Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) offer a tax-advantaged way to pay for mental health care, potentially saving you 20-30% on therapy costs. If you have one of these accounts, you can use pre-tax dollars to pay for online therapy sessions, psychiatric care, and related mental health expenses.
This guide explains exactly what's covered, how to use your accounts, and which online therapy platforms accept HSA/FSA payments.
HSA vs. FSA: Key Differences
While both accounts let you pay for healthcare with pre-tax money, they work differently:
| HSA | FSA | |
|---|---|---|
| Eligibility | Must have high-deductible health plan (HDHP) | Available through most employer plans |
| 2025 Contribution Limit | $4,300 (individual) / $8,550 (family) | $3,300 |
| Rollover | Yes—funds never expire | Generally use-it-or-lose-it (some plans allow $640 rollover) |
| Portability | You own it—stays with you if you change jobs | Tied to employer—may lose if you leave |
| Documentation | Keep records for potential audit | Usually required to submit with claims |
What Mental Health Expenses Are Eligible?
The IRS determines which expenses qualify as "medical care." For mental health, most services from licensed providers are eligible:
Generally Eligible
- • Individual therapy sessions
- • Psychiatric consultations
- • Prescription mental health medications
- • Treatment for diagnosed conditions (anxiety, depression, PTSD, etc.)
- • Substance abuse treatment
- • Copays and deductibles for mental health services
- • Psychological testing
- • Online therapy with licensed providers
Generally NOT Eligible
- • Life coaching
- • Marriage counseling (unless for diagnosed condition)
- • Spiritual counseling / energy healing
- • Therapy from unlicensed providers
- • Peer support groups (unless led by licensed clinician)
- • Self-help apps without clinical component
- • Wellness retreats
⚠️ Important Note on Marriage/Couples Counseling
Couples therapy for general relationship improvement typically doesn't qualify. However, if you're seeking therapy to address a diagnosed mental health condition that affects your relationship (like depression or anxiety), it may be eligible. Some administrators require a Letter of Medical Necessity (LOMN) from your provider.
Platforms That Accept HSA/FSA
Most online therapy platforms accept HSA and FSA debit cards as a payment method. Here's the breakdown:
BetterHelp
Accepts HSA/FSA cards directly
Talkspace
Accepts HSA/FSA cards directly
Cerebral
Accepts HSA/FSA cards directly
Calmerry
Provides superbills for reimbursement
Online-Therapy.com
Accepts HSA/FSA cards
Regain
Accepts HSA/FSA cards directly
Brightside
Accepts HSA/FSA cards directly
How to Pay with Your HSA/FSA
Using your health savings account for online therapy is straightforward:
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1
Pay directly with your HSA/FSA debit card
When signing up or paying for a subscription, enter your HSA/FSA card as the payment method. Most platforms process these like regular debit cards.
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2
Pay out of pocket and get reimbursed
Pay with a regular card, then submit a claim to your HSA/FSA administrator with receipts showing the provider, service type, and amount paid.
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3
Keep your documentation
Save all receipts, invoices, and superbills. For HSAs, you don't submit upfront but need records if audited. For FSAs, you typically submit with your claim.
What Documentation Do You Need?
To substantiate your mental health expenses, keep records that include:
- • Receipts or invoices showing provider name, date, service type, and amount
- • Explanation of Benefits (EOB) if you also used insurance
- • Superbill from your provider (itemized statement with procedure codes)
- • Letter of Medical Necessity (LOMN) for services that may need additional documentation
Most online therapy platforms can provide receipts or superbills on request. Check your account settings or contact customer support.
Tax Savings Example
Using your HSA/FSA saves you money because contributions are made with pre-tax dollars. Here's how much you could save:
Example: $3,000 spent on therapy
22% Tax Bracket
$660 saved
32% Tax Bracket
$960 saved
Plus savings on FICA taxes (7.65%) if contributed through payroll
Common Questions
Can I use my HSA/FSA for online therapy if I don't have a diagnosis?
What if my HSA/FSA card is declined?
Can I use HSA funds for my dependent's therapy?
Is the unlimited messaging feature on BetterHelp HSA/FSA eligible?
The Bottom Line
Using your HSA or FSA for online therapy is a smart way to reduce your out-of-pocket costs by paying with pre-tax dollars. Most online therapy platforms accept these payment methods, making it easy to use your health savings for mental health care.
Remember to keep documentation, understand what's eligible under IRS rules, and check with your specific plan administrator if you have questions about coverage for particular services.