Can I use HSA/FSA funds for fitness equipment as a qualified medical expense?

Thanks for the info! So does the Letter of Medical Necessity need to specify the exact equipment (like "treadmill model XYZ") or just the type of exercise? Also, how long is the LMN valid for? Would I need to get a new one each year?

The letter doesn't need to specify the exact model, but it should indicate the type of equipment needed for your treatment. For example, "patient requires a treadmill for daily cardiovascular exercise to manage hypertension." Being specific about the type of equipment is important. The LMN is typically valid for the duration of the treatment plan. For chronic conditions requiring ongoing management, this could be a year or more, but it's always good practice to get it updated annually, especially if you're planning additional equipment purchases. Your HSA administrator might have specific requirements about LMN expiration, so check with them too.

Did you still need a formal Letter of Medical Necessity or was the doctor's recommendation enough? My doctor mentioned I should exercise more but didn't write anything official.

I'm a bit skeptical - can the service actually tell you for certain if something qualifies? I thought these decisions were ultimately made by the IRS if you get audited, not a third-party service.

The doctor's recommendation wasn't enough - I needed to get a formal Letter of Medical Necessity. The service helped me understand what specifically needed to be in the letter to meet IRS requirements, which was super helpful because my doctor initially just wrote a vague note. The service doesn't make final IRS determinations, you're right about that. What it does is analyze your situation against known IRS rules and previous letter rulings to give you guidance on likelihood of qualification. It identifies the documentation you need and helps you understand the risks. My HSA administrator ended up accepting everything based on the documentation approach the service recommended.

How does this actually work? Do they just call the IRS for you? Couldn't I just do that myself? Sounds like I'd still have to talk to the IRS anyway.

Yeah right. There's no way anyone's getting through to the IRS in 30 minutes. I've tried calling multiple times this tax season and couldn't get through after hours of waiting. Sounds like a scam to me.

They don't call the IRS for you - they use technology to secure your place in line. You register your number with them, and their system navigates the IRS phone tree and waits in the queue. When an agent is about to answer, they call you and connect you directly to the agent. You do the actual talking with the IRS yourself. I was super skeptical too! I had tried calling the IRS four separate times, waiting over an hour each time before getting disconnected. But with Claimyr, I got connected in about 22 minutes. It's not instant, but way faster than trying yourself. They can't control how busy the IRS is, but they can hold your place in line so you don't have to listen to that hold music for hours.

Did your doctor specify the exact type of bike, or just that you needed one for rehab? My doc just wrote that I need "cardiovascular equipment" which seems too vague.

My doctor specified "recumbent exercise bicycle" rather than a specific brand or model. The important part was that he explained why that specific type of equipment was medically necessary - in my case, the recumbent position was crucial for proper spinal alignment during recovery. "Cardiovascular equipment" does sound too vague. Ask your doctor to be more specific about what type of equipment would best address your particular medical condition. The letter should connect your diagnosis to the specific equipment and explain why it's necessary for treatment, not just beneficial for general health.

That's a good point. I wonder if there's a way to demonstrate the "but for" test? Like if you have a home gym already but need a specific piece of equipment for medical reasons that you wouldn't otherwise buy?

Thanks for bringing this up! I actually have both an HSA and an FSA and wasn't sure which would be better to use for this. I'll definitely check with my FSA administrator first then. Do you know if the documentation requirements are different between the two?

The documentation requirements are generally similar for both - you need the Letter of Medical Necessity that clearly connects your medical condition to the specific equipment. The main difference is timing and approval process. With an FSA, you typically submit the documentation for pre-approval before purchase, and they'll tell you definitively if it qualifies. With an HSA, you make the determination yourself at the time of purchase, keep all documentation, and only need to justify it if questioned during an audit. Many people find FSAs more restrictive but appreciate the certainty of pre-approval, while HSAs offer more flexibility but with more personal responsibility.

This is incredibly helpful! I'm new to using HSA funds for medical equipment and wasn't aware of how specific the documentation needs to be. Quick question - if my doctor writes the letter but doesn't include one of those four elements you mentioned, can I ask them to revise it, or do I need to start over completely? Also, is there a standard format that doctors typically use for these Letters of Medical Necessity, or does each practice kind of do their own thing?

You can definitely ask your doctor to revise the letter - most physicians are willing to update medical necessity letters when you explain what specific elements are needed. It's much easier than starting over completely. There isn't really a standard format that all doctors use, which is part of the problem. Some practices have templates they've developed over time, while others just write freeform letters. This is why so many letters end up being too vague for HSA/FSA purposes. What I usually recommend to patients is to provide your doctor with a brief outline of what needs to be included (those four elements I mentioned), so they know exactly what the IRS is looking for. Many doctors appreciate the guidance since they want to help their patients but aren't always familiar with the specific tax requirements for medical equipment purchases. If your doctor seems hesitant to revise the letter, you might mention that this is for tax-qualified medical expenses and that the IRS has specific documentation requirements. Most physicians understand the importance of proper medical documentation once they realize it's for tax compliance purposes.

That's a really smart financial perspective that I hadn't considered! The long-term opportunity cost of using HSA funds now versus saving them for retirement is definitely something to think about. I'm curious though - if someone has a chronic condition that requires ongoing equipment replacement or upgrades over time, would that change the calculation? For instance, if someone with a back condition needs to replace their medical exercise equipment every few years due to wear from daily use prescribed by their doctor, the HSA savings might add up more significantly over time. Also, for people who are already maxing out other retirement accounts, using HSA funds for legitimate medical equipment might still make sense even with the opportunity cost, especially if the alternative is paying for gym memberships or other fitness solutions with after-tax dollars indefinitely. What's your take on those scenarios?