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I understand that an HSA can be used for qualified medical expenses, and that LASIK falls under this category. I'm considering getting LASIK done and would like to use my HSA to pay for it.

However, it will take a couple years to build up enough of a balance to cover the surgery. If I, instead, elect to get same-as-cash financing through the LASIK provider, can I make those payments from my HSA? In other words, are those payments recognized as being for a qualified medical expense, or are they disqualified because they are payments on a debt? Or is the answer to this determined by the rules of the HSA provider and not the US tax code?

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From HSA Resources -

I understand that I can reimburse myself from my HSA for qualified medical expenses that I pay out-of-pocket but is there a time limit? Do I need to reimburse myself in the same year?

You have your entire lifetime to reimburse yourself. As long as you had your HSA established at the time the expense was incurred, you save the receipt and it was not otherwise reimbursed, you can reimburse yourself for the expense from your HSA even years later.

The important thing not asked or mentioned above is that the HSA must be in place before the expense occurred. In your case, should the LASIK procedure be before the HSA is established, it's not an eligible expense.

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  • Excellent, thank you. Does this imply, then, that if I finance $3600 to make $100 payments each month for three years, that I can reimburse myself piecemeal ($100 per month) because I have a receipt to the finance company? Or do I need to wait until I pay it off completely and reimburse myself $3600 in one payment because that's what the qualified medical receipt is for?
    – Nicholas
    Jul 7, 2014 at 16:11
  • I'd only take reimbursements as fast as I make payments.
    – JTP - Apologise to Monica ♦
    Jul 7, 2014 at 16:20
  • The website for the HSA I use does allow me to setup a recurring payment to my doctor. I have not used this feature, and I don't know what happens if there isn't enough money in the account when the monthly transaction is due.
    – mhoran_psprep
    Jul 7, 2014 at 17:56
  • @mhoran_psprep - A requested payment would just not finish the transaction if there aren't funds to cover it. In my HSA, that's how it's handled.
    – JTP - Apologise to Monica ♦
    Jul 7, 2014 at 18:00
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    @Nicholas, my understanding is that from the point of view of the IRS, the amount you distribute (withdraw) from your HSA account does not need to match up to a particular receipt, as long as the total amount you distribute is always equal or less than the total of your receipts. With that in mind, you can pull the money out of your HSA immediately after the deposit clears. That being said, some banks do request that you provide receipts and they could disallow your scenario, but that's because they choose to do it that way, not because they must.
    – TTT
    Jul 9, 2014 at 21:28

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