Partial Eligibility

When you shop through Truemed, most products are either fully eligible or fully ineligible for HSA/FSA reimbursement. But some products fall into a middle category: only a portion of the cost qualifies. This is called partial eligibility, and it’s worth understanding before you complete your purchase.

What is partial eligibility?

Partial eligibility means that only a portion of the item’s price qualifies for reimbursement through your HSA/FSA. The remaining portion of the cost is considered ineligible.

This typically occurs with products that include features or upgrades beyond a basic model. Under IRS Section 213(d), HSA and FSA funds can only be used for expenses paid for medical care. When a product includes both medical and non-medical features, such as a luxury or premium upgrade, only the portion attributable to the medical purpose qualifies.

For example: a mattress with advanced cooling features may only be eligible for the portion of its cost that exceeds that of a standard mattress.

In these cases, the eligible amount is determined based on comparisons with “base models” or similar items that meet basic eligibility requirements.

How is the eligible amount determined?

Truemed’s clinical operations team determines the eligible portion of a purchase by comparing the product to a standard, comparable version of the same item. This is called the comparable item approach.

Here’s how it works:

• A standard version of the product (without premium upgrades) is identified as the reference point
• The price of that standard version represents the ineligible base cost
• The remaining amount above that base, which reflects the medically relevant features, becomes the eligible amount

This comparison is documented in the Letter of Medical Necessity (LMN) issued through Truemed, and when applicable, it appears on your itemized receipt as well. The goal is to give you clear documentation if your HSA/FSA administrator ever asks for a cost breakdown.

Common examples

Partial eligibility comes up most often in product categories where a basic version of the item qualifies medically, but the specific product purchased includes extra features that do not.

• Mattresses: A therapeutic mattress can qualify for HSA/FSA use when recommended by a provider to address a sleep disorder or chronic pain. If the mattress includes advanced cooling technology, smart sensors, or other premium features, the cost above a standard mattress may be considered ineligible.
• Adaptive or orthopedic footwear: Footwear designed for a specific medical condition can qualify. If the specific product purchased is a premium brand with features beyond the therapeutic need, a cost comparison to a standard comparable may reduce the eligible amount.

What to expect at checkout

When you go through the Truemed checkout or qualification flow for a partially eligible product, you will see the eligible and ineligible amounts broken out clearly before you pay.

Here is what the experience looks like:

1. Complete the qualification survey. Before entering your payment details, you’ll answer a brief health survey. This helps Truemed’s provider team confirm eligibility and calculate the eligible portion.
2. Review your eligible breakdown. At the payment screen, your cart will display the HSA/FSA-eligible amount and the ineligible amount separately, so you know exactly what can be reimbursed.
3. Pay the full purchase price. You pay the total cost using a credit or debit card. Only the eligible portion is reimbursable through your HSA or FSA account.

For example: If you’re purchasing a mattress that costs ＄2,500 and the eligible amount is ＄2,250, you’ll pay the full ＄2,500 at checkout, but you can seek reimbursement for up to ＄2,250 from your HSA/FSA.

Using HSA/FSA for the eligible portion

After your purchase, you can submit the eligible portion to your HSA or FSA administrator for reimbursement. Truemed provides the documentation you need to support your claim.

What Truemed provides:

• A Letter of Medical Necessity (LMN) that explains why the purchase is medically appropriate, along with an addendum that details the comparable item comparison and the eligible vs. ineligible split
• An itemized receipt (when Truemed has visibility into the specific product purchased) that separates the eligible and ineligible amounts

What to keep in mind:

• The ineligible portion is paid like any other purchase with your regular debit/credit card and is not reimbursable through HSA/FSA funds
• Some HSA/FSA administrators may request a cost comparison or additional documentation, particularly for categories like mattresses or footwear. The Truemed LMN addendum is specifically designed to address these requests
• If your administrator asks for documentation that you don’t have on hand, reach out to Truemed support at support@truemed.com and the team can help

If you have questions about partial eligibility or want to understand how it applies to a specific product, contact the Truemed support team at support@truemed.com.