FSA & HSA for Fertility Treatments: What’s Eligible and What Isn’t
Fertility treatments can be expensive, but Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) can be fantastic tools for reducing out-of-pocket costs when used correctly.
Because these accounts allow you to pay for eligible medical expenses using pre-tax dollars, they can lower the effective cost of fertility treatment by 20 to 30 percent, depending on your tax bracket.
The key is understanding when fertility treatments qualify under IRS rules and what documentation may be required.
This article explains how FSAs and HSAs apply to fertility treatments in general, including IVF, IUI, fertility testing, and medications, what is and isn’t typically eligible, and how to maximize your chances of reimbursement.
Fast Facts: FSA and HSA for Fertility Treatment
- FSAs and HSAs are excellent ways to save on fertility treatment when care is medically necessary
- IVF, IUI, fertility testing, and fertility medications may qualify
- A Letter of Medical Necessity is often required
- Elective fertility treatment and long-term storage are usually not eligible
- Annual contribution limits often mean these accounts offset part of the cost
- HSAs can sometimes cover a larger share of treatment if balances have been built up over time
How Much Can FSA or HSA Save on Fertility Treatment?
When fertility treatment qualifies as a medical expense, using pre-tax FSA or HSA dollars can meaningfully reduce the effective cost of care.
Using pre-tax funds typically lowers costs by 20 to 30 percent, depending on your tax bracket.
Tax Bracket | Example Fertility Treatment Cost | Estimated Tax Savings | Effective Cost After Savings |
20% | $10,000 | ~$2000 | ~$8,000 |
25% | $10,000 | ~$2,500 | ~$7,500 |
30% | $10,000 | ~$3,000 | ~$7,000 |
Actual savings depend on your tax bracket, how much you have available in your FSA or HSA, and whether the treatment qualifies as medically necessary.
Important Note About Contribution Limits
Annual contribution limits often determine how much fertility care can realistically be paid for using FSA or HSA funds.
For 2026, IRS contribution limits include:
- Health Care FSA: up to $3,400 per individual, with limited carryover if allowed by your employer
- Health Savings Account: up to $4,400 for self-only coverage and $8,750 for family coverage, including employer contributions
Because fertility treatments often exceed these limits, FSAs and HSAs are commonly used to offset part of the cost, not cover treatment in full.
That said, HSAs work differently. Individuals who have contributed to an HSA over several years and built up a larger balance may be able to use HSA funds to cover a significant portion, or even the full cost, of fertility treatment.
Your plan administrator has the final authority over eligibility and reimbursement.
How FSAs and HSAs Work
FSAs and HSAs allow you to pay for qualified medical expenses using pre-tax dollars, reducing the effective cost of care.
Health Care FSA (Health FSA)
A Health Care FSA is:
- Offered through employers
- Funded via pre-tax payroll deductions
- Subject to an annual contribution limit set by federal rules
- Typically, use it or lose it, though some plans allow a small carryover or grace period
- Available for qualified medical expenses for you, your spouse, and your tax dependents
FSAs are often best suited for planned, near-term fertility expenses.
Health Savings Account (HSA)
An HSA is:
- Available only if you are enrolled in a qualifying high-deductible health plan
- Funded by you, your employer, or both, up to annual contribution limits
- Fully portable and remains yours even if you change jobs or health plans
- Funds roll over year to year without expiration
- Balances can often be invested once they reach a minimum threshold
- Available for qualified medical expenses for you, your spouse, and your tax dependents
HSAs are often better suited for larger or longer-term fertility expenses, especially when balances have been built up over time.
What the IRS Considers a Qualified Medical Expense
According to IRS Publication 502, qualified medical expenses include:
“The diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for treatments affecting any part or function of the body.”
This definition forms the foundation for determining whether fertility treatments may qualify for FSA or HSA reimbursement.
When Fertility Treatments May Be FSA or HSA Eligible
Fertility treatments may qualify when they are used to diagnose or treat an underlying medical condition, such as:
- Infertility is diagnosed after appropriate evaluation
- Ovulatory disorders
- Polycystic ovary syndrome (PCOS)
- Endometriosis
- Tubal disease or tubal blockage
- Male factor infertility
- Diminished ovarian reserve
- Premature ovarian insufficiency
- Medical treatments that impair fertility, such as chemotherapy or radiation
In these situations, fertility treatment is generally considered medically necessary, rather than elective.
What Fertility Treatment Costs May Be Eligible
When fertility treatment is medically necessary, the following expenses may qualify, depending on your plan:
- Diagnostic fertility testing
- Hormone bloodwork and ultrasounds
- Fertility medications
- Ovulation induction medications
- Intrauterine insemination (IUI) procedures
- In vitro fertilization (IVF) procedures
- Egg retrieval and embryo transfer
- Anesthesia
- Embryology and laboratory services
- Short-term cryostorage directly tied to active treatment
What’s Typically Not Eligible
- Fertility treatment performed for personal or lifestyle reasons
- Fertility preservation without a medical diagnosis
- Long-term or indefinite storage fees
- Experimental treatments not recognized as standard medical care
- Medical expenses for individuals who are not you, your spouse, or an eligible dependent
Getting a Letter of Medical Necessity (LMN)
Many fertility treatments require a Letter of Medical Necessity to qualify for FSA or HSA reimbursement.
What the Letter Should Include
- Patient name and date of birth
- Diagnosis and relevant ICD-10 code, if applicable
- Brief explanation of the medical condition
- Why fertility treatment is medically recommended
- Provider name, signature, and date
Example Letter of Medical Necessity Language
“I am treating [Patient Name], DOB [MM/DD/YYYY], for infertility related to a documented medical condition. Due to this diagnosis, fertility treatment is medically necessary to diagnose, treat, or mitigate this condition and improve the likelihood of pregnancy. The recommended treatment is part of this patient’s medical care plan.”
A Letter of Medical Necessity cannot be used to justify elective or non-medical fertility treatment.
How to Improve Your Chance of Approval
- Confirm eligibility with your plan administrator before treatment
- Request a Letter of Medical Necessity when appropriate
- Ask your clinic for itemized billing
- Keep copies of diagnosis codes, lab results, and prescriptions
- Ask whether pre-approval is available
Frequently Asked Questions
Can you use an FSA for fertility treatments?
Yes, when fertility treatment is medically necessary and supported by documentation.
Can you use an HSA for fertility treatments?
Yes. HSAs follow the same IRS medical necessity rules as FSAs.
Are fertility treatments automatically covered under FSA or HSA?
No. Eligibility depends on diagnosis, documentation, and your plan administrator.
Can FSA or HSA funds be used for fertility medications?
Often yes, when medications are prescribed as part of medically necessary treatment.
Is fertility treatment HSA eligible if insurance does not cover it?
Insurance coverage and FSA or HSA eligibility are separate. A treatment may be HSA eligible even if insurance does not cover it.
FSA vs HSA for Fertility Treatment (Summary)
Feature | Health Savings Account (HSA) | Flexible Spending Account (FSA) |
Who qualifies | Must be enrolled in a qualifying high-deductible health plan | Offered through employers |
Contribution limits | Higher limits with individual and family options | Lower annual limit set by federal rules |
Funds roll over | Yes, year to year | Usually use it or lose it, some plans allow limited carryover |
Ownership | Account belongs to you | Account belongs to the employer |
Employer contributions | Sometimes | Sometimes |
Can funds be invested | Yes, once balance meets plan minimum | No |
Eligible for IVF | Yes, when medically necessary | Yes, when medically necessary |
Eligible for IUI | Yes, when medically necessary | Yes, when medically necessary |
Eligible for fertility medications | Yes, when medically necessary | Yes, when medically necessary |
Eligible for PGT | Often yes, when medically necessary, confirm with plan | Often yes, when medically necessary, confirm with plan |
Eligible for donor sperm or donor eggs | Sometimes, when medically necessary | Sometimes, when medically necessary |
Surrogacy expenses | Generally not eligible | Generally not eligible |
Key Takeaway
FSAs and HSAs are powerful tools for reducing the cost of fertility treatment when care is medically necessary. By allowing patients to use pre-tax dollars, these accounts can meaningfully lower out-of-pocket expenses.
While annual contribution limits often mean FSAs and HSAs are used to offset part of the cost, individuals who have built up HSA balances over multiple years may be able to use these funds more extensively.
Understanding eligibility rules, obtaining proper documentation, and choosing an affordable clinic can make fertility treatment significantly more accessible.
Disclaimer:
This article is for educational purposes only and does not constitute financial, legal, or tax advice. Always consult your plan administrator or a qualified tax professional regarding your specific situation.
