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Can You Use Your FSA or HSA to Pay for Medical Massage?

Once considered a luxury, massage therapy is increasingly recognized as an alternative medical treatment or a complement to conventional medicine. Studies have shown health benefits when massage therapy is used for pain management, improve blood flow and circulation, decrease inflammation, or to reduce cortisol, the body’s stress hormone.

What is a Flexible Spending Account (FSA) and Health Savings Accounts (HSA)?

A flexible Spending Account and Health Savings Account (HSA) are both special healthcare arrangements where money may be set aside using pre-tax salary deductions for out-of-pocket healthcare expenses, such as deductibles, healthcare services not covered by insurance, monthly prescriptions, co-payments, and co-insurance. The money set aside is usually referred to as contributions. You do not pay taxes on this money, which means you will save an amount equal to the taxes you would have paid on the money you set aside. A debit card is usually provided with these healthcare plans that includes your contributions. For medical expenses that qualify, you will not need to submit information to get reimbursed, as your funds will already be on the flex debit card. In some cases, additional information may be requested for reimbursement such as an itemized receipt of the healthcare service or letter of medical necessity.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law March 27, 2020, has key updates on the use of HSAs and FSAs. These changes expand qualified medical expenses and access to remote care.

Telehealth Services

High-deductible health plans (HDHPs) with an HSA may provide pre-deductible coverage for teleheath and other remote care service. This provision will las until December 31, 2021 (plan year must begin prior to this date).

Coverage for over-the-counter (OTC) medications

The CARES act restores the ability to use HSAs and FSAs to purchase certain OTC medications, like aspirin and other pain medication, allergy medications, etc. without a doctor's prescription. For the first time, menstrual care products are considered qualified medical expenses for reimbursement with an HSA or FSA. Both provisions for OTC and menstrual products apply to expenses incurred on or after January 1, 2020 and will continue without an expiration date.

Helpful Link:

IRS Medical Expenses: IRS Publication 502

What is the difference between an FSA and HSA?

An HSA is an individual account designed to work together with an HSA-eligible high deductible health plan (HDHP). Eligible contributions are tax deductible, and you can use your HSA money tax free to pay for qualified medical expenses for you, your spouse, and your qualified dependents. The employee owns the account, which means you have the flexibility to take it with you if you move to a different state or change jobs. The 2021 contribution limit is $3,550 (individual coverage) and $7,100 (family coverage).

Employers offer Flexible Spending Accounts (FSA) during the annual open enrollment period, usually in the last quarter of the year. All employees are eligible regardless of whether they have insurance or not. The employer owns the account, so the funds may not be transferred if you leave your job. The contribution limit for 2021 is $2,750.

Main Differences:

  • To be eligible for an HSA, you must have a qualified high deductible health plan (HDHP). Unlike FSAs, HSAs are not “use-it-or-lose-it” and they generally cover a broader range of qualified medical expenses than flexible spending accounts (FSAs). Unused contributions may be rolled over to the next year.

  • Unused contributions for an FSA are lost at the end of the year if you do not spend it by the deadline. They do not rollover to the following tax year, and you cannot change the contribution amount once you have elected it during open enrollment.

Helpful Links:

Can I Use FSA or HSA for Massage Therapy?

Massage therapy can be a qualified medical expense if a medical condition is diagnosed by a physician or a chiropractor for which massage therapy may be incorporated into the treatment plan, whether it is a chronic condition or temporary, such as an injury or pre- and post natal discomfort. Medical expenses are the costs of diagnosis, cure, mitigating, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body. The IRS ruling states that medical care expenses must be primarily to alleviate or prevent a physical or mental disability or ailment. Examples of illnesses that qualify include carpal tunnel syndrome, stress, arthritis, diabetes, hypertension, fibromyalgia, chronic fatigue, anxiety, depression, and pain management.

Take these steps to pay for medical massage with your FSA or HSA plan:

1. Start with Your Benefits Plan Administrator in Human Resources.

Every company that administers FSA or HSA benefits may have different documentation requirements. Ask your benefits administrator what information is needed to cover medical massage under your FSA or HSA.

2. Get a Prescription from Your Physician or a Medical Letter from Your Chiropractor

Explain to your primary care physician or chiropractor, the symptoms you have for your

condition and how medical massage may be incorporated into your treatment plan.

There are a wide variety of mental and physical conditions that could qualify for a medical massage. Stress related symptoms, circulation issues caused by diabetes or hypertension, sciatica, arthritis, tinnitus, fibromyalgia, anxiety, depression, and chronic back pain are all examples of conditions that could qualify for massage therapy with a medical diagnosis that your doctor or chiropractor has identified.

The plan administrator will need this information as proof that massage therapy is part of your preventive health or treatment plan.

The prescription or letter will need to include the following information:

  • A reason you need massage therapy, such as to help manage a medical condition, manage the symptoms of a condition for preventive, or injury rehabilitation.

  • How often will you need massage therapy? Is it a few times a week, every week, or once a month?

How often you get a massage depends on your preventive health goals, medical

condition or injury, or stress level. You will get the most health benefits when you get

massages regularly. While it may be relaxing to get a massage at a full service spa,

going once or twice a year will not undo recurring muscle tension. Integrative health

centers, independent practitioners, and day spas may offer affordable options that will

allow you to incorporate massage therapy into your wellness plan more routinely.

Massage once every week or two is ideal for keeping tension and knots from forming

in your muscle tissues. If you have chronic pain or a medical condition, you may need

massage twice a week until you feel better.

  • The duration of the treatment. How long are you going to need this treatment? Routine massage is recommended to continue until the condition or injury improves. Once you are feeling good, once a month is the recommended minimum for maintaining health of your tissue. When medical massage is approved, it is usually covered for up to 12 months.

  • Including the medical diagnosis code is also very helpful in the prescription or letter. Diagnostic coding is used to translate written descriptions of diseases, medical services, and equipment into universal medical alphanumeric codes. These codes are part of the medical billing process to submit claims to be paid by insurance carriers.

“What you do every day, matters more than what you do once in a while.” -Gretchen Rubin

Start a routine and stay consistent to maintain a healthy lifestyle!

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