Alternative Treatments: HSA Eligibility

Alternative treatment reimbursement is eligible with a Letter of Medical Necessity (LMN) from a physician with a flexible spending account (FSA), health savings account (HSA) and a health reimbursement arrangement (HRA). Alternative treatment reimbursement is not eligible with a limited care flexible spending account (LCFSA) or a dependent care flexible spending account (DCFSA).

What are alternative treatments?

Alternative treatments typically fall under the distinction of Complementary and Alternative Medicine (CAM), cover a wide range of potential professionals who specialize in treatments, therapies and disciplines to alleviate specific medical conditions. What is considered alternative medicine today could easily become a mainstream treatment tomorrow as many of these methods undergo testing and clinical trials in the future. When these methods are combined with standard medical procedures, physicians refer to this practice as "integrative medicine."

What are examples of alternative treatments?

While some Americans may choose to forgo mainstream medicine in favor of alternative treatments, unless they are used in conjunction with a traditional medical treatment or explicitly recommended by a physician, it probably will not be covered under the parameters of consumer spending accounts. For instance, acupuncture treatments are considered alternative treatments, but when they're used for pain relief to help the side effects of cancer treatment, it would be eligible with a Letter of Medical Necessity from a doctor. Some of the most common alternative medical treatments include:

  • Homeopathy: The practice of using extremely diluted forms of natural substances that are used to treat a wide variety of ailments.
  • Naturopathy: Treatments such as acupuncture, massage, herbal remedies and other noninvasive methods are believed to promote the body's own ability to heal itself.
  • Chiropractic: Chiropractors specialize in the manipulation of the spine to put the body back into an ideal alignment to treat chronic pain, joint conditions, headaches and more.
  • Energy Therapy: Through the use of magnets, these alternative healers manipulate the body's energy fields to treat a wide range of medical conditions.
  • Reiki: This is the practice of an alternative healer placing his/her hands lightly on a person's skin to access the body's natural energy. It is meant to promote relaxation, relieve anxiety and manage pain.

When are alternative treatments eligible for reimbursement?

Alternative treatments are not always thought of as legitimate by mainstream physicians, but if one of these treatments could prove useful in a treatment plan for a specific medical condition, a physician can produce a Letter of Medical Necessity (LMN) for FSA, HSA or HRA reimbursement. This letter must outline how alternative treatments will be used to alleviate the issue and how long they will last. If these treatments will last longer than the current plan year, another LMN will have to be provided to the benefits administrator to cover the duration of the treatment.

Eligibility Table

Flexible Spending Account (FSA) Limited Care FSA Dependent Care FSA Health Savings Account (HSA) Health Reimbursement Account (HRA)


Eligible with Rx

Eligible with LMN

Not Eligible

Specifically Not Covered

Alternative treatments aimed at improving general health and not specifically treating a medical condition are not eligible.


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