Please note this article was written in 2025 and the IRS is fickle!
Can You Use an HSA for Psychotherapy?
In recent years, mental health has taken center stage in discussions about healthcare and well-being. As more people seek therapy and counseling to address issues like anxiety, depression, and stress, many are looking into how they can afford these services—especially through tax-advantaged options like Health Savings Accounts (HSAs). But can you use your HSA for psychotherapy?
The Short Answer: Yes, You Can
Yes, you can use your HSA to pay for psychotherapy. According to IRS Publication 502, which outlines what medical expenses are considered eligible, “psychologist and psychiatrist services” are qualified medical expenses. This includes psychotherapy, whether provided by a licensed psychologist, licensed marriage and family therapist, clinical social worker, counselor, or psychiatrist.
However, there are important nuances to be aware of.
What Qualifies as an HSA-Eligible Psychotherapy Expense?
To be HSA-eligible, the psychotherapy service must meet the following conditions:
• Medically necessary: The therapy should be intended to diagnose, treat, or alleviate a specific mental health condition. This includes treatment for anxiety, depression, trauma, and other diagnosed psychological conditions.
• Provided by a licensed professional: The therapy must be administered by a licensed healthcare provider—such as a licensed clinical social worker (LCSW), psychologist (PhD or PsyD), licensed professional counselor (LPC), licensed marriage and family therapist (LMFT), or psychiatrist (MD or DO).
• Documented services: It’s helpful (and sometimes necessary) to retain documentation such as a diagnosis, treatment plan, or a recommendation from a healthcare provider, especially if the IRS requests proof during a tax audit.
What Doesn’t Qualify?
There are a few important exclusions:
• Life coaching or self-improvement: Services that are general in nature or geared toward personal growth—such as coaching, motivational seminars, or spiritual counseling—typically aren’t eligible.
• Couples or marriage counseling: This is a gray area. If the counseling is for relationship improvement without a diagnosed mental health condition, it may not qualify. However, if it’s part of treating a mental health disorder, it could be eligible.
• Unlicensed providers: Services from non-licensed or alternative practitioners may not be HSA-eligible, even if they involve emotional support.
How to Use Your HSA for Therapy
Using your HSA to pay for psychotherapy is fairly simple:
1. Pay directly with your HSA debit card, or
2. Pay out-of-pocket and reimburse yourself from your HSA later.
Keep detailed receipts and documentation for each session, including:
• Date of service
• Provider name and license
• Type of service
• Amount paid
Teletherapy and Virtual Services
With the rise of virtual care, many are using teletherapy. Fortunately, telehealth psychotherapy is also HSA-eligible, as long as it follows the same rules: it must be for a diagnosable condition, conducted by a licensed provider, and appropriately documented.
Final Thoughts
Your HSA is a valuable tool for covering the cost of mental health care, including psychotherapy. As long as the services are deemed medically necessary and are provided by licensed professionals, you can use HSA funds to pay for therapy tax-free. This not only helps you manage costs but also supports your overall mental and emotional well-being—something that’s more important than ever