What a health savings account can and cannot pay for

A health savings account (HSA) is only available with a qualifying high-deductible health plan. Money goes in pre-tax, grows tax-free, and comes out tax-free for eligible medical costs. That triple tax treatment is why people treat an HSA as a long-term account, not just a debit card. Eligible costs include deductibles, prescriptions, dental, vision, and many over-the-counter items. Cosmetic procedures, most gym memberships, and premiums for a regular employer plan are not eligible. The IRS publishes the list; your card issuer’s “approved” filter can be narrower or wider than the law. Keep receipts. If you invest the HSA and pay medical bills from a checking account, you can reimburse yourself years later. Without a receipt, that withdrawal becomes taxable income plus a penalty if you are under 65. Contribute enough to hit the annual limit only after the emergency fund and the 401(k) match are funded. An HSA invested in a target-date fund can sit for decades, but only if you can pay today’s doctor bills from cash.