Eligibility & Qualification Overview
Eligibility & Qualification Overview
What qualifies for HSA/FSA
HSA and FSA funds are governed by IRS Code Section 213(d), which defines a qualified medical expense as one paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for treatments affecting any structure or function of the body.
In plain terms: a purchase qualifies when it addresses a real health need, not when it simply supports general wellness or convenience.
The IRS is explicit that expenses “merely beneficial to general health” do not qualify. This is an important distinction. A fitness tracker purchased because you want to be healthier is not automatically eligible. The same tracker purchased because a clinician has determined it is medically appropriate for managing a diagnosed heart condition may qualify.
This is why eligibility depends on your individual health situation, not just the product category. The product and the health context together determine whether a purchase clears the IRS threshold.
Eligible product categories
Truemed works with merchants across a wide range of health categories. Products in these categories can qualify when a licensed clinician determines the purchase is medically appropriate for your specific health needs.
Being in a supported category does not guarantee eligibility. Two customers purchasing the same product may receive different outcomes based on their individual health profiles. Qualification is always assessed on a case-by-case basis.
Who qualifies
Qualification depends on your health, not just your purchase. To qualify through Truemed, there needs to be a medically valid reason for your specific purchase tied to a diagnosed or documented health condition.
Some examples:
- A customer with a diagnosed sleep disorder may qualify for a mattress or sleep tracking device.
- A customer managing cardiovascular disease or metabolic conditions may qualify for fitness equipment or a gym membership.
- A customer with a documented nutritional deficiency or gastrointestinal condition may qualify for specific supplements.
- A customer managing chronic pain or musculoskeletal issues may qualify for recovery tools like red light therapy or cold plunge equipment.
General health goals, like wanting to lose weight, get stronger, or sleep better without a specific underlying condition, do not meet the IRS threshold on their own. There needs to be a medical reason that goes beyond general wellness.
This is intentional. The IRS requires that HSA/FSA spending be tied to medical necessity, and Truemed’s qualification process is designed to make sure purchases meet that standard.
How Truemed determines eligibility
When you complete a purchase through a Truemed partner brand, you will be asked to fill out a brief health intake form, sometimes called a qualification survey. This form collects information about your current health, any relevant diagnoses or conditions, and why you are purchasing the product.
The reason Truemed requests this information is so our provider team can evaluate whether there is a medically necessary reason for your purchase of a specific product or service. Being able to identify a reason above the baseline of “general health” is a requirement for customers who want to use their HSA/FSA funds toward certain products.
Here is what happens after you submit the intake:
- An independent, licensed clinician reviews your health information.
- The clinician assesses whether your purchase qualifies as medically necessary given your specific health context.
- If your purchase qualifies, you receive a Letter of Medical Necessity (LMN) that supports your payment or reimbursement.
- If your purchase does not qualify, you will be notified.
Not all purchases are guaranteed to qualify. Eligibility is determined on a case-by-case basis. Truemed does not guarantee any specific outcome.
Medical necessity explained
Medical necessity is the standard the IRS uses to determine whether a product or service qualifies as a medical expense under Section 213(d). A purchase is medically necessary when it is appropriate for the diagnosis, treatment, mitigation, or prevention of a specific health condition affecting a specific person.
A Letter of Medical Necessity (LMN) is the document that establishes this. It is issued by an independent, licensed clinician and explains why a specific product is medically appropriate for your health situation. The LMN is what makes an otherwise general-purpose product eligible for HSA/FSA use.
Without an LMN, products like fitness equipment, supplements, or sleep technology are considered general wellness purchases and do not qualify under IRS rules, regardless of their health benefits.
A few important things to understand about medical necessity:
- It is personal. Medical necessity is specific to you, your health history, and your diagnosed conditions. A product that qualifies for one customer may not qualify for another.
- It is not a prescription. An LMN is not a prescription in the traditional sense. It is documentation of clinical judgment supporting the appropriateness of a purchase for your health needs.
- It has a validity period. LMNs issued through Truemed are typically valid for 12 months from the date of issue.
- Your HSA/FSA administrator has final authority. Truemed’s LMN supports your claim, but your plan administrator makes the final determination on reimbursement.
If you have questions about whether a specific purchase might qualify for you, you can start by completing the intake survey at a Truemed partner brand’s checkout.
Truemed is for qualified customers. HSA/FSA tax savings vary. Learn more at truemed.com/disclosures.
