Is Online Therapy eligible for HSA/FSA?

Online therapy is generally eligible for HSA and FSA reimbursement, as long as it's provided by a licensed professional and documented appropriately. Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) can be a lifesaver when it comes to paying for care, but can you really use them for virtual therapy?

The short answer: Yes, oftentimes you can! The long answer: Let’s break it down.

HSAs vs. FSAs: What You Need to Know About Paying for Therapy

While HSAs and FSAs get grouped together, there are some key differences between them.

HSA (Health Savings Account):

• Available only if you have a high-deductible health plan (HDHP). 
• Funds roll over year to year (you don’t lose what you don’t spend).
• You don’t need to submit documentation for reimbursement upfront, just keep records in case of an IRS audit.
• Can be used for therapy if it’s medically necessary and with a licensed provider.

FSA (Flexible Spending Account):

• Available through many employers, regardless of your insurance type.
• “Use it or lose it” model so most funds expire at the end of the plan year (some plans allow a small rollover or grace period).
• Documentation is always required when submitting a claim (receipt, Superbill, or Explanation of Benefits). Your documentation should have the provider’s credentials and name, date and duration of session, the amount paid, description of service. 
• Can also be used for therapy with a licensed provider, but sometimes may require a letter of medical necessity.

What Makes Therapy HSA/FSA Eligible?

There are a few requirements to ensure your care is covered by these pre-tax medical dollars. In order for therapy to be HSA/FSA eligible:

• It must be medically necessary. You don’t need a formal diagnosis, but the care should support your mental health.
• You have to see a licensed mental health professional. This includes psychologists, clinical social workers, or licensed counselors. Therapy interns, trainees, or those with alternative certifications not recognized by state boards are not covered by HSAs and FSAs. 
• You should have documentation. One of the perks of an HSA is that documentation is not required when seeking reimbursement. You only need to have it on hand if you’re audited. With an FSA, documentation is required when submitting a claim. Usually this comes in the form of a receipt or Superbill. 

What About Online or Teletherapy?

Online therapy is eligible if the provider is licensed and sessions are similar to in-person care. Platforms like Connect by Spring Health meet these standards, and benefits can often be used for more than just talk therapy. That includes co-pays, medication management visits , and other forms of support.

Can I Use My HSA/FSA Card Directly?

Yes! Especially on platforms that allow direct HSA and FSA payments. Just be sure to save your documentation in case of an audit.

What Doesn’t Qualify?

While these services can be meaningful and supportive for your well-being, they aren’t classified as eligible medical care under IRS guidelines, which means you generally can’t use pre-tax HSA or FSA dollars to pay for them:

• Life Coaches – Even if they help with goals or motivation, they aren’t licensed medical providers.
• Spiritual Counselors or Energy Healers – Services like Reiki or spiritual guidance don’t count as medical care.
• Unlicensed Therapists – Therapy from trainees, interns, or those with unrecognized certifications.
• Alternative Therapies – Art therapy, somatic work, hypnotherapy, etc., unless provided by a licensed clinician with documentation.
• Support Circles / Peer Groups – Grief circles or anxiety support groups led by peers (not licensed therapists).
• Dating or Relationship Coaches – Focus on personal growth, not medical treatment.
• Meditation or Mindfulness Classes – Unless prescribed by a licensed provider, they’re considered general wellness.
• Couples therapy – Unless couples therapy is deemed medically necessary, it’s usually not covered by an FSA or HSA. 
• Missed appointment fees  

From Spring Health:
We make it simple to use your HSA or FSA for eligible mental health care. With easy access to the documentation you need, getting support shouldn’t be confusing, it should be accessible, affordable, and focused on you.