Can you use an HSA or FSA for massage therapy?

What the IRS rule says

HSA and FSA funds pay for medical care as IRS Publication 502 defines it: costs tied to diagnosing or treating a disease or condition. Publication 502 says expenses that are merely beneficial to general health don't qualify.

Massage isn't listed by name in Publication 502. It does say you can include therapy received as medical treatment, and that you can't include health club dues or amounts paid to improve your general health. The IRS uses the same line for gym memberships: they count only when bought for a specific medical purpose, not for general health.

• Likely not eligible: spa massages, relaxation or stress relief, massage memberships, general wellness.
• Possibly eligible: massage a physician prescribes for a specific illness, injury or condition, documented with a letter of medical necessity.

How a letter of medical necessity works

A letter of medical necessity (LMN) is a note from your clinician that ties an expense to a diagnosed condition. Plans that will consider massage often ask for one, and their rules differ.

1. See a clinician about the condition. For example, a back injury, a chronic pain condition or a condition your doctor is treating.
2. Ask for a letter that names the condition, explains how massage is part of the treatment, and gives how often and for how long.
3. Check your plan's form. Many administrators have their own LMN form and want it on file before or with your first claim.
4. Submit itemized receipts from the massage therapist with the date, service and amount.
5. Renew the letter when the treatment period on it ends.

A letter makes a claim possible, not certain. For an FSA, your plan administrator decides. For an HSA, you must keep records showing the expense qualified; a withdrawal that doesn't qualify is taxable and may carry an additional 20% tax.

Another way to pay for massage: a wellness budget

Most massage isn't covered by insurance or HSA rules, which is exactly what a Gabriel Care membership is built for. Care plans come with a monthly wellness budget for care insurance skips, massage included, shared by your household:

Gabriel finds and books massage and other holistic practitioners for you. The clinical portion of a Care membership may be HSA/FSA eligible (Emerald $99, Sapphire $159, Onyx $299); the wellness and concierge portion is not. Gabriel can provide an itemized statement, and you should check with your plan administrator or a tax advisor. Membership could also affect whether you can keep contributing to an HSA; see HSA for self-employed people.