What is HSA eligible?

The IRS rule in one line

An HSA pays for medical care under section 213(d) of the tax code, the same definition IRS Publication 502 explains. Medical care must be primarily to alleviate or prevent a physical or mental illness or disability. Publication 502 excludes expenses that are merely beneficial to general health.

So the question is never just "what is it?" but "why am I buying it?" The same item can qualify for one person with a diagnosed condition and not for someone buying it for general wellness.

What is usually HSA eligible

• Visits: fees to doctors and other practitioners, including chiropractors and psychologists, and an annual physical even when you aren't sick.
• Acupuncture: Publication 502 lists it by name. See can you use an HSA for acupuncture.
• Prescriptions and insulin: prescribed medicines and drugs, plus insulin.
• Over-the-counter medicines and menstrual care products: the IRS says HSAs, FSAs and HRAs may pay for these.
• Lab fees that are part of medical care.
• Therapy received as medical treatment, and treatment programs for substance use disorders.
• Eyeglasses, contact lenses, hearing aids and wheelchairs, and transportation for medical care.
• Weight-loss programs for a specific disease diagnosed by a physician, such as obesity, hypertension or heart disease.
• Direct primary care fees, starting in 2026 (IRS Notice 2026-5). See HSA and direct primary care.

What usually isn't

• Vitamins and supplements taken for general health. They can qualify only when a medical practitioner recommends them for a specific diagnosed condition. See are vitamins HSA eligible.
• Gym and health club dues paid to improve general health.
• Cosmetic procedures, with narrow exceptions for deformities from a congenital abnormality, injury or disfiguring disease. Teeth whitening is excluded.
• Diet food, except special food a physician says is needed for an illness, and then only the cost above normal food.
• Most health insurance premiums. HealthCare.gov notes HSA money generally can't pay premiums.
• Diapers (unless needed for a particular disease) and funeral costs.

Common surprises

• Wearables: in September 2026 the IRS said a fitness or sleep tracker isn't a medical expense just because it tracks health data. It can qualify when bought and used primarily for a specific disease. See is WHOOP HSA eligible and is the Oura Ring HSA eligible.
• Massage, IV drips and wellness services: these depend on a documented medical reason, often with a letter of medical necessity. See HSA for massage and HSA for IV therapy.
• Exercise a doctor recommends for general health still doesn't qualify, the IRS says. A program bought solely to treat a diagnosed disease can.
• You can't double dip. Amounts paid from an HSA can't also be deducted as a medical expense on your return.

If you take HSA money for something that isn't a qualified medical expense, that amount is taxable and IRS Publication 969 says an additional 20% tax applies. Keep itemized receipts and any clinician letter with your tax records.

Gabriel and your HSA

With Gabriel Core or Plus, the clinical portion of membership may be HSA/FSA eligible ($39 of Core's $49 monthly price, or $69 of Plus's $89); the wellness and concierge portion is not. Gabriel can provide an itemized statement. Check with your plan administrator or a tax advisor before you pay with HSA funds.

Paying with HSA money is different from being allowed to contribute to an HSA. Membership could affect whether you can keep contributing (IRS Notice 2026-5), so ask a tax advisor. See HSA for self-employed people.