HSA-Eligible Summer Expenses: What Counts and What Does Not

If you have an HSA-qualified plan and you have not mapped your summer expenses yet, you are almost certainly going to leave money on the table this year.

What “HSA-Eligible” Actually Means

The Internal Revenue Service (IRS) does not publish a “summer list.” It publishes one definition that decides every purchase you make with your HSA.

Under Section 213(d) of the tax code, a qualified medical expense is something paid primarily for the diagnosis, treatment, prevention, or mitigation of a specific physical or mental condition. Routine wellness, gym memberships, and things bought “just to feel better” do not pass. A sports physical does. A skin check does. A travel vaccine does.

Two things matter before you spend a dollar. First, what makes a plan HSA-qualified is not the same as whether you have an HSA. You must be enrolled in an HSA-qualified high-deductible health plan during the months you contribute.

Second, the IRS list is not exhaustive. Something can be eligible without being on any list, as long as it meets the Section 213(d) test. For the full picture, see the IRS list of HSA-qualified expenses or IRS Publication 502.

The Four Categories That Cover Most of Your Summer

Almost every summer health expense for a self-employed family falls into one of four buckets.

Sports physicals and youth athletic exams. Required for school sports, summer leagues, and most camps. The fee qualifies whenever the visit is documented as preventive or diagnostic, even if it is mostly a checkbox for a coach.

Skin checks and dermatology. Full-body exams, biopsies of suspicious spots, and treatment for sun damage all qualify. Cosmetic procedures do not.

Vision exams and prescription sunglasses. Annual eye exams qualify. So do prescription sunglasses and prescription swim goggles. Non-prescription sunglasses generally do not.

Travel vaccines and travel-medicine consults. Vaccines for international travel (typhoid, hepatitis A, yellow fever, others) qualify. The pre-travel consult and malaria prophylaxis prescriptions qualify too.

One rule cuts across all four. If your plan is not currently HSA-qualified, none of these are deductible.

 The Eligible Expenses Almost Nobody Talks About

These are the ones that surprise people, because they do not feel “medical” in the way a doctor visit does.

Sunscreen with SPF 15 or higher. Since the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) of 2020, over-the-counter sunscreen qualifies, no prescription needed. The same law made menstrual care products eligible.

Mental health visits. Therapy, psychiatry, and counseling for a diagnosed condition qualify in full, including telehealth. Coaching and general wellness do not.

Lactation support and family planning. Breast pumps, lactation consultants, and most fertility-related expenses qualify.

Acne treatment. Prescription acne medication and dermatologist visits where acne is the reason qualify. The “is this cosmetic” question only comes up if the treatment is purely for appearance.

For a deeper dive, see HSA-eligible items most account holders miss.

Your Pre-Summer HSA Checklist

Run through this list before June. Fifteen minutes prevents most of the mistakes that end up costing 20%.

• Verify your plan is HSA-qualified. Pull your insurance card. If it does not explicitly say HDHP or HSA-qualified, call your Personal Benefits Managers (PBM) before you spend.
• List your planned summer expenses. Sports physicals, skin checks, vision exams, travel vaccines, anything you know is coming. Estimate each.
• Save every receipt. Paper or photo. The IRS does not require you to submit them, but if you are audited, the receipt is the entire defense.
• Link your HSA debit card. Reimbursing yourself later adds friction that makes you skip eligible expenses. Use the card directly.
• Flag the edge cases to your PBM. Letter of Medical Necessity items, cosmetic-adjacent expenses, and anything over $500 where eligibility is uncertain.

Question of the Month

Can you use your HSA to buy sunscreen for the family vacation?

Answer. Yes. Since the CARES Act of 2020, over-the-counter sunscreen with SPF 15 or higher qualifies, no prescription needed. The same goes for menstrual care products. Save the receipt.

Map Your Summer Spend Before You Spend a Dollar

The fastest way to turn this newsletter into actual savings is fifteen minutes on the phone with someone who already knows the rules.

→ Schedule a free summer HSA spend-down review with your Personal Benefits Manager

One last data point. According to the Employee Benefit Research Institute (EBRI), one-third of HSA account holders withdrew more than they contributed in 2023. Most treat their HSA reactively. The ones who plan ahead get the full benefit. Be the second kind.

Click here to schedule an appointment, or call 800-913-0172 to get started.    

To your health and wealth,

Wiley P. Long, III
President - HSA for America

Author of Health Sharing: The Authoritative Guide to America’s Fastest-Growing Health Insurance Alternative

The HSA for America Maximize Your HSA Newsletter is published monthly and emailed to subscribers at no charge. Subscribe now to stay on top of the critical information you need to know about health insurance, healthshare plans and managing your finances to achieve financial security.