Open enrollment is running at most employers right now, and Medicare's window opens October 15. A rule change took effect for 2026 that widens who can fund a health savings account. Bronze and catastrophic marketplace plans now count as HSA-compatible coverage (Source: IRS Notice 2026-05).
So more households will be eligible to fund one. Most people assume an HSA covers office visits, prescriptions, and whatever the deductible eats, then pay for everything else out of checking with after-tax dollars. However, the IRS test is broader than that. An expense qualifies if it is primarily for the diagnosis, treatment, cure, mitigation, or prevention of disease. Here are some of the things that clear that bar and still surprise some people:
1. Dental work and orthodontia, plus glasses, contacts, and LASIK
2. Chiropractic care, physical therapy, and acupuncture
3. Therapy and counseling
4. Hearing aids and the batteries for them
5. Over-the-counter medicine, which stopped requiring a prescription in 2020
6. Sunscreen of SPF 15 or higher, menstrual products, and first aid supplies
7. Mileage driven to and from medical appointments
8. Grab bars, a wheelchair ramp, and similar home modifications when they are medically necessary
Insurance premiums are usually not eligible, with four exceptions. COBRA qualifies, and so does health coverage you pay for while collecting unemployment. Long-term care premiums qualify up to an age-based cap, which for 2026 is $1,860 for ages 51 to 60, $4,960 for 61 to 70, and $6,200 above 70. Once you turn 65, your Medicare Part B, Part D, and Medicare Advantage premiums are eligible as well, though Medigap never is. At $202.90 a month for standard Part B in 2026 (Source: CMS), that last one is the largest recurring reimbursement most retirees will have.
One really interesting part of these accounts is that there is no deadline for reimbursing yourself. An expense you paid out of pocket in 2019, as long as it came after you opened the account, can be reimbursed in 2040, with the balance growing tax-free in the meantime. The requirements are that you never deducted it on Schedule A, never got reimbursed for it from another source, and can document it years later if asked. Keep the receipts somewhere you will actually find them, whether that is a folder in your cloud storage or a running spreadsheet.
Happy Planning,
Alex
This blog post is not advice. Please read disclaimers.