Finally, products that actually move the needle for our health are getting recognized.
Fitness equipment purchased with pre-tax dollars, at an average savings of 30 percent for qualified customers. That is a real shift.
HSA and FSA funds have historically been limited to things like co-pays, medicine, bandages, and sunscreen. Those are all fine. But the HSA and FSA space has been due for an upgrade for a long time.
Companies like Truemed have pushed that upgrade forward, focusing on products that may qualify when they are used to manage a specific health condition. Saunas, gym equipment, cold plunges, sleep aids. None of these qualify automatically, and none of them qualify for general wellness. But when a practitioner determines that equipment is medically appropriate for a condition you actually have, the door opens. We now work with Truemed directly, which means qualified customers have a clear path to using their HSA or FSA on gear that may qualify.
You may be thinking, “Okay, cool, but why does this matter?”
Let's break it down.
What Are HSA and FSA Accounts?
HSA stands for health savings account. Think of it as a health investment account. It is a pre-tax account, meaning you contribute straight from your paycheck before any taxes come out.
For the average person, that works out to roughly 30 percent saved on the dollars you contribute, though your actual rate depends on your tax bracket and where you live.
Your HSA grows tax-free and can be used for qualified medical expenses at any point. Worth knowing: if you pull money out for something that is not a qualified medical expense before age 65, you owe income tax on it plus a 20 percent penalty. Used correctly, though, you can invest within it much like a brokerage account, and it is a genuinely good tool for managing healthcare costs for you and your family.
So if it is that good, why doesn't everyone have one? Eligibility requires enrollment in a high-deductible health plan. If you are not sure whether yours qualifies, check with your plan provider or benefits administrator.
FSA stands for flexible spending account. These work differently, and for most people an HSA is the more flexible of the two.
That does not make an FSA bad. The main drawback is that for most plans, the funds expire at the end of the year. Unlike an HSA, the account generally has to be spent annually. Some plans offer a grace period or allow a limited amount to carry over, and deadlines vary, so confirm yours with your administrator.
Since not everyone has access to an HSA, an FSA is still a strong tool if you plan ahead. If you know you are making a specific purchase next year, or you have recurring health expenses, you can set aside the part of your paycheck that would otherwise go straight to Uncle Sam.
So in summary, the biggest benefit of both accounts is spending your own money before it gets taxed. On the dollars you route through the account, you are keeping what would have gone to withholding. As every 16-year-old learns fast when they see their first paycheck, that is not how the rest of your income works.
One note: there are annual contribution limits, similar to retirement accounts.
Okay, but how does this connect to fitness equipment?
What Is a Letter of Medical Necessity?
A Letter of Medical Necessity, or LMN, is documentation from a licensed practitioner stating that a specific product is medically necessary for a patient's health. It does not have to mean life-saving. Is sunscreen life-saving? Not really. An LMN states that a practitioner has determined a product or intervention would benefit your health.
In the US, we have known for decades how much exercise, sleep, and food selection matter in fighting chronic disease, things like diabetes, obesity, and high blood pressure. HSA and FSA rules are finally starting to catch up.
What is more important for your health than exercise? Whether it is cardio or strength training, few things come close.
Take a look at Mandsager et al., 2018, published in JAMA Network Open. Researchers followed 122,007 patients with a mean age of 53 who had been referred for symptom-limited exercise treadmill testing. That test estimates cardiorespiratory fitness, and patients were sorted into five bands against others of the same age and sex:
- Low, below the 25th percentile
- Below Average, 25th to 49th percentile
- Above Average, 50th to 74th percentile
- High, 75th to 97.6th percentile
- Elite, 97.7th percentile and above
Median follow-up ran 8.4 years, across 1.1 million person-years of observation.
Here is what they found. Comparing the least fit group against the most fit, the adjusted risk of death was roughly fivefold higher for low performers. Even at the top end, elite performers had lower risk than high performers, and the researchers found no upper limit where the benefit stopped.
Now compare that to something else. In the same study, smoking was associated with a 41 percent higher adjusted risk of death, and diabetes with 40 percent. Dropping one band in fitness, from above average to below average, was associated with a 41 percent higher risk. Same number. The authors concluded that the risk tied to lower cardiorespiratory fitness was comparable to or greater than traditional clinical risk factors.
Two things worth keeping in mind. This was an observational study, so it shows association rather than proof that raising your fitness causes those outcomes. And the patients were people referred for clinical treadmill testing, not a cross-section of the general public. The signal is still hard to ignore.
We have not even touched strength training. That deserves its own article, but almost everyone benefits from some form of resistance training. If you are starting out or managing a condition, ask your practitioner what makes sense for you.
Back on track. I had to show how much exercise matters, because you would think an LMN would be the easiest thing in the world to get.
TLDR: fitness is strongly associated with longevity and health.
How Do You Get an LMN?
There are two routes.
The traditional route is through your own healthcare provider. If you go that way, make sure the letter covers:
- The condition or problem being addressed
- How the exercise equipment helps that issue
- How the equipment will be used
In full transparency, this route can be slow, and results vary. The space is still evolving, and some providers are less familiar with equipment purchases than others.
The second route is Truemed, which is why we partnered with them. You complete a clinical intake form about your health history and what you are working on. An independent licensed practitioner reviews it and issues an LMN if you qualify. It happens online, and it takes a fraction of the time.
To be clear about what we can and cannot tell you: neither Truemed nor we decide whether you qualify. That determination is made by the independent practitioner reviewing your form, and no one can promise an outcome in advance.
The rules themselves can feel contradictory, and it is worth understanding why. FSA Store's guidance on exercise equipment explains that machines and weights are only eligible when used to treat a specific medical condition, never for general health and well-being, and that a provider may prescribe equipment for conditions including obesity, diabetes, and high blood pressure. In the same breath, it rules out Weight loss plans as an acceptable reason for reimbursement.
You can probably spot the tension. Obesity is listed as a qualifying condition, and then weight loss is ruled out as a reason.
Huh?
If it were up to me, HSA and FSA funds would not only be allowed for fitness equipment; they would be encouraged. Not everyone sees it that way yet. Either way, stay within the bounds of your account and your letter, and keep your documentation clean.
We cannot tell you exactly what will and will not count, for two reasons. We are not practitioners, and we do not know your health situation. What we can tell you is that the process is a lot more accessible than it was five years ago.
Our hope is that the barriers around buying fitness equipment with HSA and FSA funds keep coming down. As of now, it is possible, particularly if you are managing an existing condition.
I've Got an LMN, Now What?
Let's go.
You are now clear to purchase the equipment or products listed on your letter. Stay within its bounds, since every LMN is slightly different and specific to the patient.
Assuming your letter covers fitness equipment, you can put your HSA or FSA funds toward the gear you have been eyeing. On a $200 barbell, a qualified customer paying with pre-tax funds is looking at average savings around $60. On a $2,500 treadmill, closer to $750. Your own number depends on your tax situation and your plan.
You can either use your HSA or FSA debit card directly, or pay from personal funds and reimburse yourself from your account.
Keep every receipt and every Letter of Medical Necessity you receive. You will need them if you ever have to substantiate the expense.
*Truemed is for qualified customers. HSA/FSA tax savings vary. Qualified customers save an average of 30 percent by paying with pre-tax funds; individual savings vary. Learn more at truemed.com/disclosures.
Nothing in this article is tax, legal, or medical advice. Freedom Fitness Equipment is not a law firm, an accounting firm, or a financial advisor. Eligibility depends on your plan and on a licensed practitioner's determination. Confirm with your plan administrator or tax advisor.
Study cited: Mandsager K et al. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Netw Open. 2018;1(6):e183605.