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A Health Savings Account (HSA) is a tax-advantaged account created for or by individuals covered under high-deductible health plans (HDHPs) to save for qualified medical expenses. Contributions are made into the account by the individual or their employer and are limited to a maximum amount each year. The contributions are invested over time and can be used to pay for qualified medical expenses, such as medical, dental care, acupuncture eye treatment, chiropractic visits, vision care and prescription drugs.
A flexible spending account (FSA) is a type of savings account that provides the account holder with specific tax advantages. An FSA is sometimes called a “flexible spending arrangement” and can be established by an employer for employees. The account allows you to contribute a portion of your regular earnings before tax; employers also can contribute to employees’ FSAs. Distributions from the account must be used to reimburse the employee for qualified expenses related to qualified medical expenses, such as medical, dental, acupuncture eye treatment, chiropractic, vision care and prescription drugs.
A health reimbursement arrangement is a plan set up by an employer to cover medical expenses for its employees. The employer decides how much it will put into the plan, and the employee can request reimbursement for actual medical expenses incurred up to that amount. All employees in the same class must receive the same HRA contribution. An HRA is not an account. Therefore, employees cannot withdraw funds in advance and then use them to pay medical expenses. Instead, they must incur the expense first, then have it reimbursed. Reimbursement at the time of service is possible if the employer provides an HRA debit card.
Usually, yes. The IRS lists acupuncture as a medical expense, and HSA funds can pay tax-free for medical care as the tax code defines it. Keep your receipts: as the HSA owner, it is up to you to show that each payment was for an eligible expense.
Usually, yes, with a regular health care FSA. A limited-purpose FSA, which is often paired with an HSA, covers only dental, vision and preventive care. Your FSA administrator may ask for documentation after you pay.
It depends on what your employer's plan allows. Ask your plan administrator whether acupuncture is included.
Not automatically. Acupuncture is the clearest eligible service. Other integrative treatments may qualify when they treat a medical condition, depending on the service and your plan's documentation rules. General wellness or relaxation services usually do not qualify. Netra Restoration Therapy (NRT) combines several treatments and products, so eligibility is decided item by item, not for the program as a whole. Check with your plan administrator before using HSA or FSA funds for anything other than acupuncture.
Only in limited cases. The IRS allows herbal supplements and similar products only when a medical practitioner recommends them as treatment for a specific medical condition diagnosed by a physician. Many plans also ask for a letter of medical necessity.
Usually not for acupuncture, though some plans ask for one, along with a detailed receipt, for alternative treatments. Check your plan's rules before you pay.
Yes. A card payment going through does not by itself mean the expense is eligible, so keep your receipts in case your plan or the IRS asks for them.
Sources: IRS Publication 502, Medical and Dental Expenses (2025); IRS Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans (2025). This page is general information, not tax advice.