HRA eligible expense tool
A complete list of expenses eligible for reimbursement with an HRA. Use our interactive table to quickly filter through HRA eligible expenses from IRS Publication 502 and the CARES Act.
Ready to offer an HRA to your employees?
Expenses eligible for reimbursement with an HRA
A health reimbursement arrangement (HRA) allows employers to reimburse employees for various medical expenses listed in IRS Publication 502, which includes more than 200 eligible expenses. The type of HRA you have determines the eligibility of expenses.
For example, if you have a qualified small employer HRA (QSEHRA) or an individual coverage HRA (ICHRA), your organization can reimburse you for your individual health insurance premiums. But if you have an integrated HRA, also known as a group coverage HRA (GCHRA), your health plan premiums aren’t eligible for reimbursement. However, you may submit your copayments, coinsurance, and deductible amounts for reimbursement.
While the IRS initially prohibited employers from reimbursing employees tax-free for some medical items, the CARES Act expanded eligible items to include over-the-counter medicines without a prescription and menstrual care products in 2020.
With an HRA, you can purchase the expenses that make sense for you and your family’s health. Check out our interactive list below to see what medical services and items are eligible for reimbursement to get the most out of your health benefit.
PeopleKeep makes launching and managing an HRA more accessible and intuitive for employers by automating the most time-consuming tasks and providing award-winning customer support to employees.
HRA expense eligibility guide
The items on this list are subject to change based on changes in federal regulations. Employers can further limit which expenses they can reimburse employees for.
✔ : Items that are eligible for reimbursement
✔ RX : Items that are eligible with a prescription from your doctor
✔ NOTE : Items that are eligible with a note from your doctor
X : Items that aren't eligible for reimbursement
|
Expense |
Eligible |
HSA Compatible |
Tags |
| Acid controllers | ✔ | X | |
| Acne medicines and treatments | ✔ | X | Over-the-counter, medications, over the counter, OTC |
| Acupuncture | ✔ | X | Alternative |
| Adoption (associated medical expenses) | ✔ | X | |
| Adoption fees | X | X | |
| Alcoholism treatment | ✔ | X | therapy, rehabilitation, alcoholics |
| Allergy and sinus medicine and products | ✔ | X | Over-the-counter, medications, over the counter, OTC, pills |
| Alternative dietary supplements | ✔ NOTE | X | |
| Alternative healers | ✔ NOTE | ✔ NOTE | |
| Ambulance and emergency health services | ✔ | X | transportation |
| Anesthesia for dental treatments | ✔ | ✔ | surgery, operation |
| Anesthesia for medical treatments | ✔ | X | surgery, operation |
| Anesthesia for vision treatments | ✔ | ✔ | surgery, operation |
| Antacid | ✔ | X | Over-the-counter, medications, over the counter, OTC, Pharmacy, Prescription |
| Antibiotic ointment | ✔ | X | Over-the-counter, medications, over the counter, OTC, Pharmacy, Prescription |
| Artificial limb | ✔ | X | Prosthetics |
| Anti-diarrheal medicine | ✔ | X | Over-the-counter |
| Anti-itch products | ✔ | X | Itch, over-the-counter |
| Aspirin or other pain reliever | ✔ | X | Over-the-counter, medications, over the counter, OTC, pills |
| Asthma medicines or treatments (over-the-counter) | ✔ | X | contraceptive, contraception |
| Baby bottles | X | X | |
| Baby oil | X | X | |
| Baby rash ointment | ✔ | X | |
| Bandages and related items | ✔ | X | |
| Birth control (over-the-counter) | ✔ | X | contraceptive, contraception, |
| Blood pressure monitor | ✔ | X | |
| Body scans | ✔ | X | hospital, doctor, x-ray |
| Braille books and magazines (additional amount only) | ✔ | ✔ | vision |
| Breast enhancement | X | X | |
| Breastfeeding classes | ✔ | X | Maternity, lactation, breastfeeding, nursing |
| Breast pumps & accessories | ✔ | X | Maternity, lactation, breastfeeding, nursing |
| Breast reconstruction surgery (following mastectomy) | ✔ NOTE | X | operation |
| Cancer insurance premiums (Premiums are only reimbursable with a QSEHRA or ICHRA, not a GCHRA) | X | X | accident, sickness, illness, lump-sum, lump sum, indemnity |
| Canker and cold sore treatments (over-the-counter) | ✔ | X | Over-the-counter, medications, over the counter, OTC, medicine |
| Car modifications | ✔ NOTE | X | Transport, Transportation, wheelchair, handicap, disability |
| Childbirth classes (charges for mother only) | ✔ | X | Maternity, lamaze |
| Child or newborn care instruction | X | X | Maternity |
| Chiropractic care | ✔ | X | Chiropractor |
| Cholesterol test kits and supplies | ✔ | X | |
| Christian Science practitioners | ✔ | X | |
| COBRA premiums (COBRA premiums are only reimbursable with a QSEHRA, not an ICHRA or a GCHRA) | ✔ | ✔ | Insurance, policy, MEC |
| Cold and flu medicine | ✔ | X | Over-the-counter, medications, over the counter, OTC, medicine |
| Compression or anti-embolism socks, stockings, or hose | ✔ NOTE | X | |
| Concierge medical fees for future services | X | X | |
| Concierge medical fees for services received | ✔ | X | |
| Contact lenses and solutions | ✔ | ✔ | Vision, eye, glasses |
| Contraceptives | ✔ | X | Over-the-counter, medications, over the counter, OTC, prescription |
| Cord blood storage | ✔ NOTE | X | |
| Cord blood storage (for unidentified future use) | X | X | |
| Corn and callus remover | ✔ | X | Over-the-counter, medications, over the counter, OTC, prescription |
| Corneal keratotomy | ✔ | ✔ | Vision, eye, myopia, nearsightedness |
| Cosmetic procedures for birth defects or injury | ✔ NOTE | X | reconstructive, operation, surgery |
| Cosmetic procedures or surgery | X | X | |
| Cost of meals while attending medical conferences | X | X | |
| Cotton swabs | X | X | |
| Cough drops and sore throat lozenges | ✔ | X | Over-the-counter, medications, over the counter, OTC, |
| Cough syrup | ✔ | X | Over-the-counter, medications, over the counter, OTC, prescription |
| Counseling (marriage) | X | X | therapy |
| CPR classes | X | X | education |
| Dancing lessons | X | X | |
| Dental and oral pain products (over-the-counter) | ✔ | ✔ | tooth |
| Dental care (non-cosmetic) | ✔ | ✔ | Dentist, teeth, tooth, copay, co-pay, dentist, xrays, x-rays |
| Dental insurance premiums (Premiums are only reimbursable with a QSEHRA or ICHRA, not a GCHRA) | ✔ | ✔ | policy |
| Dental products for general health | X | X | teeth, tooth |
| Dental surgery | ✔ | ✔ | surgery, teeth, dentist, implants |
| Dental veneers | ✔ NOTE | ✔ NOTE | Dentist, teeth, tooth |
| Dentures, bridges, etc. | ✔ | ✔ | Dentist, Dental, teeth, tooth |
| Dependent care expenses (medical) | ✔ | X | |
| Dermatologist | ✔ | X | skin |
| Dermatology products | ✔ NOTE | X | skin care |
| Diabetic monitors and supplies | ✔ | X | diabetes |
| Diaper rash creams (over-the-counter) | ✔ | X | newborn, pediatric, ointment |
| Diapers and diaper services | X | X | newborn, pediatric |
| Dietary supplements | ✔ NOTE | X | |
| Dietitian/nutrition services | ✔ NOTE | X | |
| Doctor-supervised weight loss program, such as for hypertension or heart disease | ✔ NOTE | X | Obesity |
| Doctor visits (medical) | ✔ | X | health, doctor, co-pay, copay |
| Doula or birthing coach | ✔ NOTE | X | Maternity |
| Drug addiction treatment | ✔ | X | therapy, rehab, rehabilitation |
| Drugs imported and FDA-approved | ✔ | X | prescriptions, RX |
| Drugs imported and not FDA-approved | X | X | prescriptions, RX |
| Drugs purchased and consumed in another country that are legal in that country and the U.S. | ✔ | X | prescriptions, RX |
| Drugs and medicines (over-the-counter drugs) | ✔ | X | prescriptions, rx, Over-the-counter, medications, over the counter, OTC, pills |
| Dyslexia treatment | ✔ NOTE | X | therapy, rehab, rehabilitation, mental health |
| Ear drops and wax removal (over-the-counter) | ✔ | X | Over-the-counter, medications, over the counter, OTC |
| Electrolysis | X | X | cosmetic |
| Exercise equipment | ✔ NOTE | X | weight loss, weight-loss, obesity |
| Eye drops and treatments | ✔ | ✔ | Over-the-counter, medications, over the counter, OTC, vision |
| Eye examinations | ✔ | ✔ | Vision, office visit |
| Eyeglasses (prescription) | ✔ | ✔ | Vision, glasses, contacts |
| Eye-related equipment/materials | ✔ | ✔ | Vision |
| Eye surgery or treatment | ✔ | ✔ | Vision, operation |
| Facelifts | X | X | Cosmetic |
| Face masks for COVID-19 protection | ✔ | ✔ | For COVID-19 |
| Feminine hygiene products (see menstrual care products below) | ✔ | ✔ | |
| Fertility monitor | ✔ | X | pregnancy |
| Fertility treatment | ✔ | X | |
| Fiber supplements | ✔ | X | |
| First aid kits | ✔ | X | bandages, bandaids |
| Fitness programs | ✔ NOTE | X | wellness, obesity, weight loss, weight-loss, exercise |
| Fluoride treatments | ✔ | ✔ | Dental, Teeth, Dentist |
| Flu shots | ✔ | ✔ | Preventive, vaccine, immunization |
| Foam rollers (for pain relief) | ✔ | X | |
| Funeral expenses | X | X | |
| Guide dog (dog, training, care) | ✔ | ✔ | Vision |
| Hair regrowth products | X | X | Cosmetic |
| Hair removal | X | X | Cosmetic |
| Hair transplant | X | X | Cosmetic |
| Hair treatments | X | X | Cosmetic |
| Hand lotion | X | X | Over-the-counter, medications, over the counter, OTC |
| Hand sanitizer and sanitizing wipes for COVID-19 protection | ✔ | ✔ | For COVID-19 protection |
| Health club dues | ✔ NOTE | X | wellness, obesity, weight loss, weight-loss, gym |
| Health insurance premiums (Premiums are only reimbursable with a QSEHRA or ICHRA, not a GCHRA) | ✔ | ✔ | policy, medical insurance, MEC |
| Health savings account (HSA) contributions | X | X | |
| Hearing aids and batteries | ✔ | X | |
| Herbal or homeopathic medicines | ✔ NOTE | X | over-the-counter |
| Home modifications | ✔ NOTE | X | wheelchair ramp, lift, inclinator |
| Hospital insurance premiums (Premiums are only reimbursable with a QSEHRA or ICHRA, not a GCHRA) | X | X | indemnity, lump-sum, lump sum |
| Hospital services and fees | ✔ | X | ER, emergency room |
| Household help | X | X | |
| Humidifier, air filter and supplies | ✔ NOTE | X | allergy, allergies, cold, asthma |
| Immunizations | ✔ | ✔ | Vaccines, preventive, wellness |
| Incontinence supplies | ✔ | X | diapers, adult diapers |
| Infertility treatment | ✔ | X | fertility |
| Insulin, testing materials and supplies | ✔ | X | Diabetes |
| In vitro fertilization | ✔ | X | fertility |
| Laboratory fees | ✔ | X | Lab, tests |
| Lactation items and devices (for convenience) | X | X | bra, bras, tank top, maternity, breastfeeding, nursing |
| Lactose intolerance medication | ✔ | X | Over-the-counter, medications, over the counter, OTC, pills |
| Lamaze classes (charges for mother only) | ✔ | X | Maternity, childbirth, pregnancy |
| Laser / LASIK eye surgery | ✔ | ✔ | Vision |
| Late payment fees | X | X | |
| Laxatives/stool softeners | ✔ | X | Over-the-counter, medications, over the counter, OTC, pills |
| Learning disability treatments | ✔ | X | therapy |
| LED light therapy treatments | ✔ | X | therapy |
| Lice treatment (over-the-counter) | ✔ | X | Over-the-counter, medications, over the counter, OTC |
| Listening therapy | ✔ | X | hearing |
| Lodging for dental or vision care | ✔ | ✔ | hotel, motel, room |
| Lodging for medical care | ✔ | X | hotel, motel, room |
| Long-term care premiums (Premiums are only reimbursable with a QSEHRA or ICHRA, not a GCHRA) | ✔ | ✔ | policy, insurance |
| Long-term care services | X | X | |
| Magnetic therapy | ✔ NOTE | X | Alternative, Over-the-counter, medications, over the counter, OTC |
| Massage therapy | ✔ NOTE | X | Alternative |
| Mastectomy-related special bras | ✔ | X | breast, reconstructive |
| Maternity clothes | X | X | |
| Meals at a hospital or similar institution (if the principal reason for being there is to receive medical care) | ✔ | X | |
| Medicaid/CHIP insurance premiums (Premiums are only reimbursable with a QSEHRA or ICHRA, not a GCHRA) | ✔ | ✔ | policy, MEC |
| Medical abortion | ✔ | X | |
| Medical diagnostic services | ✔ | X | |
| Medical equipment and repairs | ✔ | X | |
| Medical literature, books, pamphlets, or audio | X | X | Education |
| Medical monitoring and testing devices | ✔ | X | |
| Medical operations | ✔ | X | surgery |
| Medical records charges | ✔ | X | |
| Medical X-ray fees | ✔ | X | Hospital, Doctor, x-rays, xrays |
| Medicare Part A, Part B insurance premiums (Premiums are only reimbursable with a QSEHRA or ICHRA, not a GCHRA) | ✔ | ✔ | policy, MEC |
| Medicare supplement insurance premiums (Premiums are only reimbursable with a QSEHRA or ICHRA, not a GCHRA) | ✔ | ✔ | policy, MEC |
| Menstrual care products (tampons, pads, liners, cups, sponges, and other similar products) | ✔ | ✔ | Tampons, pads, liners, cups, sponges, and other products |
| Mental health counseling | ✔ | X | therapy |
| Midwife | ✔ | X | Maternity, childbirth |
| Modified equipment (extra cost only) | ✔ NOTE | X | capital expense, improvement |
| Monitors and test kits | ✔ | X | Over the counter, Over-the-counter, OTC |
| Motion sickness medication | ✔ | X | Over the counter, Over-the-counter, OTC |
| Multiplan insurance premiums (Premiums are only reimbursable with a QSEHRA or ICHRA, not a GCHRA) | ✔ | ✔ | policy, health, vision, prescription, dental, medical, MEC |
| Nasal sprays | ✔ | X | RX, Over the counter, Over-the-counter, OTC, medication, nose, prescription |
| Nasal strips | ✔ | X | RX, Over the counter, Over-the-counter, OTC, medication, nose, prescription |
| Norplant insertion or removal | ✔ | X | birth control, contraceptive |
| Nursing services (wages and taxes) | ✔ | X | Nurse |
| Nutritional supplements | ✔ NOTE | X | Over the counter, Over-the-counter, OTC, medication, vitamins |
| OB/GYN fees | ✔ | X | Doctor, Hospital, Childbirth, Maternity, wellness |
| Occlusal guards to prevent teeth grinding | ✔ | ✔ | Dental, Dentist |
| Occupational therapy (for medical / disability) | ✔ | X | rehabilitation, rehab |
| Optometrist or ophthalmologist fees | ✔ | ✔ | Vision, eye, office visit |
| Organ transplants (recipient and donor) | ✔ | X | Hospital |
| Orthodontia (braces and retainers) | ✔ | ✔ | Dental, Dentist, teeth |
| Ortho keratotomy | ✔ | ✔ | Vision |
| Orthopedic and surgical supports | ✔ | X | equipment, braces |
| Orthopedic shoes and inserts | ✔ NOTE | X | |
| Orthotics | ✔ | X | |
| Ovulation monitor | ✔ | X | Fertility, Maternity, Pregnancy |
| Oxygen | ✔ | X | CO2 |
| Physical exams | ✔ | ✔ | Wellness, Preventive |
| Physical therapy | ✔ | X | rehabilitation |
| Physical therapy supplies | ✔ | X | |
| Physician retainer fee | X | X | |
| Pregnancy tests | ✔ | X | Maternity, pregnancy, fertility, childbirth |
| Premium tax credits (the portion of insurance premiums that tax credits cover) | X | X | |
| Prescription drugs | ✔ | X | Rx, medicine, pharmacy, script, copay, co-pay |
| Prescribed drugs for cosmetic purposes | X | X | |
| Prescription insurance premiums (Premiums are only reimbursable with a QSEHRA or ICHRA, not a GCHRA) | ✔ | ✔ | policy |
| Psychiatric / therapy | ✔ | X | counseling, mental health |
| Radial keratotomy | ✔ | ✔ | vision, cornea, surgery, operation, RK |
| Reading glasses | ✔ | ✔ | Vision, eye |
| Short-term medical insurance premiums (Premiums are only reimbursable with a QSEHRA or ICHRA, not a GCHRA) | ✔ | ✔ | Insurance |
| Sleep aids and sedatives (over-the-counter) | ✔ | X | RX, Over the counter, Over-the-counter, OTC, medication, pills |
| Smoking cessation (programs/counseling) | ✔ | X | therapy, rehab |
| Smoking cessation drugs, nicotine gum, or patches | ✔ | X | RX, Over the counter, Over-the-counter, OTC, medication, prescriptions |
| Special equipment | ✔ NOTE | X | |
| Special foods | ✔ NOTE | X | diet, dietary |
| Special school (for mental and physical disabilities) | ✔ NOTE | X | Education |
| Speech therapy | ✔ | X | |
| Spermicidals | ✔ | X | Contraceptive, contraception, birth control |
| Splints, supports, and braces | ✔ | X | |
| Sterilization | ✔ | X | Contraceptive, contraception, birth control |
| Stomach remedies/aids for indigestion | ✔ | X | Over-the-counter, OTC, medication |
| Sunglasses (prescription) | ✔ | ✔ | Vision |
| Sunscreen / sunblock and creams with SPF 15+ | ✔ | X | Over the counter, Over-the-counter, OTC, medication |
| Sunscreen / sunblock with SPF <15 or suntan lotion | X | X | Cosmetic, OTC, Over the counter, Over-the-counter |
| Surgery (non-cosmetic) | ✔ | X | |
| Swimming lessons (for therapy) | ✔ NOTE | X | therapy, rehabilitation |
| Swimming lessons (for general health) | X | X | |
| Take-home urinary tract infection test | ✔ | X | OTC, Pharmacy |
| Teeth bleaching or whitening | X | X | Cosmetic, Dental |
| Toothpaste, medicated (difference in cost only) | ✔ RX | ✔ RX | Dental |
| Toothpaste, toothbrush, floss, etc. | X | X | Personal Use |
| Transgender treatments/surgery | ✔ NOTE | X | |
| Transportation and parking (to dental or vision care) | ✔ | ✔ | miles, mileage, travel |
| Transportation and parking (to eligible medical care) | ✔ | X | miles, mileage, travel |
| TRICARE insurance premiums (Premiums are only reimbursable with a QSEHRA or ICHRA, not a GCHRA) | ✔ | ✔ | policy, MEC |
| Tubal ligation | ✔ | X | |
| Tuition or educational classes | ✔ NOTE | X | |
| Urological products | ✔ | X | catheters |
| UV protection clothing | X | X | Personal Use Item |
| Vaccinations | ✔ | ✔ | Preventive, Wellness, flu, shots |
| Varicose vein removal surgery (for medical care) | ✔ | X | Surgery, Operation |
| Vasectomy | ✔ | X | Infertility, surgery, operation, hospital, birth control |
| Vision care | ✔ | ✔ | Eye, optomologist, co-pay, copay |
| Vision insurance premiums (Premiums are only reimbursable with a QSEHRA or ICHRA, not a GCHRA) | ✔ | ✔ | policy, eye, plan |
| Vision operations | ✔ | ✔ | eye, surgery |
| Vision products | ✔ | ✔ | Eye |
| Vitamins | ✔ RX | X | Rx, prescription |
| Vitamins (for general health) | X | X | |
| Walking aids (canes, walkers, crutches) | ✔ | X | Durable Medical equipment |
| Wart removal treatments | ✔ | X | Over the counter, Over-the-counter, OTC, medication |
| Weight loss drugs | ✔ RX | X | Obesity, Rx, prescription |
| Weight loss foods | X | X | |
| Weight loss program (for general health) | X | X | |
| Wheelchair and repairs | ✔ | X | |
| Wound care | ✔ | X | Over the counter, Over-the-counter, OTC, medication, bandaids, bandages, wraps |
Both employers and employees need to become familiar with the IRS list of eligible expenses for HRAs. This understanding allows employees to make informed choices about their medical expenses while employers can ensure they comply with IRS regulations.
HRAs provide a valuable benefit to employees by reimbursing them for certain medical costs. By following the IRS guidelines and staying up-to-date with any changes in regulations, both employers and employees can maximize the benefits of these arrangements.
What is IRS Publication 502?
IRS Publication 502 is a document that lists which medical and dependent care items employees can claim as a deduction on Schedule A of Form 1040, also known as the Federal Income Tax Return. This document is especially important for organizations that offer personalized health benefits as it lists eligible expenses for HRAs, health savings accounts (HSAs), and flexible spending accounts (FSAs).
How PeopleKeep can help
When your organization offers an HRA through PeopleKeep, our team of experts reviews employee reimbursement requests for compliance. If it’s a qualified expense, we notify employers so they can reimburse their employees. If not, we’ll notify employees of any issues, such as a missing doctor’s note.
You can administer three types of HRAs with our software:
- Qualified small employer HRA (QSEHRA)
- Individual coverage HRA (ICHRA)
- Group coverage HRA (GCHRA)
GUIDE
Get our HRA compliance toolkit
This toolkit offers quick reference material to help you with HRA compliance.
