▦ Avows · Eligibility guide · Fitness
The trick: most fitness purchases aren't eligible by default, but become eligible with a Letter of Medical Necessity (LMN) from your doctor. If you have a real condition that exercise treats — back pain, obesity, hypertension, anxiety, diabetes — your gym membership and recovery gear can be tax-free.
What's a Letter of Medical Necessity? A short note from your doctor stating that the item or service treats a specific medical condition. It's typically one paragraph. Avows generates pre-filled doctor-email templates for common conditions — see the in-app LMN flow. The LMN goes in your records; you submit it with your reimbursement claim.
No LMN required. Chiropractic visits and adjustments for back pain, neck pain, sciatica are eligible the same way an MD visit is. Many people don't realize this and pay out of pocket.
Track in VaultIRS Pub 502 §213(d) · HSA + FSA eligible
Also no LMN required. Acupuncture sessions for chronic pain, migraines, fertility, anxiety — all directly eligible. Cupping and similar Traditional Chinese Medicine modalities depend on the practitioner's licensing and the condition treated.
Track in VaultIRS Pub 502 §213(d) · HSA + FSA eligible
If a doctor prescribes massage for a specific condition (chronic pain, fibromyalgia, post-surgery recovery, severe anxiety), licensed massage therapy is eligible. The LMN should name the condition.
Track in VaultIRS Notice 2010-59 · HSA + FSA with LMN
Yes, really. If your doctor prescribes exercise for obesity, hypertension, type 2 diabetes, depression, or specific cardiac/orthopedic conditions, your gym membership becomes eligible. Boutique fitness, yoga studios, Pilates can qualify too.
Track in VaultIRS Pub 502 §213(d) · HSA + FSA with LMN
Same logic as a gym membership: if exercise is medically prescribed, the trainer fees follow. The LMN should specify the program type (e.g. "supervised resistance training for osteoporosis").
Track in VaultIRS Pub 502 §213(d) · HSA + FSA with LMN
Transcutaneous Electrical Nerve Stimulation devices for pain relief — eligible without LMN as durable medical equipment. Replacement pads, electrodes, and gels are also covered.
Shop on AmazonIRS Pub 502 §213(d) · HSA + FSA eligible
Medical-grade compression socks (15-20 mmHg or higher) are eligible without LMN if marketed for circulation, varicose veins, or DVT prevention. Athletic compression sleeves typically need an LMN.
Shop on AmazonIRS Pub 502 §213(d) · HSA + FSA eligible (medical-grade)
Theragun, Hyperice, and similar percussion massagers can be eligible with an LMN for chronic muscle pain, fibromyalgia, or post-injury recovery. The doctor's letter is the unlock.
Shop on AmazonIRS Pub 502 §213(d) · HSA + FSA with LMN
Foam rollers, lacrosse balls, mobility sticks — when prescribed for a physical therapy regimen or chronic muscular condition, they're eligible. Without an LMN, they're considered general fitness equipment and not eligible.
Shop on AmazonIRS Pub 502 §213(d) · HSA + FSA with LMN
Apple Watch, Fitbit, Whoop, smart scales — eligible only when prescribed for a specific medical purpose (cardiac monitoring, weight management for obesity, sleep apnea tracking). Generic fitness use doesn't qualify.
Shop on AmazonIRS Pub 502 §213(d) · HSA + FSA with LMN
Affiliate disclosure: Some "Shop on Amazon" links above are Amazon Associates links. If you buy something through them, Amazon pays Avows a small commission at no extra cost to you. It supports the project — and unlike everywhere else on the internet, that's the only thing it does. We don't track which links you click, we don't sell your data, we don't even know you came from this page.
This is not legal or tax advice. "With LMN" items require a doctor's Letter of Medical Necessity describing the specific condition treated. Plan administrators occasionally reject LMN-backed claims even when the IRS rules support them — your plan has final say. Avows can generate pre-filled doctor email templates for common conditions, but the doctor and the patient are the ones who decide if a condition warrants a letter.
Avows includes pre-filled email templates for common conditions — chronic pain, anxiety, sleep apnea, hypertension, obesity, diabetes — so you can ask your doctor in 30 seconds, not 30 minutes.
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