Google's new Fitbit Air is officially HSA/FSA eligible for qualifying customers, giving you more ways to use your pre-tax health savings. But before you rush to check out, it helps to understand how HSA and FSA eligibility actually works for wearables—because for most devices, it's a little more complicated than it sounds.
How FSA and HSA eligibility works for wearables
Health Savings Accounts and Flexible Spending Accounts let you set aside pre-tax dollars to pay for qualified medical expenses. The IRS determines what counts as true medical expenses, and historically, fitness trackers and smartwatches haven't made the cut on their own. The IRS has ruled that devices of this type are generally used to promote "general health," not to treat or monitor a specific medical condition, which means they typically don't clear the bar for qualified medical expenses.
According to the FSA Store's eligibility list, a wearable device becomes eligible when it is necessary for treating or monitoring a specific medical condition, as opposed to just for general wellness. This is where a “Letter of Medical Necessity” comes in.
What is a Letter of Medical Necessity?
A Letter of Medical Necessity (LMN) is essentially a doctor's note that classifies a specific purchase as a qualified medical expense under IRS guidelines. To get one, your physician must certify that the device in question will be used to treat or monitor a legitimate medical condition, such as obesity, a heart condition, sleep apnea, or diabetes. Once you submit that LMN to your benefits administrator, your wearable purchase will most likely be approved for reimbursement.
When it comes to securing your LMN, you might not even need to make a doctor's appointment, thanks to certain third-party players like Truemed partnering with a number of health tech companies. You'll see the option to “Pay With Truemed” at checkout at Whoop, Coros, and Amazfit, to name a few. From there, you'll be asked a few questions about your health circumstances, and you’ll be matched with a provider to determine your eligibility. If you qualify, you’ll get an LMN that will allow you to use your HSA or FSA funds to complete your purchase.
How to use your HSA/FSA funds to buy a Fitbit Air (or any health tracker)
Once you've confirmed your eligibility—ideally with an LMN in hand—there are two main ways to use your pre-tax health dollars to purchase a wearable: paying directly with your FSA or HSA card at a qualifying retailer, or paying out of pocket and submitting for reimbursement afterward.
Option one: Pay directly with your FSA or HSA card
The simplest method is to use your FSA or HSA debit card at the point of sale, the same way you'd use any other credit card.
Confirm the retailer accepts FSA/HSA payments. Major retailers like Amazon, Walmart, and Target accept FSA/HSA cards for eligible items, and the Google Store may accept them directly for the Fitbit Air, given its certified eligibility status. Specialty health retailers like FSA Store and HSA Store are also strong options, as everything they sell is pre-vetted for eligibility.
Have your LMN ready. Even if you're paying directly with your card, your plan administrator may follow up and request documentation. Keep your LMN accessible.
Swipe your card and save your receipt. The transaction may go through without any extra steps, but if your administrator later flags the purchase, your receipt and LMN are your proof.
Note: If your wearable isn't on a pre-approved eligibility list, your FSA card may be declined at the register even if you have a valid LMN. In that case, you can try option two.
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Option two: Pay out of pocket, then submit for reimbursement
If your FSA card doesn't work at checkout—or if you'd rather buy from a retailer that doesn't support FSA/HSA payment—you can pay with any form of payment and request reimbursement from your plan administrator afterward.
Purchase the device using a personal credit card or any other payment method, and keep your itemized receipt.
Obtain your Letter of Medical Necessity if you haven't already. Your doctor will need to specify your diagnosis, explain why the device is medically necessary, and confirm it's being prescribed to treat or monitor your condition (not just for general wellness).
Log in to your benefits portal or contact your plan administrator. Most FSA and HSA administrators have an online portal where you can submit reimbursement claims directly.
Upload your documentation. You'll typically need to submit your itemized receipt and your LMN together. Some administrators may also ask for additional information about the device.
Wait for approval and payment. Processing times vary by administrator, but most claims are reviewed within a few business days to a few weeks. If approved, you'll be reimbursed from your FSA or HSA balance via direct deposit or check.
If the Fitbit Air isn't your style, check out these other major brands offering HSA/FSA-eligible fitness trackers.
The bottom line
Even if a device is marketed as health-focused, that doesn't automatically make it FSA or HSA eligible. For most smartwatches and fitness trackers, eligibility hinges on your documentation, not just the device features appearing medically sound. Some administrators scrutinize wearable purchases more closely than others, and approval is never guaranteed. If you have a qualifying medical condition and a physician willing to support your case with an LMN, you may be in great shape to put those pre-tax dollars to work.
FSA funds are use-it-or-lose-it on an annual basis (with some grace period exceptions), so timing matters. If you're near the end of your plan year and have a balance to spend, a qualifying wearable purchase could be a smart way to put those funds to work before they expire. HSA funds, by contrast, roll over indefinitely, so there's less urgency (but the reimbursement process is the same).
Also worth noting: you can reimburse yourself from an HSA for a past eligible purchase at any time, even years later, as long as you have the receipt and documentation. That flexibility makes HSA accounts particularly useful for health tech purchases. Whatever you buy, keep meticulous records. The IRS expects you to be able to back up every HSA purchase you make, and good record-keeping is the simplest way to protect yourself if questions ever arise.
