Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) are tax-advantaged accounts that can be used to pay for qualified medical expenses. HSAs can be set up individually or through an employer. Health FSAs are set up through an employer. Ask your HR department about any accounts available through your employer. To contribute to an HSA, you generally must have an eligible high-deductible health plan and meet other eligibility requirements. HSA funds do not expire. FSA elections usually occur during your employer’s open enrollment period for the following plan year. FSA funds generally expire at the end of the plan year, though some plans allow a carryover or grace period. HSAs and FSAs are U.S. tax-advantaged accounts. Self-employed individuals can have an HSA if they qualify, but cannot have a health FSA.

HSA/FSA accounts allow individuals to use pre-tax money to pay for qualified medical expenses. Under tax rules, these may include expenses for treating, mitigating, or preventing a diagnosed medical condition. Because HSA/FSAs use pre-tax money, you’re getting more purchasing power for your dollars. Rather than pay taxes on income and then spend it on qualified medical expenses, eligible individuals can use pre-tax funds. For 2026, HSA contribution limits are $4,400 for self-only coverage or $8,750 for family coverage, plus an additional $1,000 if you are at least 55 years old. Individuals can contribute up to $3,400 pre-tax to their health FSA for 2026. Your savings depend on your tax rate.

To determine whether certain products or services qualify under tax rules as medical expenses for treating, mitigating, or preventing a diagnosed medical condition, HSA/FSA plan administrators often require a letter from a licensed practitioner. This letter is called a “Letter of Medical Necessity.” A letter does not automatically make a purchase eligible for HSA/FSA funds.

You may be able to use your HSA/FSA card. After you pay and complete the survey, a licensed practitioner will review it and may issue a Letter of Medical Necessity if appropriate. If you receive one, hold onto it for the next 3 years.

If you prefer to use your regular credit card, you are welcome to do that and we will send you instructions for how to submit for reimbursement from your administrator.

Generally it takes 24-48 hours. If you aren’t seeing your letter in your inbox, check spam, then reach out to support@truemed.com for help!

If you do not qualify, you are able to reapply for HSA/FSA spending at a later date. Reach out to support@truemed.com if you have any questions.

You can occasionally request a split invoice from the merchant that you are making a purchase from, but like your normal bank account, you generally need to have the funds to cover the purchase to avoid a rejection.

Please contact team@truemed.com so TrueMed can help you troubleshoot the issue. HSA/FSA plan administrators often have detailed requirements, so it may be as simple as re-issuing your Letter of Medical Necessity using the administrator’s form.

For most Americans, open enrollment is in the last four months of the year, though timing varies by employer. You can elect to increase your FSA contributions during this time for the following plan year. Your full yearly FSA election is available from the start of the plan year, even before all payroll contributions have been made. With an HSA, you can only spend what has been deposited so far. Funds may be used only for qualified medical expenses under tax rules. A licensed practitioner’s recommendation does not automatically make a purchase eligible. If you contribute through payroll, contributions are generally deducted from your paycheck before tax withholding throughout the year.