The complete guide to HRA eligible expenses in 2026

This blog was originally written in 2024 and has been updated with information for 2026.

A health reimbursement arrangement, or HRA, lets employers reimburse employees with tax-free dollars for qualified medical costs and, with certain plan types, individual health insurance premiums. Employees get the most out of the benefit when they know exactly what qualifies, since reimbursement that goes unclaimed is value left unused. This guide walks through what is HRA eligible in 2026, which HRA expenses now qualify that did not in years past, and where the line falls between an approved claim and a denied one.

How the IRS decides what is HRA eligible

Whether an expense counts as an HRA eligible expense traces back to one source of authority: Section 213(d) of the Internal Revenue Code, which defines medical care as amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting a structure or function of the body.¹ The IRS spells out the practical application of that definition in Publication 502, which serves as the working reference for HRA eligible items across nearly every plan.²

A few principles follow from that definition and are worth keeping in mind as you read the lists below. An expense generally qualifies when its primary purpose is medical rather than personal or cosmetic. Items that serve both a medical and a personal function, such as vitamins or a fitness program, usually require documentation showing a specific medical need. Employers also retain the ability to design a plan that covers fewer categories than the IRS permits, so the terms of an individual plan can be narrower than the full universe of what the tax code allows.

How your HRA type affects what you can submit

The type of HRA an employer offers shapes which HRA expenses are reimbursable, particularly when it comes to premiums.

An individual coverage HRA, or ICHRA, is available to employers of any size and is structured around the reimbursement of individual health insurance premiums purchased on the marketplace, with the option to add qualified medical expenses as well.

A qualified small employer HRA, or QSEHRA, is built for businesses with fewer than 50 full-time employees and can be designed to reimburse individual insurance premiums, qualified medical costs, or both.

For the medical, dental, vision, and pharmacy expenses covered in the rest of this guide, the eligible list is largely consistent across HRA types. The premium question is where plan design matters most.

What changed for 2026

The most recent expansions to the eligible list come from IRS guidance issued in 2024, and they are the additions employees are most likely to have missed. Notice 2024-71 established that condoms are treated as medical care and can be reimbursed under an HRA, FSA, or HSA.⁴ Notice 2024-75 followed by confirming that over-the-counter oral contraceptives, including emergency contraception, qualify as well.⁵ Neither requires a prescription, which places them alongside menstrual care products as everyday HRA approved items that many people still assume are excluded.

Weight loss medications are the other category drawing real attention heading into 2026. Prescription GLP-1 drugs such as semaglutide and tirzepatide are HRA eligible when a licensed provider prescribes them to treat a diagnosed condition such as obesity, type 2 diabetes, or a related metabolic disorder. When the prescription is written for weight management rather than a specific diagnosis, many administrators ask for a letter of medical necessity, so employees should request that documentation early and keep it with their receipts.

The complete list of HRA eligible expenses

The categories below cover the medical care, products, and services that qualify under most HRA plans in 2026.

Medical care and services

• Office visit copays, coinsurance, and amounts applied to a deductible

• Primary care, specialist, and OB/GYN visits

• Optometrist, ophthalmologist, and dermatologist visits

• Hospitalization and hospital services

• Surgical procedures and medical operations

• Anesthesia for medical, dental, and vision procedures

• Laboratory fees and diagnostic testing

• Medical X-rays and imaging

• Body scans

• Annual physical exams and preventive care

• Immunizations and vaccinations

• Ambulance service and emergency transportation

• Chiropractic care

• Acupuncture

• Physical therapy and occupational therapy

• Nursing services

• Addiction and alcoholism treatment

• Smoking cessation programs

• Services of a Christian Science practitioner

• Medical records charges
  
  

Mental and behavioral health

• Therapy and counseling that treats a diagnosed condition

• Psychiatric care

• Psychologist and psychoanalyst services

• Mental health counseling

Dental care

• Routine cleanings and exams

• Dental X-rays

• Fillings, crowns, and bridges

• Root canals

• Extractions and oral surgery

• Dentures

• Orthodontic treatment, including braces and retainers

• Occlusal guards to prevent teeth grinding

• Anesthesia for dental procedures

Vision care

• Eye exams and vision tests

• Prescription eyeglasses and reading glasses

• Prescription sunglasses

• Contact lenses, including saline solution and enzyme cleaner

• Laser eye surgery, including LASIK

• Other corrective procedures such as radial keratotomy and orthokeratology

Over-the-counter medicines and products (no prescription required since 2020)

• Pain relievers such as aspirin, ibuprofen, and acetaminophen

• Cold, cough, and flu medicine, including cough drops and syrup

• Allergy and sinus medication

• Over-the-counter asthma treatments

• Antacids and acid reducers

• Antibiotic ointment and anti-itch cream

• Acne medication and treatments

• Laxatives

• Sleep aids and sedatives

• Canker and cold sore treatment

• Lice treatment

• Wart removal products

• Diaper rash cream

• Nasal sprays and nasal strips

• Lactose intolerance medication

• Bandages, wound care supplies, and first aid kits

• Menstrual care products

• Condoms and spermicides

• Over-the-counter contraceptives, including emergency contraception

• Pregnancy and ovulation test kits

• Sunscreen rated SPF 15 or higher

• Incontinence and urological supplies

Prescription medications

• Prescription drugs of all kinds

• Insulin and diabetic supplies

Medical devices and equipment

• Blood pressure monitors

• Glucose monitors and continuous glucose monitors

• Crutches, walkers, wheelchairs, and other walking aids

• Hearing aids and batteries

• Breast pumps and related accessories

• Oxygen and oxygen equipment

• Artificial limbs and artificial teeth

• Orthotics, orthopedic supports, and surgical supports

• Splints and support braces

• Mastectomy-related specialized bras

• Guide dogs and other service animals, including their care

• Braille books and magazines, to the extent the cost exceeds a standard edition

• Thermometers and home test kits

• Medical equipment and repairs

Procedures and treatments

• Fertility treatment, including in vitro fertilization

• Pregnancy and childbirth care, including midwife services and childbirth classes

• Sterilization procedures such as vasectomy and tubal ligation

• Contraceptive implants, including insertion and removal

• Birth control, prescription and over the counter

• Legal abortion

• Dental and vision surgery

• Organ transplants

• Varicose vein removal when medically necessary

• Breast reconstruction following a mastectomy

• Gender-affirming care and related treatment

• Adoption-related medical expenses incurred for the child

• Cord blood storage when used to treat a medical condition

Travel and related costs

• Transportation that is primarily for and essential to medical care

• Lodging connected to medical, dental, or vision care, within IRS limits

• Legal fees necessary to authorize treatment for mental illness

HRA eligible expenses that require a prescription or letter of medical necessity

Some items qualify only when an employee can show they are treating a specific medical condition rather than supporting general health. These dual-purpose expenses typically call for a prescription or a letter of medical necessity from a provider.

• Vitamins and dietary or nutritional supplements

• Medicated toothpaste and similar dual-purpose products

• Homeopathic and alternative medicines

• Prescription weight loss drugs, including GLP-1 medications

• Doctor-supervised weight loss programs

• Exercise equipment and fitness programs prescribed for a specific condition

• Massage therapy

• Swimming therapy or other prescribed therapeutic activity

• Orthopedic shoes and inserts

• Compression socks

• A humidifier purchased for a respiratory condition

• Home modifications for disability access

• Vehicle modifications for a medical condition

• Special schooling and tutoring for a mental or physical disability

• Dyslexia and learning disability treatment

• Dermatology products

• Dental veneers when medically necessary

• Dietitian services

• Doula services

• Services of an alternative healer

Insurance premiums that may qualify

Premium reimbursement depends heavily on the HRA type, as noted earlier, but the IRS recognizes several categories of premiums as medical expenses.

• Individual health insurance premiums, including marketplace coverage, under a QSEHRA or ICHRA

• COBRA continuation premiums, reimbursable with a QSEHRA or ICHRA

• Dental and vision insurance premiums

• Prescription drug insurance premiums

• Medicare Part A and Part B premiums

• Medicare supplement premiums

• Long-term care insurance premiums, subject to age-based limits

• TRICARE premiums

• Medicaid and CHIP premiums

• Short-term medical insurance premiums, where the plan permits

What is not eligible for reimbursement under an HRA

The IRS draws clear lines around expenses that serve a personal, cosmetic, or general wellness purpose. The items below are generally not HRA eligible, though a few can qualify when a provider documents a specific medical need and the plan permits the claim.

Personal and family services

• Adoption fees

• Childcare

• Funeral expenses

• Marriage counseling

Insurance and membership fees

• Gym and athletic club memberships

• Automobile insurance premiums

• Life and cancer insurance premiums

Cosmetic and personal care

• Cosmetics and general toiletries

• Cosmetic procedures, unless required to correct a deformity from a birth defect, injury, or disease

• Teeth whitening and bleaching

• Face lifts and electrolysis

• Hair transplants, hair regrowth products, and non-medical hair treatment

• Hand lotions

• Dental floss

• Over-the-counter toothpaste

General health and wellness

• General vitamins and supplements that are not prescribed

• Elderberry supplements

• Immune products such as Airborne or vitamin C when not prescribed

• Weight loss foods purchased for general health

• Weight loss programs pursued for general health

• Sunscreen rated below SPF 15

• UV protection clothing

• Diapers, diaper pails, and baby powder

• Over-the-counter lactation items used for general purposes

Miscellaneous

• Concierge medical fees, depending on the plan

• CPR classes

• Long-term care services, which are generally not covered under an HRA

Common misconceptions about HRA eligible expenses

A few outdated assumptions still lead employees to either skip valid claims or submit ones that get denied. The most common involves over-the-counter medicine. Before 2020, the Affordable Care Act required a doctor's prescription before an HRA could reimburse OTC drugs, and a great deal of older guidance still reflects that rule. The CARES Act eliminated the requirement effective January 1, 2020, with no expiration date, so OTC pain relievers, cold and allergy medicine, antacids, and similar products are now reimbursable on their own.³ Employees who still believe they need a prescription are often leaving money unclaimed.

The opposite mistake is just as common, which is assuming that anything health-related qualifies. General wellness purchases such as gym memberships, everyday vitamins, and weight loss foods bought for general health are not HRA eligible unless a provider ties them to a specific diagnosis. The deciding factor is always whether the expense treats a medical condition rather than supporting overall health, and keeping that distinction in view prevents most denied claims.

Still have questions?

Take Command's HRA administration platform lets employees upload eligible expenses for fast approval and reimbursement. Talk to a Take Command expert for more information or to get started.

Frequently asked questions about HRA eligible expenses

Are over-the-counter medications reimbursable without a prescription?

Yes. Despite a lot of older guidance suggesting otherwise, OTC medicines have not required a prescription since 2020. Everyday products such as pain relievers, cold and allergy medicine, antacids, and first aid supplies are HRA eligible on their own, so employees only need to keep their receipts to submit them.

Are GLP-1 and other weight loss drugs HRA eligible?

Prescription weight loss medications, including GLP-1 drugs such as semaglutide and tirzepatide, are HRA eligible when a licensed provider prescribes them to treat a diagnosed condition like obesity or type 2 diabetes. When the prescription is written for weight management rather than a specific diagnosis, many plan administrators ask for a letter of medical necessity, so it helps to request that documentation at the first visit.

Are condoms, contraceptives, and menstrual products HRA eligible?

Yes to all three. The CARES Act made menstrual care products reimbursable in 2020, and IRS guidance issued in 2024 confirmed that condoms and over-the-counter contraceptives, including emergency contraception, count as qualified medical care. None of these require a prescription to submit.

Can I use my HRA for glasses?

Yes. Vision care is reimbursable under most HRA plans, and that includes prescription eyeglasses, reading glasses, and contact lenses. Non-prescription or purely cosmetic eyewear does not qualify unless a provider prescribes it for a medical reason.

Does an HRA cover copays?

Yes. Copays for office visits, prescriptions, and other medical services are reimbursable, which makes an HRA a practical way to offset routine out-of-pocket costs throughout the plan year.

Are over-the-counter medications reimbursable through an HRA?

Yes, and as of 2026 they no longer require a prescription. The CARES Act removed that requirement in 2020, so OTC pain relievers, cold and allergy medicine, antacids, and similar products are HRA approved items on their own.

Can I use my HRA for medical travel?

Generally yes, when the travel is primarily for and essential to receiving medical care. Transportation and lodging connected to treatment can qualify, so employees should keep detailed records and confirm the specifics with their plan administrator.

Does an HRA cover dental care?

Yes. Cleanings, exams, fillings, crowns, root canals, dentures, and orthodontics are all reimbursable. Cosmetic dental work, such as whitening, is not eligible unless it is medically necessary.

References

1. Internal Revenue Code, Section 213(d), Definition of medical care.

2. Internal Revenue Service, Publication 502, Medical and Dental Expenses.

3. Coronavirus Aid, Relief, and Economic Security (CARES) Act, Section 3702, effective January 1, 2020.

4. Internal Revenue Service, Notice 2024-71, Safe harbor for amounts paid for condoms.

5. Internal Revenue Service, Notice 2024-75, Preventive care benefits, over-the-counter contraceptives, and related guidance.

6. Internal Revenue Service, Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans.