What Can You Pay For With Your HSA? (Including Primary Care in 2026)
A Health Savings Account (HSA) lets you pay for a wide range of healthcare costs with pre-tax dollars. Here’s the practical picture — including what 2026 added.
The long-standing qualified expenses
HSAs have always covered a broad set of qualified medical expenses, including things like:
- Doctor and hospital visits, and your deductible/coinsurance
- Prescription medications
- Dental care (cleanings, fillings, and more) and vision care (exams, glasses, contacts)
- Many medical supplies and equipment
- Lab work, imaging, and a long list of treatments
The IRS defines the full list; some everyday items qualify and some don’t, so it’s worth checking specifics.
What 2026 added: direct primary care
The headline change for 2026 is direct primary care (DPC). Beginning January 1, 2026, a qualifying DPC membership fee is an HSA-qualified expense — up to $150/month for an individual or $300/month for a family — and joining a qualifying DPC arrangement no longer disqualifies your HSA contributions. This is the rule this whole site is about; the 2026 pillar guide covers it in full.
Common things HSAs don’t cover
A few notable exclusions:
- Most health-insurance premiums (there are limited exceptions, e.g., COBRA, certain Medicare premiums, and coverage while receiving unemployment).
- Cosmetic procedures that aren’t medically necessary.
- General health items that aren’t for a specific medical condition.
- Employer-paid DPC fees — the DPC benefit only applies when paid from your own HSA, not by an employer or through a pre-tax cafeteria plan.
The tax advantage, briefly
The reason this matters: HSA contributions are pre-tax (or deductible), the balance grows tax-free, and withdrawals for qualified expenses are tax-free. Using it for newly-qualified primary care means paying for a service you’d buy anyway with untaxed dollars.
As always, confirm specifics against the IRS guidance and your tax advisor — and read the 2026 DPC rules and limits for the part that’s new.
Frequently asked questions
What does an HSA cover?
Qualified medical expenses — things like doctor visits, prescriptions, dental and vision care, many medical supplies, and, as of 2026, qualifying direct primary care membership fees up to the caps. Some expenses (like most insurance premiums) are excluded.
Is direct primary care newly covered by HSAs?
Yes. Beginning January 1, 2026, a qualifying direct primary care fee is an HSA-qualified expense, up to $150/month for an individual and $300/month for a family, paid from your own HSA.