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Eligible HSA Expenses: Exploring the Grey Area
HSA Massage Rules
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When looking at HSA dollars and how to spend them, it’s important to consider how one expense can be qualified and another similar expense is not.  A good example of the grey area in the otherwise "black vs. white", "yes vs. no", "qualified vs. non-qualified expense" HSA world we live in, would be “massage”.

Massage therapy appears nowhere in the long list of eligible HSA expenses that the IRS provides.  But in certain, clearly defined circumstances it can become an eligible expense from your health savings account.  Consider the following scenario:

Sally was involved in a fender bender.  After the accident she went to her chiropractor, got an adjustment and got back to daily life.  She worked through the first few days after the wreck just fine, but after 4 days the real pain set in.  She went to her general practitioner to be examined. 

He could see that nothing was broken, but the impact of the accident had left her with a twisted muscle in her lower back.  The pain was exacerbated by Sally’s desk job.  Dr. Smith wrote Sally a prescription for two therapeutic massages, knowing they would aid her recovery. 

HSA Prescription Requirements
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Therapeutic massage/body work is similar to relaxation massage, but it is more concentrated on correcting things like strained muscles and repetitive use injuries.  Dr. Smith saw massage as a viable option for Sally, to both ease her pain and speed healing.  He knew that two visits would help get the back muscle to relax and get her back into the swing of things.  With the doctor’s prescription, Sally was able to use her HSA dollars.  She also made sure that she had a very good paper trail in the case of an audit by the IRS. 

If Sally had not gone to see Dr. Smith and instead went to a spa/massage center in her neighborhood, she could not use her HSA funds to pay for her treatment.  The doctor’s prescription is the key.  Unless a procedure is deemed medically necessary, you cannot use your HSA funds to pay for it. 

Dr. Smith made the call.  His prescription made Sally’s massage treatment a qualified HSA expense.  Sally put her prescription for two therapeutic massages into her HSA folder and matched the receipts.  She was careful not to misuse funds.  Perfect!

Navigating HSA Rules
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Massage is a great example of one of those vague and tricky areas that may or may not be an eligible HSA expense, based on a few very important factors.  The golden rule if you’re ever in doubt, is to get a prescription from your doctor for whatever medicine or procedure you’re questioning.

The moral of the story is that when you’re navigating the grey area of qualified HSA expenses, it’s always in your best interest to make sure you use your HSA funds correctly.  This isn’t always easy, so please keep in mind there are several resources to help you determine whether or not a certain expense will be deemed eligible for funds from your health savings account. 

First, you can check the official IRS position on the issue by consulting IRS Publication 502.  We know that’s a little tedious to read through, so you can easily visit our webpage on Eligible HSA Expenses and use our convenient dropdown features to help you quickly find what you’re looking for.  But if you want a quick and easy answer, you can always contact our office and we would be more than happy to answer any questions you may have on the matter. 

Let us know what you think in the comments below, and share this post with others who have health savings accounts to help them out!

Be smart and safe with your HSA and as always, we look forward to hearing from you!


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Posted by HSA Admin at 6/20/2013 7:06:00 PM
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