Can I use my FSA/HSA for gym membership?

Key points:

1. Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) let you reserve pre-tax dollars for eligible medical expenses.
2. Fitness fees do not always 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 your medical condition. 

We don’t need medical studies to show that regular exercise benefits our general health.

But scores of research show that physical activity can prevent or help manage specific medical conditions. These include high blood pressure, back pain, high cholesterol, heavy weight, heart disease and mental health issues.

And so if you exercise to prevent or treat a condition, you may be able to save on related fitness fees by using funds from your Health Savings Account (HSA) or Flexible Spending Account (FSA). But you can only unlock those savings if you have the Letter of Medical Necessity from a licensed provider.

Here, we’ll explain how to get a Letter of Medical Necessity 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’s the difference between 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. By reducing your taxable income, they help you save money for health-related items. So HSA/FSA funds offer excellent tax advantages, especially for people with regular care needs and those who stay on top of routine care.

This Dr. B article explains the differences between the two accounts in detail. But here are two primary differences.

Availability

Health Savings Accounts: HSAs are available to those with a High-Deductible Health Plan (HDHP). These plans include high deductibles you must pay before the insurer covers any health costs and specify the most you’ll spend out of pocket annually. If you qualify, you can set up an HSA with any bank or financial institution that offers them. For 2025, individuals can deposit up to $4,300 into their HSA, and families can deposit up to $8,550.

Flexible Spending Accounts: FSAs are only available if an employer creates an account and offers it to employees as a benefit plan. That means you can only save with one if it’s arranged by your employer. For 2025, individuals can contribute up to $3,300 to their FSA funds. Sometimes, an employer matches or adds a percentage of their employee contributions as an incentive.

HSA/FSA “rollover” funds

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

Flexible Spending Accounts: 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 employees may rollover a portion of their remaining funds to use in the following year. For 2025, the maximum amount you can roll over is $660.

How can I use FSA/HSA for gym memberships and fitness expenses?

You can only use HSA and FSA funds for medical expenses—*goods and services that prevent or alleviate an illness, injury or disability. Things that benefit *general health don’t qualify. Because exercise benefits general wellness, related costs do not immediately qualify.

However, if a physician recommends exercise to prevent or treat a condition, gym memberships, personal training sessions, trackers, fitness apps and class fees may be paid for with HSA/FSA funds.

Qualifying 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

But for fitness expenses to qualify, a provider must write a Letter of Medical Necessity explaining why they recommend exercise as a treatment for a condition.

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 an injury, illness or other 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.

Can I get a Letter of Medical Necessity online?

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

To find out if you qualify, complete a short health assessment about the condition you’re trying to manage, 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 receive it. As long as you’re within those 12 months, you may be able to file repeated expenses—like monthly gym membership fees—with the same letter.

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

Here’s how to get fitness fees reimbursed by HSA/FSA funds.

1. Make your purchase: Buy or renew a gym membership, class, app, personal training session or other fitness expense—and save your receipt.
2. Find your HSA/FSA plan administrator: Find your HSA provider’s information through the financial institution that set up your HSA. Contact your employer's HR department if you don’t know who your FSA administrator is. 
3. Access your administrator's web service: Set up a new account or use your login details to access your HSA or FSA administrator's online platform.
4. Locate their 'Reimbursement' or 'Claims' section: Find the dedicated area that handles reimbursements or claims.
5. Submit your letter and receipts: Upload your Letter of Medical Necessity and the fitness product or service receipt. Purchases must be made on or after the date of your letter.
6. Wait for your claim to be processed: Your administrator may take a few days or weeks to review and process your claim. Once confirmed, they’ll deposit the reimbursement amount into your specified account. 
7. Submit tax forms: You don’t need to submit additional tax forms for 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. 

What else 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

Sources:

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

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

Internal Revenue Service. (2023). Publication 969: Health savings accounts and other tax-favored plans.

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

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