Can you use an HSA or FSA for a hormone test?

Many readers ask whether a hormone test can be paid for with a health savings account (HSA) or a flexible spending account (FSA). The short answer is that it often can, but two things decide it: whether the test counts as a qualified medical expense under the rules, and whether the seller’s checkout takes your card.

We are not tax advisers. Use this page to know what to ask.

What the IRS says about lab tests

IRS Publication 502 covers medical expenses for tax purposes. It says you can include amounts you pay for laboratory fees that are part of medical care, and amounts you pay for an annual physical examination and diagnostic tests by a physician. It defines medical expenses as the costs of diagnosing, treating or preventing disease. It says they do not include expenses that are merely beneficial to general health. IRS Publication 502

The wording leaves a gap. A test you buy yourself, with no physician involved, is not clearly addressed. Publication 502 also says medical care expenses must be primarily to alleviate or prevent a physical or mental illness or disability, so the reason you are testing may matter. Whether your plan accepts it is your plan’s call.

HSA rules in short

IRS Publication 969 says that, for an HSA, qualified medical expenses are amounts the account holder pays for medical care. If you take money out of an HSA for something that isn’t a qualified medical expense, you pay tax on it, and an additional 20% tax can apply. (Publication 969 says there is no additional tax on withdrawals after you are disabled, reach age 65 or die.) You must keep records showing that withdrawals were only for qualified medical expenses. You don’t send those records with your tax return. IRS Publication 969

FSA rules in short

For a health FSA, Publication 969 says qualified medical expenses are those specified in the plan that would generally qualify for the medical and dental expenses deduction. That means your employer’s plan document sets the list within the IRS rules, and plans differ. Ask your plan administrator for its list of eligible expenses and what proof it wants.

Whether the seller takes your card

Paying with an HSA or FSA debit card at checkout is a separate matter from eligibility. It depends on the seller’s payment system. The seller’s pages that we use for facts do not state whether it accepts HSA or FSA cards, so we don’t say it does. Check at checkout, and ask your plan administrator before you pay.

Some other services state on their own pages that they accept HSA or FSA cards. Our comparison pages for lab-based services and at-home kits record what each says.

Questions to ask your plan

• Does my plan cover a lab test I order myself, or only one a clinician orders?
• Do I need a letter or note from a clinician?
• What receipt do you need?

Before you buy, check that the service is available in your state. See where testing is unavailable, and how the process works in walk-in labs.