Financial Health

HSA/FSA Longevity Guide

Which longevity interventions are tax-advantaged? A practical breakdown of what qualifies, what doesn't, and how to maximise your health savings accounts.

What are HSA and FSA accounts?

Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) are US tax-advantaged accounts that let you pay for qualified medical expenses with pre-tax dollars — effectively giving you a 22–37% discount on healthcare depending on your tax bracket. Both require a qualifying high-deductible health plan (HDHP) in the case of an HSA, while FSAs can accompany most employer health plans.

The key difference: HSA money rolls over indefinitely and can be invested like a retirement account. An FSA is generally use-it-or-lose-it within the plan year (with a small grace period or $640 carryover option, depending on your employer). For longevity-focused individuals, the HSA is the more powerful long-term tool.

Feature	HSA	FSA
2025 contribution limit (individual)	$4,300	$3,300
2025 contribution limit (family)	$8,550	$6,600 (combined)
Rolls over year to year	Yes — forever	No (use-it-or-lose-it)
Can be invested	Yes — triple tax advantage	No
Requires HDHP	Yes	No
Employer can contribute	Yes	Yes
Available without employment	Yes (if you have HDHP)	No
Can reimburse past expenses	Yes — no time limit	No — must use in plan year

Clearly eligible

These items are unambiguously eligible for HSA/FSA reimbursement. Buy them with your HSA/FSA card directly, or pay out of pocket and save receipts for reimbursement.

Prescription medications

Metformin, statins, blood pressure meds, etc.

Lab blood panels

Any diagnostic test ordered by a physician — ApoB, CBC, metabolic panel, lipids, hormones.

DEXA scan (bone density)

Widely covered when ordered for osteoporosis risk assessment.

VO2max testing

Covered when ordered diagnostically for cardiovascular assessment.

Continuous glucose monitors (CGM)

Now generally eligible following CARES Act expansion; confirm with your HSA administrator.

Blood pressure monitors

OTC home blood pressure cuffs are clearly eligible.

Pulse oximeters

Eligible as medical devices.

CPAP supplies

Machine, masks, filters, and distilled water.

Sunscreen SPF 15+

Eligible since the CARES Act (2020). Must be labelled as sunscreen.

First aid supplies

Bandages, antiseptics, gauze, thermometers.

Mental health services

Therapy, psychiatry, and prescription mental health medications.

Dental and vision care

Exams, cleanings, glasses, contacts — eligible for HSA, often excluded from standard FSA.

Gray area — may be eligible with a Letter of Medical Necessity

These items are not automatically eligible, but can become eligible when a physician provides a Letter of Medical Necessity (LMN) linking the expense to a specific diagnosed medical condition. Ask your doctor — many will write LMNs for appropriate patients. Keep the letter with your tax records.

Vitamin D (prescription or Rx-grade)

OTC vitamin D is NOT eligible. If your doctor prescribes it for a diagnosed deficiency (common), it becomes eligible.

Omega-3 / fish oil (prescription only)

Vascepa (icosapent ethyl) and Lovaza are FDA-approved Rx drugs — clearly eligible. OTC fish oil capsules are NOT eligible.

Testosterone therapy

Eligible when prescribed by a physician for diagnosed hypogonadism.

Red light therapy devices

Eligible with a Letter of Medical Necessity (LMN) from your doctor for a specific diagnosed condition (e.g., wound healing, skin condition).

Sauna (home or membership)

May be eligible with an LMN for specific medical conditions (chronic pain, cardiovascular rehabilitation). Not eligible for general wellness.

Specific OTC supplements prescribed by a doctor

If a physician writes a prescription or LMN for a supplement to treat a diagnosed condition, it may become eligible. Requires documentation and varies by HSA administrator.

Function Health, Inside Tracker, or similar panels

If ordered through a physician or as a diagnostic service, typically eligible. Direct-to-consumer wellness panels without physician involvement are a gray area.

Genetic testing (e.g., for hereditary disease risk)

Medically ordered genetic tests for disease risk (BRCA, APOE) are generally eligible. Consumer ancestry/wellness tests are not.

Not eligible

The IRS requires that eligible expenses treat, prevent, or diagnose a specific medical condition. General wellness supplements do not qualify, even if they are evidence-based.

OTC NMN / NR supplements

Not eligible — considered a supplement, not a medical expense.

OTC resveratrol, quercetin, berberine

Not eligible without a prescription and diagnosed condition.

OTC magnesium, zinc, B-complex

Not eligible even though they are widely used for health.

OTC fish oil / omega-3 capsules

Ineligible — only the Rx versions (Vascepa, Lovaza) qualify.

Gym memberships (general fitness)

Not eligible in most cases. Exception: occasionally covered with physician LMN for obesity treatment — very rare.

Vitamins A, C, E (OTC)

General vitamins without a prescription are not eligible.

Collagen, creatine, protein powder

Not eligible — classified as food/supplement, not medicine.

Consumer epigenetic age tests

TruAge, Elysium Index, etc. — not eligible as they are wellness, not diagnosis.

Cosmetic procedures

Botox, fillers, and cosmetic surgery are not eligible. Reconstructive surgery following an injury may be.

Strategy: maximise HSA for longevity

1. Prioritise lab testing

Lab panels are clearly eligible and provide the highest information value of anything you can spend health dollars on. Use your HSA to cover ApoB, Lp(a), fasting insulin, testosterone panel, and anything else your doctor orders. Function Health and similar services may qualify when ordered through a physician.

2. Get prescriptions for Rx-eligible forms

Vitamin D supplements aren't eligible, but prescription vitamin D (Drisdol, 50,000 IU capsules) is. OTC fish oil isn't eligible, but Vascepa (icosapent ethyl) is an FDA-approved Rx drug that is. Ask your doctor whether the Rx form of a supplement you take makes sense for you.

3. Get LMNs for borderline items

If you use a red light therapy device for wound healing or a sauna for chronic pain management, ask your physician to document the medical necessity. Many will do this if you have a legitimate condition. Keep the letter permanently — the IRS has no time limit on audits for HSA misuse.

4. Invest your HSA — don't spend it

HSA is the only account with triple tax advantage: contributions are pre-tax, growth is tax-free, and withdrawals for medical expenses are tax-free. If you can afford to pay medical expenses out of pocket, do so — and let the HSA grow invested. You can reimburse yourself for any eligible expense years or decades later with no deadline.

5. Stack HSA + limited-purpose FSA

If you have an HSA, you can also open a Limited-Purpose FSA (LPFSA) through your employer for dental and vision expenses. This lets you use both accounts simultaneously — keeping your HSA invested while the LPFSA covers near-term dental and vision costs.

6. Use FSA for predictable annual expenses

FSA is use-it-or-lose-it, so model your expected eligible spending each year carefully. Annual blood panels, dental cleanings, vision exams, prescription meds, and sunscreen are all predictable. Load your FSA to match those known costs and avoid the end-of-year panic.

Eligible lab tests worth prioritising

These are HSA/FSA-eligible (when physician-ordered) and provide actionable longevity intelligence that most standard annual physicals miss.

Test	Why it matters	Est. cost	Insurance
ApoB	Superior cardiovascular risk marker vs. LDL-C. Should be on every adult's annual panel.	$20–50 out of pocket; often included in lipid panels.	Usually covered when ordered diagnostically.
Lp(a) — Lipoprotein(a)	Genetically determined cardiovascular risk. Test once — levels are largely fixed.	$30–60 out of pocket.	Increasingly covered; confirm with insurer.
hsCRP — high-sensitivity C-reactive protein	Systemic inflammation marker. Predicts cardiovascular and all-cause mortality risk.	$15–30 out of pocket.	Widely covered.
Homocysteine	Elevated levels linked to cardiovascular, cognitive, and all-cause mortality risk. Modifiable with B vitamins.	$20–40 out of pocket.	Often covered.
HbA1c	3-month average blood glucose. Essential for catching pre-diabetes early.	Often included in standard panels.	Routinely covered.
Fasting insulin	Much earlier warning sign of insulin resistance than HbA1c alone.	$15–40 out of pocket.	Sometimes covered; often needs physician justification.
Vitamin D (25-OH)	Deficiency is extremely common and linked to immune, bone, cardiovascular, and cognitive outcomes.	$20–50 out of pocket.	Covered when ordered for deficiency screening.
Vitamin B12	Low levels cause neurological symptoms; especially important for vegans and metformin users.	Usually included in micronutrient panels.	Generally covered.
Total testosterone + free testosterone	Low testosterone in men accelerates multiple ageing pathways. Women benefit from testing too.	$40–80 out of pocket for full panel.	Covered when symptoms present.
Thyroid panel (TSH, free T3, free T4)	Thyroid dysfunction is common, under-diagnosed, and highly treatable.	Usually included in standard panels.	Routinely covered.
DEXA scan (body composition)	Gold-standard measurement of lean mass, fat mass, and bone density. Tracks sarcopenia risk.	$50–150 out of pocket.	Covered for bone density; body composition coverage varies.
Ferritin + iron panel	Iron overload is common in men and post-menopausal women; associated with oxidative stress.	$20–40 out of pocket.	Generally covered.

Costs are estimates and vary significantly by lab, location, and insurance. Use GoodRx, DirectLabs, or Ulta Lab Tests to find discounted out-of-pocket pricing.

Disclaimer

HSA and FSA eligibility rules are set by the IRS and can change. Individual plan administrators may interpret eligibility differently. This guide is for informational purposes only and does not constitute tax or financial advice. Confirm eligibility with your HSA administrator before submitting a claim. Consult a qualified tax professional for advice specific to your situation. Last updated for 2025 contribution limits.