Using your HSA or FSA

1. The rule in one paragraph

Under IRS Publication 502, a qualified medical expense is an amount paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for treatment affecting a structure or function of the body. Two things follow from that. First, the expense has to be tied to a medical condition, not to general wellbeing or convenience. Second, anything directed at improving appearance without meaningfully improving bodily function is explicitly excluded, no matter who performs it.

That single test explains every line in the table below.

2. Service-by-service

Charge	Generally qualifies?
Initial consultation ($250) Physician evaluation of your symptoms and history	Yes
Follow-up visit ($150) Physician care for an identified condition	Yes
Discovery call Free, so nothing to reimburse	N/A
Prescription medication Paid to the pharmacy, including GLP-1 medication prescribed for a diagnosed condition	Yes
Smoking or alcohol cessation care Programmes and prescription medication	Yes
Menopause, sleep, and sexual health care Evaluation and treatment of symptoms	Yes
Monthly membership fee ($150) Bundles clinical visits with access and community benefits	Partly, at best. See section 3
Botox® for cosmetic purposes Smoothing lines and wrinkles	No. See section 5
Member social events, seminars, workshops Community benefits, not medical care	No

"Generally qualifies" means the expense fits the IRS definition in the ordinary case. Your plan administrator still has the final say on your account, and some administrators are stricter than the IRS requires.

3. Why membership is complicated

You may have seen that from 1 January 2026, federal law allows HSA funds to be used for Direct Primary Care membership fees, up to $150 a month for an individual. That change is real, but it is narrower than the headlines suggest, and we do not claim it applies to us. The statutory definition requires the arrangement to provide primary care services only, and it specifically excludes arrangements that provide prescription drugs other than vaccines. Finding Her MD is a specialty wellness practice, not primary care, and medication management is central to what we do.

Setting that provision aside, the older and more general rule still governs: a retainer that buys access, availability, and community benefits is not a medical expense, because it is not payment for the treatment of a condition. Where a membership fee bundles access with actual clinical services, only the portion attributable to clinical care can reasonably be treated as qualifying.

What that means for you in practice:

• If you want to use HSA or FSA funds with confidence, pay per visit rather than by membership. A $150 follow-up visit is a clean, documented medical expense.
• If you prefer membership, ask us for an itemised statement showing the visits provided during the period. We will produce one on request.
• Confirm with your plan administrator before submitting a membership charge. Do not assume.

We would rather tell you this plainly than let you find out at tax time.

4. Weight-management medication

Medication prescribed for a diagnosed condition is a qualified expense. Weight-loss treatment specifically qualifies when it is prescribed by a physician to treat a specific disease, such as obesity or a condition made worse by weight, rather than for general health or appearance.

In our practice, GLP-1 medication is prescribed after a physician evaluation and for a documented clinical indication, which is the condition the IRS test turns on. Keep the pharmacy receipt and, if your administrator asks for it, ask us for a letter of medical necessity. See section 6.

Note that this is a separate question from whether your health insurance covers the medication. Those are two different systems with two different sets of rules, and the answer to one tells you nothing about the other. How medication billing works →

5. Why Botox is different

The tax code excludes cosmetic procedures from qualified medical expenses. A procedure is cosmetic if it is directed at improving appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease.

Botox® Cosmetic, used to soften lines and wrinkles, falls squarely inside that exclusion. It does not qualify, and paying for it from an HSA creates a tax liability plus a penalty. Please use a regular card for aesthetic treatments.

Botulinum toxin used to treat a diagnosed medical condition is treated differently under the same rule, but that is a different treatment from the aesthetic service on our price list, and it would need to be documented as such.

6. Letters of medical necessity

Some administrators ask for a letter of medical necessity before reimbursing a charge. It is a short note from your physician stating the condition being treated, the treatment, and why it is medically appropriate.

We will write one at no charge for any care we have actually provided and any condition we have actually diagnosed. Ask through the contact form or, once it is live, the patient portal. We will not write a letter to make a cosmetic treatment look medical.

7. Receipts and records

You receive an itemised receipt for every payment, showing the date, the service, and the amount. Keep it. HSA and FSA reimbursements can be audited years later, and the burden of showing that an expense qualified sits with the account holder.

If you need a duplicate receipt or a statement covering a date range, ask and we will send it.

8. Questions to ask your plan

Four questions will resolve almost every case. Ask your plan administrator:

• Do you reimburse physician consultation fees from a practice that does not bill insurance?
• Do you reimburse a monthly medical membership fee, and if so do you require it to be itemised by visit?
• Do you require a letter of medical necessity for prescription weight-management medication?
• What documentation do you want on the receipt?

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