HSA and FSA: using them for prescriptions and telehealth

Updated 2026-10-13 · Reviewed for accuracy by the EKO Labs team. Educational only; not medical advice.

If you have a Health Savings Account (HSA) or a health Flexible Spending Arrangement (FSA), you can usually use that money, tax-free, for prescription medicines and for medical care, including doctor visits by video. This guide explains what the IRS counts as a qualified medical expense, the special rule for weight-related care, what changed for telehealthTelehealth a medical visit by video or phone., the 2026 limits and the records you should keep. It is general information, not tax, legal or medical advice; ask your plan administrator or a tax professional about your own situation.

HSA, FSA and HRA in one minute

• HSA: an account you own, usually paired with a high deductible health plan (HDHP). Unused money stays in the account from year to year and stays with you if you change jobs.
• Health FSA: offered by an employer. You choose an amount each year that is taken from your pay before tax. FSAs are generally “use-it-or-lose-it”, but a plan may allow a grace period of up to 2½ months after the plan year or a limited carryover.
• HRA (health reimbursement arrangement): funded only by the employer; what it pays for depends on the plan.

What counts as a qualified medical expense

According to IRS Publication 969, qualified medical expenses are generally amounts paid for “medical care” as defined in section 213(d) of the tax code, the same kinds of expenses described in IRS Publication 502. Examples that matter for telehealth patients:

• Prescription medicines. The IRS defines a prescribed drug as one that requires a prescription by a doctor for its use by an individual. InsulinInsulin the hormone that moves sugar from the blood into the body's cells. also counts.
• Over-the-counter medicines and menstrual care products. For HSAs and FSAs these count whether or not they are prescribed. This is different from the itemized medical deduction on your tax return, where drugs that are not prescribed (other than insulin) do not count.
• Fees for medical care from doctors and other medical practitioners for diagnosis and treatment. Ask your administrator which documents it needs for a visit done by video or phone.

What usually does not count

• Medicines imported from other countries, unless they were imported legally, for example a drug the FDA announces individuals can legally import. A prescribed drug bought and used in another country counts only if it is legal in both that country and the United States.
• Vitamins and nutritional supplements, unless a medical practitioner recommends them as treatment for a specific condition diagnosed by a physician.
• Cosmetic procedures, gym or health club dues, and diet foods.
• Controlled substances that are not legal under federal law (such as marijuana), even if your state allows them.

Weight-related care: the IRS rule

IRS Publication 502 says amounts you pay to lose weight count only if the weight loss is a treatment for a specific disease diagnosed by a physician, such as obesity, hypertension or heart disease. They do not count if the purpose is appearance, general health or a sense of well-being. If your prescription or visit is for weight management, your HSA or FSA administrator may ask for extra documentation, such as a note from your prescriber about the diagnosis. Plans differ, so ask before you pay.

Telehealth and HSA eligibility: what changed

• Telehealth before the deductible. Public Law 119-21 (July 4, 2025) made permanent the rule that an HDHP may cover telehealth and other remote care before you meet the deductible, and that separate telehealth coverage does not stop you from contributing to an HSA. It applies to plan years beginning after 2024.
• Bronze and catastrophic plans. Since January 1, 2026, bronze and catastrophic plans are treated as HSA-compatible. IRS Notice 2026-05 says they do not have to be bought through an Exchange to qualify.
• Direct primary care. Since January 1, 2026, people in certain direct primary care arrangements may contribute to an HSA and may use HSA money tax-free for the periodic fees.

2026 limits

• HSA contributions: up to $4,400 with self-only HDHP coverage or $8,750 with family coverage, plus $1,000 more if you are 55 or older at the end of the year.
• HDHP: minimum deductible $1,700 (self-only) or $3,400 (family); maximum out-of-pocket $8,500 or $17,000.
• Health FSA: up to $3,400 in salary reductions; if your plan allows a carryover, up to $680.
• Medicare: from the first month you are enrolled in Medicare, you can no longer contribute to an HSA, but you can still spend the money already in it on qualified expenses.

The IRS updates these amounts every year.

Using HSA money for something else

If you take HSA money for anything other than qualified medical expenses, that amount is added to your taxable income and usually has an additional 20% tax. The additional tax does not apply to distributions after you become disabled, reach age 65 or die.

Keep good records

The IRS says you must keep records that show your HSA distributions were used only for qualified medical expenses, that those expenses were not paid or reimbursed from another source, and that you did not also deduct them on your tax return. You do not send these records with your return; keep them with your tax records. In practice, keep an itemized receipt that shows:

• the patient's name and the date;
• the pharmacy, doctor or clinic;
• what was bought or provided (for a prescription, the medicine and prescription number); and
• the amount paid.

An FSA often asks for these documents after you use the card or when you file a claim.

Step by step

• Ask the pharmacy or provider whether they accept HSA or FSA cards. If not, you can usually pay another way and ask your account to reimburse you.
• Ask for an itemized receipt every time.
• For weight-management care, medicines from outside the U.S. or anything unusual, ask your administrator before you pay.
• Do not claim the same expense twice (HSA or FSA plus a tax deduction or another reimbursement).
• Check your FSA deadline so you do not lose money at the end of the plan year.

Questions to ask your plan administrator

• Which documents do you need for a prescription or a telehealth visit?
• Do you need a note from my doctor for this treatment?
• Does my FSA have a grace period or a carryover, and what is the last day to file claims?
• Is my health plan HSA-compatible this year?

EKO Labs does not give tax advice. Our team can answer questions about your visit or prescription in Portuguese or English by phone.

Sources: IRS Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans (qualified medical expenses, over-the-counter medicines, recordkeeping, additional 20% tax and exceptions, Medicare, FSA grace period and carryover, 2026 HSA and HDHP amounts); IRS Publication 502 (2025), Medical and Dental Expenses (medicines, imported drugs, nutritional supplements, weight-loss programs, controlled substances); IRS news release IR-2025-119 and Notice 2026-05 (telehealth, bronze and catastrophic plans, direct primary care under Public Law 119-21); IRS 2026 inflation adjustments, Revenue Procedure 2025-32 (health FSA $3,400, carryover $680). Consulted October 2026. This guide is general information, not tax, legal or medical advice.