HRA eligible expenses: The complete guide to reimbursement

See what your HRA covers: medical visits, prescriptions, dental care, vision, mental health & insurance premiums. Get tax-free reimbursements for qualified expenses with our complete 2025 guide.

Charles Daly

Written by

Charles Daly

Colin Maguire

Reviewed by

Colin Maguire

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TL;DR

  • What's Covered: Medical visits, prescriptions, dental care, vision, mental health, medical equipment, insurance premiums (depending on HRA type), and even travel for medical care

  • What's NOT Covered: Cosmetic procedures, gym memberships, general wellness items, OTC meds without prescription, vitamins/supplements without Rx

  • HRA Types Matter: QSEHRA (small employers), ICHRA (any size), and Traditional HRAs each have different rules—especially for premium reimbursements

Even the most comprehensive healthcare plans come with a lot of fine print. But if your employer offers a Health Reimbursement Arrangement (HRA), you’ve got one big advantage: the ability to get tax-free reimbursement for many of your out-of-pocket medical costs.

There’s just one catch: not everything counts.

This guide breaks down exactly what you can and can’t use an HRA for. We’ll walk you through eligible expenses—like doctor visits, prescriptions, dental care, and insurance premiums—and flag what’s not covered, like cosmetic procedures and gym memberships. We’ll also explain how different types of HRAs (QSEHRAs, ICHRAs, and traditional HRAs) handle reimbursements, and give you a step-by-step guide to actually submitting a claim.

What is an HRA—and how does it work?

A Health Reimbursement Arrangement (HRA) is an employer-funded benefit that lets you get reimbursed for certain health care expenses without paying tax on the money you receive.

Unlike a Health Savings Account (HSA) or Flexible Spending Account (FSA), you don’t own an HRA, and you don’t contribute to it. Instead, your employer sets the rules, funds the account, and approves reimbursements according to IRS guidelines (under IRS Publication 502) and the specifics of your HRA plan.

The basics:

  • Tax-free reimbursements for qualified expenses

  • Funded entirely by your employer

  • Not portable—you can’t take the funds with you if you leave your job.

  • Covers you, your spouse, and dependents (in most cases)

There are several types of HRAs, each with different use cases:

HRA TypeBest For
QSEHRASmall businesses (fewer than 50 FTEs)
ICHRABusinesses of any size
Traditional HRALarger employers

Remember: the IRS determines what’s eligible, and your plan may set further rules within that scope.

What expenses are eligible for reimbursement?

The Internal Revenue Code defines eligible expenses broadly as costs incurred, among other things, for “the diagnosis, cure, mitigation, treatment, or prevention of disease.” But that doesn’t mean everything health-related qualifies.

Below, we’ve broken eligible expenses into categories to help you quickly find what applies to your situation.

Medical care and doctor visits

If you visit a doctor, specialist, clinic, or urgent care facility for a medical reason, you can likely get reimbursed. This includes:

  • Primary care visits

  • Specialist consultations (e.g., dermatology, orthopedics, neurology)

  • Urgent care and walk-in clinics

  • Telehealth or virtual visits

  • Diagnostic services (e.g., blood work, X-rays)

Reimbursable costs include: copayments, coinsurance, and out-of-pocket payments for medically necessary visits. If your provider is out-of-network and you pay upfront, that too is eligible.

Preventive checkups are also covered, even if you’re not sick. Annual physicals, vaccinations, and routine screenings fall under the IRS’s medical care definition.

Prescription medications

Most HRAs cover prescription drugs—whether they’re taken short-term (e.g., antibiotics) or long-term (e.g., insulin, antidepressants, birth control).

What qualifies:

  • Brand-name and generic medications prescribed by a doctor

  • Refills and maintenance meds

  • Insulin

What doesn’t: Over-the-counter meds like ibuprofen or antihistamines unless you have a written prescription from a doctor. The same rule applies to things like acid reducers, laxatives, and cold medicine.

Over-the-counter medications (with a prescription)

Thanks to the CARES Act (2020), certain OTC items are eligible again—but only if you get a prescription. Examples include:

  • Pain relievers (e.g., Advil, Tylenol)

  • Allergy medications (e.g., Claritin, Zyrtec)

  • Sleep aids

  • Cold and flu treatments

  • Heartburn and antacid meds

Some OTC items—like menstrual care products and COVID-19 test kits—no longer require a prescription. We’ll cover those in a later section.

Dental, vision, mental health, and more: other eligible expenses

HRAs cover way more than check-ups and prescriptions The IRS allows reimbursement for a range of services and items, including dental work, glasses, mental health treatment, menstrual care, and even medical devices you use at home.

Here’s what qualifies.

Dental care

Dental expenses are fully eligible for reimbursement, provided they’re for prevention, diagnosis, or treatment of dental disease, not purely cosmetic.

Covered:

  • Exams and cleanings

  • Fillings, crowns, and root canals

  • Extractions

  • Braces and retainers

  • Dentures and dental implants

  • X-rays

  • Periodontal treatment

Not covered:

  • Teeth whitening or cosmetic veneers

  • Over-the-counter whitening strips

Orthodontic treatments like braces can be reimbursed over time as payments are made, or in full with proper documentation depending on your plan.

Vision care

Vision expenses are also eligible, whether you need a routine eye exam or corrective treatment.

Covered:

  • Eye exams

  • Prescription eyeglasses and contact lenses

  • Lens solution and cleaning supplies

  • LASIK or other corrective eye surgeries

  • Vision therapy (if prescribed)

Not covered:

  • Non-prescription glasses or blue light blockers

Cosmetic contact lenses (e.g. color-changing lenses without prescription)

Mental health and therapy

Mental health care is eligible for reimbursement under IRS rules when the care constitutes treatment for disease or disability. Many employers now emphasize this as part of overall wellness. However, this is one area where it’s important to read the fine print. Coaching or general “wellness” support may not qualify unless medically necessary and provided by a credentialed therapist or clinician.

Menstrual care and reproductive health

Thanks to the CARES Act, menstrual care products were added to the list of eligible HRA expenses in 2020. These include:

  • Tampons

  • Pads and panty liners

  • Menstrual cups

  • Period underwear

  • Pain relief medications (with Rx) for menstrual symptoms

Also covered under reproductive care:

  • Fertility treatments (e.g., IVF, egg retrieval)

  • Pregnancy tests

  • Prenatal vitamins (with Rx)

  • Breast pumps and lactation assistance supplies

Yes, you can get reimbursed for the cost of freezing your eggs or sperm, as long as it's necessary to overcome inability to have children and your plan allows it.

Medical equipment and supplies

Durable medical equipment (DME) and related supplies are often overlooked but highly reimbursable when purchased for treatment of a medical condition. This is one of the broadest categories of eligible expenses.

Covered items include:

  • Crutches, wheelchairs, walkers

  • CPAP machines and supplies

  • Blood pressure monitors

  • Glucose meters and diabetic test strips

  • Insulin pumps and supplies

  • Hearing aids and batteries

  • Breast pumps

  • Bandages, gauze, and wound care supplies

  • Mobility aids

  • Orthopedic shoes (if prescribed)

Not covered:

  • Air purifiers

  • Mattresses or pillows (even if marketed for medical use)

  • General-use household items like thermometers or humidifiers, unless specifically prescribed

Keep prescriptions or doctor’s notes for medical equipment purchases, especially if the item could be considered general-purpose.

Health insurance premiums

Yes, some HRA types let you get reimbursed for monthly insurance premiums—but not all of them. Here’s the breakdown:

Premium TypeQSEHRAICHRATraditional HRA
Individual marketplace plan✅ Yes✅ Yes❌ Usually not
Spouse’s employer plan✅ Yes❌ No✅ Yes, depending on HRA terms
Medicare (Parts A, B, D)✅ Yes✅ Yes✅ Yes, in certain circumstances
Dental/Vision premiums✅ Yes✅ Yes✅ Yes, depending on HRA terms

If your plan reimburses premiums, you’ll usually submit a proof-of-payment statement each month or once per plan year.

 If you’re unsure whether your HRA reimburses premiums, check your Summary Plan Description (SPD) or ask your HRA administrator.

Travel for medical care

Travel costs associated with necessary medical treatment can also be reimbursed, within limits.

Eligible costs:

  • Mileage for driving to medical appointments (at IRS rates)

  • Parking fees and tolls

  • Bus, train, or airfare (if no suitable care is available locally)

  • Hotel or lodging (up to $50 per night per person)

Not eligible:

  • Meals or entertainment

  • Travel for general wellness, checkups, or elective care

  • Companion’s expenses (unless required for care, e.g., a minor child)

You’ll need to log the mileage, date, and destination for each trip—some apps make this easier to track and submit.

Other reimbursable services

There are dozens of other items on the IRS-qualified list that people don’t realize they can claim. Here are a few you might not have thought of:

  • Smoking cessation programs

  • Weight loss programs (if prescribed for a medical condition)

  • Service animals and related care

  • Physical therapy

  • Acupuncture

  • Chiropractic services

  • Home modifications for medical reasons (e.g., ramps, handrails—with Rx)

Note: Many of these require documentation, especially prescriptions, physician letters, or invoices that describe the medical purpose.

What expenses are not eligible for HRA reimbursement?

Not everything health-adjacent qualifies. The IRS draws a firm line between medical care and general wellness, and many everyday expenses—even if they feel health-related—don’t count.

Here’s what’s typically not reimbursable:

  • Cosmetic procedures (e.g., Botox, teeth whitening, elective plastic surgery)

  • Gym memberships and fitness classes (unless prescribed and medically necessary)

  • Vitamins and supplements (unless prescribed to treat a specific condition)

  • Over-the-counter items without a prescription, including pain relievers, allergy meds, and cold remedies

  • Personal hygiene products (e.g., toothpaste, shampoo, deodorant)

  • Maternity clothes, diapers, and baby gear

  • Funeral expenses or life insurance premiums

  • General wellness apps or meditation subscriptions

  • Travel expenses not tied to treatment (e.g., vacation during recovery)

If an expense is primarily for comfort, appearance, or general wellness—not diagnosis, treatment, or prevention—it probably doesn’t qualify.

HRA types: how eligibility differs between QSEHRA, ICHRA, and traditional HRAs

Different HRAs have different rules. Some can reimburse premiums, others can’t. Some have dollar limits. Here’s how it breaks down:

QSEHRA (Qualified Small Employer HRA)

Who it’s for: Employers with fewer than 50 full-time employees Key features:

  • Annual reimbursement caps (set by the IRS)

  • Can reimburse individual health premiums + qualified medical expenses

  • Must be offered to all full-time employees on equal terms

  • Often used in place of traditional small group health plans

Unique eligibility notes:

  • Premiums for spouse plans are eligible

  • HSA compatibility requires a special setup

  • Reimbursements are reported on your W-2

ICHRA (Individual Coverage HRA)

Who it’s for: Employers of any size Key features:

  • No reimbursement cap (employer decides)

  • Can reimburse premiums only, expenses only, or both

  • Employers can offer different reimbursement rates by “employee class”

  • Must be paired with individual coverage (ACA or Medicare)

Unique eligibility notes:

  • Medicare and COBRA premiums are eligible

  • Great for remote/distributed teams

  • Not HSA-compatible unless structured for premiums-only

Traditional HRA

Who it’s for: Larger employers with group health plans Key features:

  • Often tied to the employer’s group insurance

  • Reimbursement rules vary widely

  • May have fewer options for individual customization

  • Not portable, not HSA-compatible

Unique eligibility notes:

  • May restrict reimbursements to deductibles and copays only

Always check your Summary Plan Description (SPD). The IRS sets the ceiling, but your employer decides how high they go.

How to get reimbursed: a step-by-step process

Getting your money back should be easy—and it is, if you know the steps.

Step 1: Know what’s covered

Start by reviewing your HRA’s eligible expenses. Use this guide, check your SPD, or use your HRA dashboard (like Thatch’s) to confirm eligibility.

Step 2: Pay for the expense

Use your personal funds (credit card, bank account) to pay the provider or purchase the item. Keep your receipts and any supporting documents (like a prescription or Explanation of Benefits).

Step 3: Submit your claim

Use your HRA platform to upload:

  • Proof of purchase (receipt or invoice)

  • Date of service

  • Type of service or item

  • Prescription or doctor’s note (if required)

Some platforms allow you to snap a photo; others may request a PDF or digital form.

Step 4: Get reimbursed

Once approved, the reimbursement will be issued—typically via direct deposit. Timing depends on your employer’s setup, but most reimbursements are processed within 5–10 business days.

Pro tips: how to get the most out of your HRA

  • Save your receipts: Create a digital folder and upload as you go. Don’t wait until the end of the year.

  • Batch your claims: Submitting multiple eligible expenses together reduces admin time and speeds up reimbursement.

  • Get Rx letters pre-approved: If you regularly buy OTC meds, ask your doctor for a standing prescription.

  • Submit early: Don’t wait until the deadline. Some HRAs have strict end-of-year or 90-day cutoffs.

  • Coordinate with your spouse: If you both have HRAs, make sure you’re not double-claiming the same expense.

Frequently asked questions

Can I use my HRA for my spouse or kids? Yes, most HRAs allow you to claim expenses for your spouse and tax dependents. Always check your plan rules to confirm.

Do I need a prescription for over-the-counter medications? Yes—unless the item is exempt (e.g. menstrual products, COVID tests). You’ll need a written prescription for pain relievers, allergy meds, etc.

Is massage therapy eligible? Only if prescribed for a medical condition by a licensed provider. A general spa day doesn’t count.

Can I use HRA funds for expenses from last year? It depends. Some HRAs allow a “run-out” period for submitting past-year claims (e.g. 60–90 days). Others don’t. Check your plan timeline.

Can I use both an HRA and an HSA? Maybe. QSEHRAs and ICHRAs can be made HSA-compatible—but not always. You can’t double-dip for the same expense.

How long does reimbursement take? Typically, 5–10 business days.  Some administrators process faster (3-5 days with direct deposit, or even within 24 hours in some cases)  while others take longer (up to 10-15 days for mailed checks). 

Final takeaways

HRAs are some of the most flexible and tax-efficient ways to manage health care costs—but only if you know what’s eligible and how to claim it.

To recap:

  • Eligible expenses include: medical, dental, vision, mental health, insurance premiums, medical equipment, and more

  • Not covered: cosmetic procedures, general wellness, and non-medical personal items

  • Different HRAs cover different things—know your type

  • Submitting claims is easy—especially with a platform like Thatch

  • Staying organized helps you capture every dollar you’re owed

If your employer offers an HRA, use it. And if you're not sure what's eligible, bookmark this guide—you’ll be glad you did.

Charles Daly is a ghostwriter, B2B marketing strategist, and the co-author of I Will Follow You Anywhere: The True Story of a 9/11 Responder and a Comedian who Took on Congress by John Feal with Charles Daly, foreword by Jon Stewart (2026)
Written by
Charles Daly /Writer

Charles Daly is a ghostwriter, B2B marketing strategist, and the co-author of "I Will Follow You Anywhere: The True Story of a 9/11 Responder and a Comedian who Took on Congress" by John Feal with Charles Daly, foreword by Jon Stewart (2026)

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This article is for general educational purposes and is not legal advice. The opinions shared here belong to the author and are not official statements from Thatch. For legal and tax questions, please feel free to consult with a qualified professional.

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