Care for a chronically ill parent can already count as medical care.

Seven questions show if paid care fits the HSA rule, and which papers their doctor needs. Your answers are never sent.

Check the rule: 2 minutes → See a sample letter

A licensed practitioner decides whether to certify. Your plan makes the final call.

On device
The 2-minute check
Doctor
Certifies, or does not
Your plan
Makes the final call
§7702B
The rule it follows

HSA Letter in 15 seconds

Text version:
  1. Paying for Mom's care after tax? A paid caregiver helps with bathing, dressing and meals.
  2. That care can count as medical. If she is chronically ill and care follows a plan of care: IRS §213(d).
  3. A practitioner decides. They can say no; your plan has the last word.
  4. Today: check the rule. Seven questions, run on your device. Your answers are never sent.
  5. HSA Letter. Know the HSA rule for their care. hsaletter.com

See a sample letter.

What a letter of medical necessity usually contains, so you know what to ask the person’s own doctor for. Clearly watermarked and unsigned, with names and details invented for illustration. Only a physician who agrees with a letter signs it.

[Physician name], DO
Internal Medicine · Telehealth
State-licensed physician
NPI: SAMPLE
License #SAMPLE
Date: SAMPLE

Re: Letter of Medical Necessity — qualified long-term care services

Patient: Sample Patient · DOB 0·/0·/19·· · Care requested: Personal care assistance (bathing, dressing, meals) from a licensed home care agency, not a relative

To whom it may concern:

I am the treating physician for the above patient. Based on my clinical evaluation, I certify that the patient is a chronically ill individual as 26 U.S.C. §7702B(c)(2) defines the term, and that the services below are required by that individual and are provided under the plan of care I have prescribed.

Certification (dated: SAMPLE)

  • Diagnosis: Parkinson disease with progressive gait and balance impairment (ICD-10 G20.x).
  • Unable to perform bathing and dressing without substantial assistance, and expected to need it for at least 90 days.
  • Certified within the last 12 months; to be renewed each year.

Plan of care

Help with bathing and dressing four mornings a week and with meal preparation, from a caregiver employed by a licensed home care agency, for 12 months, reassessed at the next visit. The written plan of care is attached.

[Signature line — blank in this sample]
[Physician name, credentials]
Unsigned sample. A real letter would carry the physician’s own name, license number and NPI, and only if they chose to sign.
ILLUSTRATIVE SAMPLE ONLY. Not a real patient, diagnosis, or physician signature. Issuance of any letter depends on individual clinical review; not all requests qualify. This sample does not guarantee plan approval.

Start with the co-op.care assessment →

Care for a chronically ill loved one is medical care by statute

This is the part most people get backwards, and it decides whether a letter holds up.

A letter cannot turn a personal expense into a medical one. In March 2024 the IRS said so directly (IR-2024-65) — notes based on self-reported information do not convert food, wellness or exercise spending into medical care, and real documentation requires a visit with the diagnosing and treating provider, in person or by telehealth.

But qualified long-term care services are already medical care under IRS §213(d) via §7702B(c), when two conditions hold: the person is chronically ill, and the services follow a plan of care prescribed by a licensed health care practitioner. Nothing is being converted. The certification is what the law asks for.

The standard we apply. Unable to perform at least two activities of daily living for 90 days or more without substantial assistance, or requiring substantial supervision because of severe cognitive impairment. Certified within the last twelve months, renewed annually. Personal and maintenance care count when they are part of that plan of care — which is why help with bathing, dressing, meals and supervision sits comfortably inside the definition.

What we decline. General fitness and wellness. Food and supplements for general health. Any request that arrives as “write me a letter so I can pay for this.” And anyone who does not meet the standard above — we tell you up front. A review that never says no is not a review.

Check this first. HSA funds cover you, your spouse, and your dependents, including a parent you could claim as a dependent except for their income (IRS Publication 969). If you are paying for a parent, that is the question that most often decides whether any of this works.

Check your situation against this standard, point by point → Seven questions, on your device, with a printable list of what the paperwork needs. Then practice asking the doctor for an honest assessment.

The IRS sets a yearly HSA contribution limit, higher for family coverage, with a catch-up from age 55; the 2026 figures are in IRS Rev. Proc. 2025-19. Your tax rate decides the share of a qualifying expense you keep.

General information, not tax or legal advice. Eligibility depends on IRS rules, your plan’s terms and your circumstances.

One more rule — and it is the one that most often voids a good letter

Everything above is about who certifies. This is about who delivers the care.

Under §213(d)(11), payment for long-term care is not treated as paid for medical care when the care is provided by your spouse or a relative — and the statute closes the obvious workaround by adding “directly or through a partnership, corporation, or other entity.” Routing a family member’s work through an LLC does not fix it.

Plainly: paying a non-relative professional caregiver for a chronically ill parent is the ordinary, workable case. But a daughter who leaves her job to care for her mother cannot be paid for that from an HSA — however real the need, however genuine the visit, however well-written the letter. We would rather you know that now.

The one carve-out is licensure. The statute excludes a relative’s care “unless the service is provided by a licensed professional with respect to such service.” A family member who holds a nursing or aide license, working within it, is not excluded — so for a family caregiver, getting licensed changes how the care they already give is treated.

“Relative” follows §152(d)(2)(A)–(G): children, siblings, parents, grandparents, aunts and uncles, nieces and nephews, in-laws. General information, not tax advice.

Checking one purchase, not paid care?

This page is about paid care for a chronically ill person. For a single product or service, the ComfortCard covered-care check asks about the person and the help they need, not about the purchase, and it says no when the answer is no. If you are sorting a list of everyday health expenses into IRS buckets, use the on-device expense sorter at agentichsa.com.

Open the covered-care check at comfortcard.org → Sort a list of expenses at agentichsa.com →

A letter should read like a chart note, not a brochure.

A good letter sets out the diagnosis, the clinical reasoning, the care requested, the expected benefit and the duration. No template-speak and no marketing claims. Plan administrators can tell the difference.

This page stores nothing about you.

Common questions

Will my HSA/FSA always approve this?

No service can promise that. Each plan administrator makes the final determination based on IRS rules, your plan document, and the documentation provided. A letter in §213(d) format, written only if a physician agrees after reviewing the case, is the kind of documentation plans look for. It supports a claim; it does not decide it.

Who certifies, and who signs a letter?

A licensed health care practitioner (a physician, registered nurse or licensed social worker) certifies that a person is chronically ill (26 U.S.C. 7702B(c)(2) and (c)(4)). A letter of medical necessity is written and signed by a physician who knows the case, under their own name and license, or the physician declines. HSA Letter does not issue letters. An unsigned draft is never a letter.

What if the doctor says no?

That is their call to make. Ask what is missing, and run the check again if the care or the person’s needs change. The practice page rehearses hearing a no.

What does the rule ask for in writing?

Two things: a licensed health care practitioner's certification, dated within the last 12 months, that the person is chronically ill, and a plan of care that practitioner prescribes for the help being paid for. The 2-minute check lists which of these your case is missing.

How long does a certification last?

The rule asks for a certification dated within the last 12 months, renewed each year (26 U.S.C. 7702B(c)(2)). Your plan may ask for its own renewal as well, so check your plan document.

Is this medical advice?

No. The check sorts your answers against the rule; it is general information, not medical, tax or legal advice. Any letter reflects the clinical judgment of the physician who signs it.

Where to go next

Pick the need that matches yours. Each link goes to a page that works today.

Does the rule fit?Seven questions on your device, then a printable list of what the paperwork needs. Find paid careThe co-op.care assessment, for care from someone who is not a relative. You give the care yourselfSupport for a family caregiver. The rule treats a relative's care differently. Keep the papersThe ComfortCard family file holds receipts and letters on your own device. One purchase, not paid careThe covered-care check asks about the person and says no when the answer is no. Sort a list of expensesThe on-device IRS bucket sorter for everyday health expenses, at agentichsa.com. Plan their wishesCare Wishes: fifteen short cards, tapped not typed, kept on your device.