In 2022, the average American spent approximately $12,914 on healthcare, according to data from the Centers for Medicare & Medicaid Services (CMS).
A Health Savings Account (HSA) is a valuable tool to help manage and reduce these costs. An HSA is a specialized savings account designed to cover qualified medical expenses, including doctor visits, prescription medications, and even service animals.
Mental health conditions affect one in five Americans. A psychiatric service animal can play a vital role in managing these conditions, offering support and improving quality of life.
You can use your HSA to cover expenses related to an emotional support animal (ESA), but specific conditions must be met. Eligible expenses may include the cost of purchasing, training, and maintaining your ESA.
You may also read: Can FSA Benefits be Spent on Service Animals?
What Documentation Do You Need?
To qualify for HSA reimbursement, you must obtain a Letter of Medical Necessity (LMN) from a licensed medical professional.
This letter confirms that your ESA is essential for treating a diagnosed mental or physical health condition and that it provides benefits beyond other forms of treatment or medication.
Without this letter, your HSA reimbursement request will likely be denied.

Key Questions Before Using Your HSA
Does Your Assistance Animal Qualify?
To use HSA funds for your ESA, the animal must primarily serve a medical purpose. Therapy and companion animals typically do not qualify. Under the Americans with Disabilities Act (ADA), a service animal is defined as a dog or miniature horse trained to perform specific tasks for someone with a disability.
Examples include:
- A dog trained to alert a deaf person.
- A dog trained to calm someone with PTSD.
Emotional support animals, on the other hand, assist with mental health conditions such as anxiety, depression, phobias, and mood disorders.
How Does HSA Reimbursement Work?
When using your HSA to pay for qualified expenses, you have two options:
1. Paying Directly from Your HSA
If you choose to pay directly from your HSA, you can use:
- An HSA debit card, which works like a regular debit card for qualified purchases.
- Checks linked to your HSA account.
- Online payments through your HSA administrator’s portal, if available.
2. Paying Out of Pocket and Reimbursing Later
If you don’t have enough funds in your HSA at the time of purchase, you can pay for the expense yourself and reimburse the cost later.
To do this:
- Log into your HSA portal and transfer funds to your bank account.
- Request a check from your HSA administrator.
- Use your HSA debit card to withdraw funds, if permitted.
Important Considerations
- Keep detailed records: Save all receipts and documentation to prove that your expenses qualify for HSA reimbursement. You’ll need to report reimbursements to the IRS using Form 1099-SA.
- Contribution limits: For 2022, you can contribute up to $3,650 for self-only coverage and up to $7,300 for family coverage into an HSA, according to Healthcare.gov.
- Rollover benefits: Unlike Flexible Spending Accounts (FSAs), HSA funds roll over year to year, and any interest or earnings are tax-free.
Remember, owning a service or emotional support animal can be costly. According to the National Service Animal Registry, the initial cost of a service animal ranges from 15,000 to 30,000, with additional expenses for training and maintenance.
📌 At Wave Tax we can advise you or your family on the importance of HSAs and their many benefits.
Contact us at info@wavetax.us