using a debit card or paying out-of-pocket for reimbursement. Many HSA providers issue a debit card linked directly to your account, which can be used at the point of sale where medical expenses are accepted. When using this method, retain all receipts and the prescription or Letter of Medical Necessity. These documents serve as proof that the expense was qualified, which is crucial for tax purposes and in case of an IRS audit.

Alternatively, you can pay for the eligible items out-of-pocket using a personal credit card or other funds, and then seek reimbursement from your HSA. This approach allows your HSA funds to remain invested and grow tax-free for a longer period. To initiate a reimbursement, you typically submit a claim to your HSA administrator, providing documentation such as the itemized receipt, a copy of the prescription, and potentially an Explanation of Benefits (EOB) if an insurance claim was involved. The exact process for reimbursement varies slightly among HSA providers, but generally involves logging into your online account and submitting the required information.

Meticulous record-keeping is important regardless of the payment method chosen. The IRS requires taxpayers to maintain records sufficient to show that HSA distributions were used for qualified medical expenses and were not reimbursed from other sources or taken as an itemized deduction. These records should be kept for at least three years, aligning with the general statute of limitations for tax audits. When filing your annual tax return, you will typically use IRS Form 8889 to report HSA contributions and distributions, ensuring proper accounting of your healthcare savings.