Using Your HSA or FSA for Foot Care

If you're like most people, you probably have money sitting in a Health Savings Account or Flexible Spending Account that you're not fully utilizing. These accounts are meant to help you afford healthcare expenses, but many people don't realize just how much foot care actually qualifies. Those custom orthotics you've been putting off? That podiatrist visit you keep postponing? Your HSA or FSA might cover them, and you're already paying into the account anyway.

The Basics You Need to Know

Health Savings Accounts work alongside high-deductible health plans, letting you contribute pre-tax dollars that you can use for qualified medical expenses. For 2023, you can put in up to $3,850 if you're covering just yourself, or $7,750 for family coverage. If you're 55 or older, there's an extra $1,000 catch-up contribution available. The best part about HSAs is that the money rolls over year after year, so there's no pressure to spend it before December 31st.

Flexible Spending Accounts are a bit different. These are typically offered through your employer, and for 2023, most plans allow contributions up to $3,050. The catch with FSAs is that you generally need to use the money within the plan year or risk losing it, though some employers offer a grace period or let you carry over a small amount. This makes planning your foot care expenses more critical with an FSA than an HSA.

Both accounts share one major advantage: you're spending pre-tax dollars on healthcare. This means every dollar goes further than it would if you were paying out of pocket with money you've already been taxed on. For someone in a 25% tax bracket, that $400 pair of custom orthotics effectively costs only $300 when purchased through your HSA or FSA.

What Foot Care Actually Qualifies

The IRS has specific guidelines about what counts as a qualified medical expense, and foot care covers more than you might think. Any treatment or service aimed at diagnosing, treating, or preventing a medical condition typically qualifies. Visits to a podiatrist or orthopedic specialist for issues like plantar fasciitis, bunions, or chronic heel pain are covered. The diagnostic tests they order, including X-rays and MRIs, also qualify.

Custom orthotics and prescription shoe inserts are eligible when recommended by a healthcare provider. This is important because over-the-counter inserts from the drugstore might not qualify unless they're specifically prescribed to treat a diagnosed condition. The same goes for therapeutic shoes for people with diabetes or other conditions that affect foot health. If your doctor writes it as a prescription, you're generally on solid ground for reimbursement.

What doesn't qualify is where things get a little tricky. Cosmetic procedures like routine pedicures won't make the cut, even if they make your feet look great. General comfort items like slippers or foot massagers typically don't qualify either, unless they're prescribed to treat a specific medical condition. The key distinction is medical necessity versus general wellness or cosmetics. At Wasatch Foot & Ankle Institute, we make sure to provide the proper documentation you need for your HSA or FSA claims when prescribing treatments or devices.

Making the Most of Your Account

Smart planning is everything when it comes to maximizing these benefits. Start by estimating your foot care needs for the year. If you know you'll need orthotics, plan for regular podiatrist visits, or anticipate treatment for a chronic condition, factor those costs into your contribution amount. This is especially important for FSAs where the use-it-or-lose-it rule applies.

Timing matters too. Rather than rushing to spend your FSA balance in December, spread your foot care appointments and purchases throughout the year. This gives you time to properly address issues and avoid making hasty decisions about treatments or products just to use up your funds. For those with HSAs, you have more flexibility since the money stays in your account indefinitely, but it still makes sense to use the funds for current needs rather than letting expenses pile up.

Keep every receipt and piece of documentation related to your foot care expenses. Your account administrator might require proof that an expense was medically necessary, especially for items that could be used for general wellness. A letter from your podiatrist explaining why custom orthotics are necessary for your specific condition can be invaluable if your claim gets questioned. Many people use dedicated folders or smartphone apps to organize their HSA and FSA receipts, making tax time and reimbursement much less stressful.

How to Actually Use Your Funds

Many HSA and FSA accounts come with a debit card that makes the process incredibly simple. When you visit your podiatrist or purchase eligible foot care products at approved retailers, you can pay directly with the card. The amount automatically deducts from your account, and you're done. Just make sure to keep the receipt in case your administrator needs to verify the purchase later.

If you don't have a debit card or you paid out of pocket, you'll need to submit a claim for reimbursement. This typically involves logging into your account administrator's website, uploading your receipts, and providing details about the purchase. Most plans process reimbursements within a few weeks, though it varies by administrator. Some people prefer this method because it gives them more control over their claims and documentation.

One thing to watch out for is making sure the provider or retailer accepts HSA and FSA payments. Not every medical office or store is set up to process these cards, even if the service or product qualifies. Call ahead or check before your appointment to avoid surprises at checkout.

Common Mistakes to Avoid

The biggest mistake people make is assuming they know what qualifies without checking. Just because something relates to foot health doesn't automatically make it eligible. Always verify with your plan administrator or check IRS Publication 502, which lists qualified medical expenses. This saves you from spending your HSA or FSA funds on something that won't be reimbursed or could trigger an audit.

Another common error is failing to get proper documentation from your healthcare provider. If you're purchasing custom orthotics or specialized footwear, having a prescription or letter of medical necessity can make all the difference in whether your claim gets approved. Don't rely on the retailer's word that something qualifies. Get it in writing from your doctor.

Finally, many people with FSAs don't plan ahead and end up scrambling at year-end to spend their remaining balance. This leads to purchasing things you don't really need or paying for services you could have scheduled more strategically throughout the year. Set calendar reminders to check your balance quarterly and adjust your foot care plans accordingly.

Frequently Asked Questions

Does insurance need to deny a claim before I can use my HSA or FSA?

No, you don't need an insurance denial to use your HSA or FSA for foot care. These accounts are designed to cover out-of-pocket medical expenses, including deductibles, copays, and services your insurance doesn't cover at all. If your insurance covers part of a podiatrist visit but you have a copay, you can use your HSA or FSA for that copay immediately.

Can I buy compression socks with my HSA or FSA?

Yes, but only if they're medically necessary. Compression socks prescribed by a doctor to treat conditions like venous insufficiency, diabetes-related circulation issues, or lymphedema typically qualify. Regular compression socks purchased for general comfort during travel or long work days usually don't meet the medical necessity requirement unless you have documentation from your healthcare provider.

Are custom orthotics covered by HSA and FSA?

Custom orthotics prescribed by a podiatrist or other qualified healthcare provider are generally covered by both HSA and FSA accounts. The key is having proper documentation showing they're medically necessary for treating a diagnosed condition like plantar fasciitis, flat feet, or other biomechanical issues. Over-the-counter inserts typically don't qualify unless specifically prescribed.

What happens to my FSA money if I don't use it all?

Most FSA plans have a use-it-or-lose-it policy, meaning unused funds at the end of the plan year are forfeited. However, some employers offer a grace period of up to two and a half months or allow you to carry over up to $610 into the next year. Check your specific plan details to understand your options and plan your foot care expenses accordingly.

Can I use my HSA or FSA for foot surgery?

Absolutely. Medically necessary foot surgeries, including bunion removal, hammertoe correction, ankle surgery, and procedures to address chronic foot problems, are qualified medical expenses. This includes the surgery itself, pre-operative consultations, post-operative care, prescribed medications, and any necessary medical equipment for recovery like walking boots or crutches.