Paying from an HSA or FSA, and the records to keep

The short version

A health savings account (HSA) and a flexible spending account (FSA) both hold money set aside for medical costs. Both are meant to pay for qualified medical expenses. What counts, how you pay, and what records you need depend on your account and its rules, so your plan administrator is the one to ask.

What you can do on your own is keep good records. That part is the same whichever account you have.

Check before you pay

Before you pay for a scan, test, or procedure from an HSA or FSA, confirm with your plan administrator that it counts as a qualified medical expense under your account. Ask how they want you to pay: with the account’s card, or by paying yourself and asking to be reimbursed. Ask what documentation they need if they review the payment.

Note the date you asked and what they told you. If the answer was in writing, keep it with your records.

If the service is for a spouse or dependent, ask about that too. Whose account can pay for whose care is a question for the administrator, not a guess to make at the front desk.

Keep itemized receipts

A card slip that only shows a total is not enough on its own. Ask the provider for an itemized receipt that shows:

• The provider or facility name and address.
• The date of service.
• What the service was, by name.
• The amount charged and the amount you paid.
• Your name as the patient, or the name of the family member who received the care.

Keep the estimate and the bill with the receipt

For self-pay care, the receipt is one of three documents worth keeping together. The written Good Faith Estimate shows what you were told it would cost. The bill shows what you were charged. The receipt shows what you paid, and when.

Keeping all three in one place helps in two ways. If your account administrator asks what a payment was for, you have the answer. If the bill came in well above the estimate, you have what you need to compare them.

A simple filing habit

Pick one place for these records and use it every time. A folder on your phone, a folder in a drawer, or both. Scan or photograph paper receipts the day you get them, since thermal paper fades. Name each file the same way, for example the date of service, the provider, and the service. Keep the records for as long as your plan administrator or a tax professional tells you to.

BoDirect Plus includes a receipt folder for exactly this: each estimate, bill, and receipt filed by service and date, kept for you and only you.

What this guide does not cover

Contribution limits, tax treatment, deadlines to use FSA money, and whether a specific service qualifies all depend on your account and your situation. For those, ask your plan administrator, and for tax questions, a tax professional.