Can I pay for therapy with my HSA or FSA?

A: Yes. Therapy that treats a mental health condition is an IRS-eligible medical expense, payable with HSA or FSA funds — including sessions with cash-pay therapists your insurance doesn't cover.¹ Paying with pre-tax dollars effectively discounts every session by your tax rate.

Worked example: $160/session paid from an HSA, 30% combined tax rate → the session really costs you about $112. Over 40 sessions, that's $1,920 kept.

Do this: pay with the HSA/FSA card and keep the receipt or superbill. If your plan administrator asks, a "letter of medical necessity" from your provider settles eligibility. Note: general life coaching isn't eligible — licensed treatment is.

Source: 1. IRS Publication 502, Medical and Dental Expenses (therapy) — irs.gov.