Can I use my HSA or FSA to pay for massage therapy?

Key Points

1. Rehabilitation therapies like massage can be transformational for healing from injuries or managing the pain of a chronic illness.
2. Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) let you reserve pre-taxed funds to pay for qualified medical expenses. However, rehabilitation therapies only qualify under FSA or HSA withdrawal rules if a licensed provider documents the connection in a Letter of Medical Necessity.
3. With Dr. B, you can skip the waiting room and take a convenient $15 online medical consultation with a licensed provider. If you qualify, they’ll email a Letter of Medical Necessity to your inbox within one day—often within hours!

When you’re ill or injured, a world of treatments can help you recover, heal or feel your best. But paying for those treatments can be a challenge—especially if your health insurance does not cover them and is costly out of pocket.

Paying with tax-free funds from a Health Savings Account (HSA) or Flexible Spending Account (FSA) can save you up to 40% off fees, empowering you to manage your healthcare costs more effectively.

But it’s not as easy as swiping your FSA or HSA card at the checkout stand—you need a Letter of Medical Necessity confirming the service treats your injury or illness.

Here, we’ll guide you through the specifics, providing the support and reassurance you need.

Plus, we'll show you how you may be able to get a Letter of Medical Necessity online with a $15 medical consultation from Dr. B.

First, what is an HSA/FSA?

Health Savings and Flexible Spending accounts are tax-advantaged accounts that let you save funds to pay for healthcare expenses that won’t be subject to income tax. That means they help reduce your taxable income, giving you more money to pay for medical services and items that can help improve your health and quality of life!

Here are some details and differences between them:

Health Savings Account:

ELIGIBILITY: To open an HSA, you must have a high-deductible health plan (HDHP) that specifies the minimum amount of money you must pay before the plan covers costs. For 2025, individual plans must have a deductible of at least $1,650 and family plans at least $3,300. The maximum you can pay out of pocket annually is $8,300 individually or $16,600 as a family. You can have this insurance plan through your work or purchase it privately.

HOW TO OPEN: You can open an HSA with any financial institution that offers them. Research online, ask the bank you use if they provide one, or find out if your insurer has HSA partners. Your HSA provider will then be referred to as your HSA administrator.

YEARLY DEPOSIT LIMIT: In 2025, single people can deposit up to $4,300 into their HSA, and families can deposit up to $8,550.

HSA WITHDRAWAL RULES: Many people use their HSA to pay for their insurance premiums, doctor copays, prescriptions and over-the-counter medications. But you can also use them for eye exams, glasses, dental care and more.

HOW TO USE: Your HSA administrator may give you an HSA debit card, which you can swipe at your doctor’s office, pharmacy and elsewhere. Otherwise, you can pay for the item or service with other methods and submit the receipt for HSA reimbursement.

UNUSED FUNDS: Leftover HSA funds stay in your account from one year to the next and can incur interest. Financial institutions offer varying interest rates. So, if you plan to open an HSA, compare rates before doing so!

TAX FILING: During tax season, your HSA administrator will send you a copy of Form 1099-SA. Use it to complete Form 8889, which you must submit with your annual tax return.

Flexible Spending Account:

ELIGIBILITY: FSAs are only available if you get your health insurance through your job and your employer offers one as a benefits program.

HOW TO OPEN: Your employer’s HR department can help you opt into their FSA—if they offer one—and the institution will be your FSA administrator. You may need to file specific documents through your office’s HR department.

YEARLY DEPOSIT LIMIT: In 2025, you can contribute up to $3,200 from your payroll income into your FSA. (Married partners can each contribute that amount.) Some employers match their employees’ contributions as an extra incentive to care for your health!

FSA WITHDRAWAL RULES: You can use your FSA for doctor copay visits, prescription drug costs and OTC medicines. Ambulance rides, dental work, oral care, crutches, Covid-19 tests, and more are also covered.

HOW TO USE: You may be given an FSA debit card. You may also be able to make an online account with your FSA administrator, where you can file receipts and get them reimbursed from your FSA account. Or you may have to file receipts with your employer’s HR department. They’ll fill you in on the details of your particular plan!

UNUSED FUNDS: Unused FSA funds are forfeited to your employer at the end of each year. But employers can opt to do one of two things: give you two-and-a-half months to use the funds or roll over a set amount you can use the following year. (The maximum amount they can roll over in 2025 is $660.) They don’t have to do either, though. So make sure you’re aware of what’s in your account as the year ends!

TAX FILING: If you only use your FSA funds on yourself, you won’t need to file any yearly tax forms. (But save your medical receipts, just in case!) If you used your FSA to pay for any dependent’s health needs, you must file Form 2441.

When can you use FSA/HSA for massage?

To qualify as a medical expense, an item or service must prevent or alleviate an illness, injury or disability. Things that benefit our general health don’t qualify.

For example, if we exercise because we know it’s good for our overall health and wellness, our fitness costs are not medical expenses. But if exercise helps us treat a diagnosed heart condition, mental health issue, high BMI or other condition, our HSA/FSA funds may foot the bill for a gym membership, personal training cost or fitness class.

Similarly, rehabilitation therapy fees only qualify if a licensed provider specifies in a Letter of Medical Necessity that the therapy treats or alleviates a condition or injury. This document ensures that the treatment—and related costs—meet HSA/FSA guidelines.

Covered medical conditions include (but are not limited to):

• Back pain
• Chronic pain/syndrome
• Fibromyalgia
• Disc degeneration or disorder
• Multiple sclerosis
• Muscle spasms
• Post-traumatic stress disorder
• Stress
• Sleep disorder

Can I get a Letter of Medical Necessity online?

If you have an injury or condition that rehabilitation therapy can treat or manage, Dr. B may be able to help you get a Letter of Medical Necessity online to save on fees!

1. Take a consultation: Take a $15 online chat consultation with Dr. B. A licensed provider will review your information. If you qualify, they’ll email your letter within 1 day.
2. Get/take your service: Pay for your massage or other rehab service, and save your receipt!
3. Submit your letter and receipt: Find your HSA/FSA administrator online. Log into/create an account. Locate their 'Reimbursement' or 'Claims' section. Upload your Letter of Medical Necessity and related receipts.
4. Wait for reimbursement: Your administrator may take a few days or weeks to finalize your claim and transfer funds from your HSA/FSA account into your chosen bank account.
5. Repeat with new receipts: Your letter will specify how many treatments you can take for a particular period. For example, a provider will recommend 24 massages within 12 months. Before filing, check with your administrator—you may be able to submit all your expenses for reimbursement in one go, or you may have to repeat the submission process every time you make a massage purchase. (If the latter, you can do so with the same letter for all purchases made within the 12 months.)

Want to find out if you qualify for a Letter of Medical Necessity? Start a consultation today!\ \ Sources:

Folks, Jason. IRS bumps up 2025 FSA contribution limits. HealthEquity.

Health Insurance Marketplace. What’s a health savings account?

IRS. Frequently asked questions about medical expenses related to nutrition, wellness, and general health.

IRS. (2024). Publication 969: Health savings accounts and other tax-favored health plans.

IRS. (2023). Publication 502: Medical and dental expenses.

IRS. (2024). Healthcare FSA reminder: Employees can contribute up to $3,300 in 2025; must elect every year.