HSA and FSA eligible claims in practice ads: what the IRS rules allow you to say

“HSA and FSA eligible” is a phrase patients look for, and practices add it to service pages, Google Ads and year-end emails because it answers a real question: can I pay for this from my health account? The answer depends on federal tax law, on the person’s own plan and on why they are getting the service, so a flat promise in an ad can be wrong for the reader even when it is right for someone else. This guide is for owners and marketing staff at independent medical, dental, med spa, chiropractic and integrative practices.

It covers what the tax code counts as medical care, the cosmetic and general wellness exclusions, the IRS warning about notes from doctors sold to turn personal purchases into medical ones, what changed for health savings accounts in 2025 and 2026, and how to word the claim so it stays true. The membership side of the 2025 law is in our direct primary care marketing guide, and price claims in general are covered in advertising cash prices for a medical practice. For year-end reminders about plan years, FSA grace periods and carryover, see our guide to year-end use your benefits campaigns.

The short version

• Eligibility follows the purpose, not the service name. An HSA or FSA can pay for medical care as defined in 26 U.S.C. 213(d): diagnosis, cure, mitigation, treatment or prevention of disease, or affecting a structure or function of the body.
• Cosmetic work is excluded. Section 213(d)(9) leaves out procedures aimed at appearance that do not meaningfully promote the proper function of the body, with narrow exceptions for deformity from a congenital abnormality, an accident or trauma, or a disfiguring disease.
• General wellness is excluded. The IRS says expenses that are merely beneficial to general health are not medical expenses, and it warned in 2024 that a note from a doctor based only on self-reported information does not change that.
• The plan decides too. A health FSA pays expenses specified in the plan, and the account holder is the one who answers to the IRS for HSA spending.
• Say “may be eligible” and point to the plan. An eligibility claim is a factual claim, and under FTC policy the practice needs a reasonable basis for it before it runs.

What the tax code counts as medical care

Both kinds of accounts borrow one definition. Section 223(d)(2) defines qualified medical expenses for an HSA as amounts paid for medical care as defined in section 213(d), to the extent not covered by insurance or otherwise. IRS Publication 969 says qualified medical expenses for a health FSA are those specified in the plan that would generally qualify for the medical and dental expenses deduction. So the starting point for any “eligible” claim is section 213(d)(1)(A): amounts paid for the diagnosis, cure, mitigation, treatment or prevention of disease, or for the purpose of affecting any structure or function of the body.

Publication 502 turns that definition into a list. For 2025 returns it includes, among other items, fees paid to a chiropractor for medical care, acupuncture, eye surgery to treat defective vision, and dental care to prevent and alleviate dental disease, naming cleanings, sealants, fluoride treatments, X-rays, fillings, braces, extractions and dentures. The IRS FAQ adds that a dental exam, an eye exam and a physical exam are medical expenses because each diagnoses whether a disease or illness is present, and that therapy to treat a diagnosed mental illness is a medical expense while marital counseling is not.

Publication 502 also lists what does not count. It says amounts paid to whiten teeth cannot be included, that health club dues cannot be included, and that dancing or swimming lessons cannot be included even when a doctor recommends them, if they are only for the improvement of general health. Over-the-counter medicines and menstrual care products are a special case: Publication 969 and the IRS FAQ say they can be paid from an HSA or FSA even though they are not deductible under section 213 unless prescribed, except insulin.

Cosmetic services and the 213(d)(9) exclusion

Section 213(d)(9) says medical care does not include cosmetic surgery or other similar procedures, defined as any procedure directed at improving the patient’s appearance that does not meaningfully promote the proper function of the body or prevent or treat illness or disease. The exception covers surgery or procedures necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury from an accident or trauma, or a disfiguring disease. Publication 502 gives face lifts, hair transplants, hair removal by electrolysis and liposuction as examples of procedures that generally cannot be included.

For a med spa or aesthetic practice, this means a blanket “HSA and FSA accepted” banner across the site sends the wrong message. A practice can accept an account’s payment card at the front desk, and the card may even work, but whether the expense qualifies is a separate question the card swipe does not answer. If a treatment your practice offers is used both for appearance and to treat a diagnosed condition, describe that difference on the page and say that eligibility depends on the reason for treatment and on the patient’s plan. Do not suggest that a patient can make a cosmetic visit eligible by mentioning a symptom.

Weight loss, nutrition, supplements and wearables

The IRS answers these in its FAQ on nutrition, wellness and general health, and in Publication 502. A weight-loss program is a medical expense only if it treats a specific disease diagnosed by a physician, such as obesity, diabetes, hypertension or heart disease. Nutritional counseling is a medical expense only if it treats a specific disease diagnosed by a physician. Supplements count only if a medical practitioner recommends them as treatment for a specific medical condition diagnosed by a physician. A gym membership counts only if bought for the sole purpose of affecting a structure or function of the body, such as a prescribed plan of physical therapy to treat an injury, or the sole purpose of treating a specific diagnosed disease.

Food is narrower still. The FAQ says food or beverages count only if they do not satisfy normal nutritional needs, they alleviate or treat an illness, and a physician substantiates the need, and even then only the cost above a product that meets normal nutritional needs counts. On September 23, 2026, the IRS added a question on wearable devices that track bodily functions. It says a device with both medical and nonmedical uses is not a medical expense merely because it tracks health information, and that it is one only if the person buys and uses it primarily to help diagnose, cure, mitigate, treat or prevent a specific disease. A generalized desire to monitor or improve health is not enough.

For weight-loss, integrative and functional medicine practices, the practical point is that the same program can be eligible for one patient and not for another. Our weight-loss clinic marketing guide covers the claims side of those programs.

Letters of medical necessity and the IRS warning

Plan administrators may ask for documentation before they pay a claim, and patients then ask the practice for a letter. Publication 969 says a health FSA participant must give the plan a written statement from an independent third party that the expense was incurred and its amount, and must keep records; for an HSA, the account holder must keep records showing that distributions paid qualified medical expenses that were not paid from another source. What a letter needs to say is set by each plan, so ask the patient what their plan requested.

On March 6, 2024, the IRS issued IR-2024-65 warning that companies were misrepresenting when food and wellness expenses can be paid from health accounts. It said that notes from doctors based merely on self-reported health information do not turn non-medical food, wellness and exercise expenses into medical expenses, because such a note does not show that the expense relates to a targeted diagnosis-specific activity or treatment. The release gives an example: a person with diabetes buys a paid “doctor’s note” to claim healthy food, and the claim is denied. It also says that plans paying non-medical expenses are not qualified plans, and that then all payments under the plan, even for real medical expenses, become taxable income to the participants.

A practice should write a letter only for a patient it has actually evaluated, for a specific diagnosed condition, describing the treatment and why it treats that condition. Do not sell letters as a product, do not advertise them as a way to use pre-tax money, and do not write one for a purpose the IRS lists as general health. If you are unsure whether your state treats issuing such a letter as part of the practice of medicine with its own documentation duties, ask your board or a health care attorney.

What changed for HSAs in 2025 and 2026

Pub. L. 119-21, enacted July 4, 2025, amended section 223 in three ways that practices hear about. It added section 223(c)(1)(E), so a direct primary care service arrangement that meets the definition is not treated as a health plan that blocks HSA contributions, for months beginning after December 31, 2025, and it added those fees to the list of expenses an HSA can pay. Our direct primary care guide covers the fee limits and the IRS questions and answers in Notice 2026-5.

The same law made permanent the rule in section 223(c)(2)(E) that a plan does not fail to be a high deductible plan because it has no deductible for telehealth and other remote care services; Publication 969 says the amendments apply to plan years beginning after 2024. None of these changes widened what counts as medical care under section 213(d). A practice that adds telehealth or a membership does not make its cosmetic or general wellness services eligible.

What a wrong claim costs the patient

Under section 223(f)(1), HSA money used exclusively for qualified medical expenses is not included in income. Under 223(f)(2) and (4), money used for anything else is included in income and, before the age set for Medicare eligibility and absent disability or death, is subject to an additional tax of 20 percent of that amount. For a health FSA, IR-2024-65 says the claim may simply be denied. In both cases the patient carries the result of an eligibility promise the practice made, which is why the claim belongs in the FTC’s frame for factual claims.

Section 5 of the FTC Act, 15 U.S.C. 45, prohibits deceptive acts or practices in commerce. The FTC Policy Statement on Deception looks at the net impression a claim leaves on a reasonable consumer, and the Policy Statement Regarding Advertising Substantiation says objective claims need a reasonable basis before they are made. “This service is HSA eligible” is an objective claim. A reasonable basis for it is a reading of section 213(d) and the current IRS publications for that specific service, not the fact that payment cards went through last year.

How to word eligibility on pages and ads

Put the qualifier in the same place as the claim. If an ad’s headline mentions health accounts, the ad itself should say “may be eligible” and the landing page should explain in one or two sentences what decides it. Keep cosmetic services off any list headed “eligible”. Link to IRS Publication 502 so the reader can check, and invite them to call their plan administrator. If the practice accepts account payment cards, say that as a payment method, separate from any claim about tax treatment.

Year-end emails reminding people that FSA money may expire are fine if they are accurate. Publication 969 says FSAs are generally use-it-or-lose-it plans, but a plan can provide a grace period of up to two and a half months or a limited carryover, so do not tell readers their balance will be lost on December 31. Say the money may expire depending on their plan’s rules and that they should check their plan.

Questions to ask before an eligibility claim runs

• Does this specific service diagnose, treat, mitigate or prevent a disease, or affect a structure or function of the body?
• Is any part of the service directed at appearance, and does it fall under the 213(d)(9) exclusion?
• Is the service listed, or listed as excluded, in the current Publication 502 or the IRS FAQ?
• Does eligibility depend on a diagnosis the patient may not have?
• Does the ad or page say “may be eligible” and point to the patient’s plan in the same place as the claim?
• Is the practice offering or selling letters that the IRS warning in IR-2024-65 describes?
• Does any year-end message assume a December 31 deadline that the reader’s plan may not have?

Use and avoid

• Use: “Medical services may be paid with HSA or FSA funds. Eligibility depends on your plan and the reason for treatment. Check with your plan administrator.” Avoid: “All services HSA and FSA eligible.”
• Use: “We accept HSA and FSA cards as a payment method.” Avoid: “Use your pre-tax dollars for [cosmetic treatment].”
• Use: “If your clinician diagnoses a condition this program treats, your plan may ask for documentation.” Avoid: “Get a doctor’s note so your FSA covers it.”
• Use: “FSA funds may expire depending on your plan’s rules.” Avoid: “Use it or lose it by December 31!” without the plan caveat.
• Use: a link to IRS Publication 502. Avoid: “IRS approved” or “HSA certified” badges, which no IRS program issues.

An illustration

This example is invented. [Practice name] in [Town] offers a medical weight-loss program, a skin clinic and chiropractic care. Its draft holiday email says “Spend your FSA before it disappears: all of it is HSA and FSA eligible!”

On review, the office manager rewrites it. The chiropractic paragraph says chiropractic care for medical purposes may be paid with HSA or FSA funds and links to Publication 502. The weight-loss paragraph says the program may be eligible when it treats a specific condition a physician has diagnosed and that the patient’s plan may ask for documentation. The skin clinic section drops the eligibility line and says the clinic accepts account cards as a payment method, with a note that cosmetic treatments are generally not eligible. The headline becomes “Check your FSA balance and your plan’s deadline.”

Checklist

• List each service you mention with health accounts and check it against section 213(d) and the current Publication 502.
• Keep cosmetic services out of any eligibility list unless an exception clearly applies to the patient.
• Say “may be eligible” in the same place as the claim, in ads and on pages.
• Point readers to their plan administrator and link to Publication 502.
• Write letters only after an actual evaluation, for a specific diagnosed condition, and never sell them.
• Check year-end messages for grace period and carryover wording.
• Keep a short file showing the basis for each eligibility claim and the date it was checked.

How we help

We build practice websites, local SEO, Google Ads and lead generation and an AI front desk for independent practices. For payment pages and ads, we write health account wording that says “may be eligible”, separates payment methods from tax claims, and links readers to the IRS and their plan. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. For the wider rules, see our healthcare marketing rules guide.

Sources

• 26 U.S.C. 213: Medical, dental, etc., expenses (213(d)(1) medical care, 213(d)(9) cosmetic surgery)
• 26 U.S.C. 223: Health savings accounts (223(c)(1)(E), 223(c)(2)(E), 223(d)(2), 223(f))
• IRS Publication 502, Medical and Dental Expenses, for 2025 returns (dated February 5, 2026)
• IRS Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans, for 2025 returns (dated February 11, 2026)
• IRS FAQ: Medical expenses related to nutrition, wellness and general health (last updated September 23, 2026)
• IRS news release IR-2024-65 (March 6, 2024): companies misrepresenting nutrition, wellness and general health expenses as medical care
• IRS Notice 2026-5: health savings account changes under Pub. L. 119-21
• 15 U.S.C. 45: Unfair methods of competition and deceptive acts or practices
• FTC Policy Statement on Deception
• FTC Policy Statement Regarding Advertising Substantiation

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