Using an HSA or FSA to pay for STD testing

A health savings account, or HSA, and a health flexible spending arrangement, or FSA, let you pay for medical care with money that isn't taxed. STD tests fit IRS rules for what these accounts can pay for. The details that trip people up are payment method and paperwork.

This page explains how the IRS rules apply. It is not tax advice. For your own situation, check with your plan administrator or a tax professional.

Key points

• The IRS defines medical care as the costs of "diagnosis, cure, mitigation, treatment, or prevention of disease." An STD test is diagnosis.
• IRS Publication 502 lists lab fees that are part of medical care as a medical expense.
• You can pay with your HSA or FSA card if the provider accepts it, or pay another way and reimburse yourself.
• Keep an itemized receipt. FSAs require one before they pay you back. HSA owners need records in case of an IRS question.
• Our tables have an HSA/FSA column that shows which providers say they accept these cards.

Why STD tests qualify

HSAs and health FSAs pay for "qualified medical expenses," which IRS Publication 969 defines by pointing to medical care under section 213(d) of the tax code. Publication 502 describes medical care as "the costs of diagnosis, cure, mitigation, treatment, or prevention of disease."

Two parts of the IRS guidance line up with STD testing:

• Lab fees. Publication 502 says you can include "amounts you pay for laboratory fees that are part of medical care."
• Tests that check for disease. An IRS FAQ says a physical exam counts "because the physical exam provides a diagnosis of whether a disease or illness is present." An STD test does the same for specific infections.

The same IRS FAQ says that expenses for medical care under section 213 "are eligible to be paid or reimbursed under an HSA, FSA, Archer MSA, or HRA."

Paying with your card

The simplest route is to use your HSA or FSA debit card at checkout. Some providers say outright that they accept these cards. Labcorp OnDemand, for example, lists HSA and FSA payment on its STI test page. The HSA/FSA column in our comparison table shows what each provider says.

If a provider doesn't accept the card, or the card is declined, pay with a regular card and reimburse yourself.

Reimbursing yourself

From an HSA

You can pay out of pocket and take a distribution from your HSA later for the same expense. Publication 969 says distributions "may be tax free if you pay qualified medical expenses." It also says you "must keep records sufficient to show" that the money went to qualified medical expenses. You usually don't send receipts to anyone. You keep them.

From an FSA

FSAs work differently. Publication 969 says you must give the FSA "a written statement from an independent third party stating that the medical expense has been incurred and the amount of the expense." In practice, that means submitting an itemized receipt or invoice from the testing provider through your FSA's claim process.

What your receipt should show

Ask for, or download, an itemized receipt. STDcheck, for example, says it can provide an itemized receipt on request. A useful receipt shows:

• The provider's name.
• The date of service or purchase.
• What you bought, such as the test or panel name.
• The amount you paid.

Your FSA administrator may want specific wording. Check its claim instructions before you submit.

The receipt names the service. If you'd rather keep that private, store it somewhere only you can open, and submit it only to your account administrator.

Doctor consults and treatment

If a result is positive, the follow-up is also medical care under the same IRS definition, which covers treatment. That includes a doctor's consult. Publication 502 counts prescribed medicines as a medical expense.

Your spouse or dependents

Publication 969 says an HSA can pay qualified medical expenses for you, your spouse and your dependents. So an HSA can pay for a spouse's test. It can't pay for a partner who isn't your spouse or dependent.

Claiming a tax deduction instead

If you don't have an HSA or FSA, you may still be able to deduct medical costs. Publication 502 says you can deduct only the part of your total medical and dental expenses that is more than 7.5% of your adjusted gross income, and only if you itemize on Schedule A.

You can't deduct an expense twice. Publication 502 says you "can't include expenses you pay for with a tax-free distribution" from your HSA. Expenses reimbursed by an FSA are excluded too.

A short checklist

1. Choose a test in our comparison table and check the HSA/FSA column.
2. Pay with your HSA or FSA card, or with a regular card if needed.
3. Save the itemized receipt.
4. For an FSA, submit the receipt through your plan. For an HSA, keep it with your records.