Can I use my FSA/HSA for gym membership?

Using exercise to prevent or reverse an illness? Here's how to get a Letter of Medical Necessity online to use your HSA/FSA dollars for fitness fees.
A curvy Black woman wearing gym clothes and a hair wrap and a muscular white woman wearing gym clothes stand close together, laughing, resting against a well of a gym.

Key points:

  1. Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) allow you to save pre-tax dollars you can use to pay for eligible medical expenses.
  2. Gym membership and fitness class fees do not immediately qualify as eligible HSA/FSA expenses. But they may qualify if a provider recommends that you exercise to prevent or treat a medical condition.
  3. For fitness expenses to qualify for HSA/FSA reimbursement, a provider must write a Letter of Medical Necessity detailing why exercise prevents or treats a specific medical condition. Qualifying patients may be able to get a Letter of Medical Necessity online with a Dr. B consultation.

We don’t need medical studies to show that regular exercise benefits us.

But scores of research show that physical activity can prevent or reverse conditions like hypertension, diabetes, chronic pain, erectile dysfunction and more. Fitness can also support brain health. And it improves mood and self-esteem for those with mental health issues.

If you’re exercising to prevent or treat a condition, you may be able to pay for fitness fees with funds from your Health Savings Account (HSA) or Flexible Spending Account (FSA). Paying with these funds means you won’t pay income tax on the money you spend on gym memberships or fitness class fees.

But to get coverage, you need a Letter of Medical Necessity from a licensed provider.

Here’s more about how to use HSA/FSA accounts for exercise expenses. Plus, how Dr. B may be able to help qualifying patients get a Letter of Medical Necessity online with a $15 consultation.

What is HSA and FSA?

Health Savings Accounts (HSA) and Flexible Savings Accounts (FSA) allow you to set aside pre-tax dollars you can use to pay for qualified medical expenses.

FSA and HSA tax benefits mean you won’t pay income tax on funds you use for health-related items. Unused HSA funds immediately carry over from one year to the next, and you won’t pay tax on any interest these funds accrue. So HSA/FSA funds offer excellent tax advantages, especially for people with regular care needs and those who stay on top of routine care.

What’s the difference between HSA and FSA?

Both HSA and FSA accounts allow you to set aside pre-tax funds you can use to pay for qualifying medical expenses. The IRS determines the differences between HSA and FSA accounts—including how much of your income you can put into them yearly. But there are two primary differences to consider when looking to set up an HSA or FSA account.


Health Savings Accounts are available to those with a high-deductible health plan—including those who get coverage through the Health Insurance Marketplace.

Flexible Spending Accounts are only available as an employee benefit—meaning you can open one if offered by your employer. Sometimes, an employer will match or add a percentage of employee contributions as an incentive.

HSA/FSA “rollover” funds

Unused HSA funds immediately “roll over” from one year to another so that you can save untaxed dollars for future medical needs.

Unused FSA funds get forfeited back to your employer. Some employers extend a “grace period” where you can use those funds for a few months in the next year. They may also set up their FSA plan so a portion of the remaining funds roll over. (For 2024, the maximum amount you can roll over is $610.)

What can I use my HSA/FSA card for?

You can use FSA/HSA funds to pay for copays, deductibles and prescription drug costs. Other HSA-eligible expenses and FSA-qualified expenses include:

  • Over-the-counter medications
  • Menstrual products
  • Dental care
  • Eye care
  • Substance abuse programs
  • Acupuncture
  • Covid-19 prevention (like masks and at-home tests)
  • Chiropractic care
  • Ambulance costs
  • Hearing, mobility and service animal aids
  • Therapy, psychological or psychiatric care
  • Long-term needs like home improvements

How you can use HSA for gym membership

Medical expenses are goods and services that prevent or alleviate a physical or mental illness or disability. Things that benefit general health don’t qualify. That means gym memberships and fitness class fees are not immediately eligible for coverage. But if a physician recommends exercise to prevent or treat a condition, they become eligible for coverage by HSA/FSA funds.

Covered medical conditions include:

  • Arthritis
  • Autoimmune disease
  • Back pain
  • Balance and coordination issues
  • Cancer 
  • Chronic fatigue
  • Cognitive decline disorders like dementia and Alzheimer’s
  • Diabetes
  • Erectile dysfunction
  • Fatty liver disease
  • Fibromyalgia
  • Gout
  • Heart disease
  • High blood pressure
  • High cholesterol
  • Kidney disease
  • Mental health conditions like depression + anxiety
  • Migraines
  • Obesity + heavier weight
  • Osteoporosis
  • Polycystic ovary syndrome
  • Pre-diabetes  
  • Physical injury
  • Respiratory diseases
  • Sleep disorders
  • Stroke

For fitness expenses to qualify, your provider must write a Letter of Medical Necessity explaining why they recommend exercise as a treatment for a condition. You can then file receipts for fitness purchases made on/after the date on that letter for HSA/FSA reimbursement.

What is a Letter of Medical Necessity?

A Letter of Medical Necessity is a document explaining why an expense is medically necessary for preventing or treating your condition.

Eligible items because of medical necessity include:

  • Physical therapy after an injury
  • Iron supplements for anemia
  • Blood sugar test kits for those with diabetes
  • Exercise to improve heart health for those with hypertension
  • Fitness classes to reduce pain for those with osteoarthritis

Regarding fitness, the letter explains why the expense meets HSA/FSA guidelines. To make sure you get fitness fees paid for or reimbursed by HSA funds, you’ll want to save your letter and any applicable receipts for three years.

How do I get fitness fees reimbursed by my HSA/FSA administrator?

Once you have your Letter of Medical Necessity, here’s how to get gym membership and fitness fees reimbursed by HSA/FSA funds.

  1. Make your fitness purchase: Buy or renew a gym membership, class, personal training session or other fitness expense—and save your receipts.
  2. Find your HSA/FSA administrator: HSA and FSA funds are managed by plan administrators. If you’re not sure who your FSA manager is, contact your employer's HR department.
  3. Go to your administrator’s website: Login to your HSA/FSA administrator's website and locate their 'Reimbursement' or 'Claims' section.
  4. Submit your Letter of Medical Necessity and receipts: Upload your letter and relevant receipts.
  5. Wait for reimbursement: It may take a few days (or weeks) for your administrator to review your claim and deposit your reimbursement amount into your account.
  6. Submit forms come tax time: You don’t need to submit additional forms for purchases made with FSA funds. (Unless you use funds to pay for the expenses of a dependent.) For HSA purchases, your administrator will send you Form 1099-SA during tax season. Use the information on that form to fill out Form 8889 with your federal income tax filing. Additionally, your HSA administrator will submit Form 5498-SA for you.

Banner advertising Dr. B's services for letter of medical necessity for fitness

Can I get a Letter of Medical Necessity online?

Qualifying patients may be able to get a Letter of Medical Necessity online with a $15 Dr. B consultation.

To find out if you qualify, complete a short health assessment about the conditions you’re trying to prevent or reverse. A licensed health provider will review your information. If eligible, they’ll email you a Letter of Medical Necessity detailing your condition and why the requested items qualify as HSA/FSA-eligible expenses.

Your letter is valid for 12 months from the date you received it. You may be able to file repeated expenses—like monthly gym membership fees—with the same letter as long as you’re within those 12 months. And when it’s time for a new letter? Dr. B will be here for you!


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

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

IRS. (2022). Health savings accounts and other tax-favored plans.

Mahindru, A., et al. (2023). Role of physical activity on mental health and well-being: A review. Cureus.

Ruegsegger, G. N., et al. (2018). Health benefits of exercise. Cold Spring Harbor Perspectives in Medicine.

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