What Vitamins and Supplements Are HSA Eligible?

Health Savings Accounts (HSAs) provide a tax-advantaged way for individuals to save and pay for qualified medical expenses. These accounts offer a unique benefit by allowing pre-tax contributions, tax-free growth through investments, and tax-free withdrawals for eligible healthcare costs. Determining which expenses qualify for HSA reimbursement can be complex, particularly for over-the-counter items like vitamins and supplements. Eligibility depends on Internal Revenue Service (IRS) guidelines, which distinguish between general wellness and medical treatment.

General Eligibility Criteria for Medical Expenses

The IRS defines “medical care” as expenses paid primarily 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 serves as the foundation for determining HSA eligibility. Expenses that promote general health or well-being do not meet this criterion. For instance, costs associated with general cosmetic surgery, gym memberships for overall fitness, or basic personal hygiene products are usually not considered qualified medical expenses.

The emphasis remains on the direct medical purpose of the expense. This means that an item or service must be intended to address a specific health condition or bodily function. While many products contribute to a healthy lifestyle, only those directly linked to medical care as defined by the IRS are eligible for tax-free reimbursement from an HSA.

Vitamins Requiring a Letter of Medical Necessity

Vitamins and supplements can be HSA-eligible if a medical practitioner diagnoses a specific medical condition and recommends the product as treatment. This requires a Letter of Medical Necessity (LMN). An LMN must be issued by a licensed healthcare professional, such as a doctor, physician assistant, or nurse practitioner. The letter needs to specify the diagnosed medical condition, identify the recommended vitamin or supplement, and explain how it will treat or alleviate the condition. It should also indicate the expected duration of treatment.

For example, a vitamin D supplement could be HSA-eligible if a healthcare provider diagnoses a patient with a severe vitamin D deficiency and prescribes it as a treatment. Similarly, specific B vitamins might qualify if prescribed to manage neuropathy linked to a diagnosed medical condition.

Vitamins and Supplements Not Eligible Without a Diagnosis

Most over-the-counter vitamins and supplements for general health purposes are not HSA-eligible without a specific diagnosis and a Letter of Medical Necessity. This includes common daily multivitamins, general immune boosters, fish oil supplements, probiotics, and products marketed for hair, skin, or nail health. The IRS considers these items as “general wellness” products intended to maintain overall health rather than treat specific medical conditions.

An important exception to this rule is prenatal vitamins, which are typically HSA-eligible without an LMN because they address the specific medical condition of pregnancy and are recognized as standard care.

Documentation and Record Keeping

Maintaining records is important for all HSA expenses, especially for vitamins and supplements. Account holders are responsible for proving that distributions were used for qualified medical expenses. In the event of an IRS inquiry or audit, proper documentation validates the eligibility of your expenses.

You should retain copies of the Letter of Medical Necessity, if applicable, along with itemized receipts for the vitamins and any supporting documentation, such as lab results confirming a deficiency. These records should clearly show the date of purchase, description of the item, and amount paid. Keeping these documents for at least as long as your tax return is subject to audit, typically three years, is a prudent practice to avoid potential penalties on non-qualified distributions.