Finally, products that truly move the needle for our health are being recognized.
Fitness equipment at an average of 30% off - this is incredible!
HSA & FSA funds have typically only been allowed to be used for things like co-pays, medicine, band-aids, sunscreen, etc. Now, these are all really great things, but the HSA & FSA space has been due for an upgrade for quite some time.
Companies like TrueMed (whom we don’t recommend, and explain why later), the space is gaining a lot of traction. They have put a huge emphasis on products that mostly fall under the category of “preventative medicine.” We are talking about saunas, gym equipment, cold plunges, supplements, sleep aids, etc. These are things that promote healthy living and absolutely are just as important (in some cases, more so) as traditional purchases through HSA & FSA funds.
Now, you may be thinking - “Okay, cool, but why does this matter?”
Let’s break it down.
What are HSA & FSA accounts?
HSA stands for health savings account. It is essentially a health investment account. The account is a pre-tax account, meaning you can contribute straight from your paycheck before any taxes are taken out.
For the average person, this equates to a roughly 30% savings, which is huge.
Your HSA grows tax-free and can be used for medical expenses at any point. You can invest within your HSA, similar to a brokerage account. An HSA is a great tool for managing healthcare costs for you and your family. So if it’s so great, why doesn’t everyone have one? Well, you have to be eligible, and this depends on your healthcare plan. If you aren’t sure, you can check with your plan provider or benefits administrator.
FSA stands for flexible spending account. These accounts are not quite as cool as an HSA.
This doesn’t mean they are bad; however, the biggest negative about an FSA is that the funds expire at the end of the year. Unlike an HSA, your account must be spent each year.
This is unfortunate, but because not everyone has access to an HSA, an FSA can still be an awesome tool if you plan accordingly. So, if you plan to make a specific purchase next year or have recurring health expenses each year, you can plan ahead and save the part of your paycheck that would normally go to Unlce Sam.
So, in summary here, the biggest benefit of both accounts is having access to your tax-free money. I mean that’s like saying you make 75k a year and walking home with 75k; unfortunately, as all 16-year-olds quickly learn, that’s not how paychecks work.
Note - there are limits on contributions, similar to retirement accounts.
Okay, but how does this connect to fitness equipment?
What’s a Letter of Medical Necessity?
This is the key.
A Letter of Medical Necessity is essentially a letter from a medical provider that states that a certain product is medically necessary for the health of the patient. Now, this doesn’t have to mean life-saving. After all, is sunscreen life-saving? Not really. Basically, an LMN states that a doctor believes a product or intervention would benefit your health.
In the US, we have a large percent of the population that is chronically ill. We have known for decades the important role that exercise, sleep, and food selection play in fighting chronic disease - things like diabetes, obesity, high blood pressure, etc. Well, HSA & FSA funds are starting to catch up.
After all, what is more important for your health than exercise? Whether it is cardio or strength training, I’d argue that nothing is more important for the health society as a whole than exercise, well maybe relationships, but that’s a whole other article right there.
Let’s take a quick look at a study from Mandsager et all. 2018. In this study, they looked at 122,000 patients with an average age of 53. They had each of them take a VO2 max test. They then ranked them by percentile:
- Low (0-25th percentile)
- Below Average (26th-50th percentile)
- Above Average (50th-75th percentile)
- High (76th to 95th percentile)
- Elite (top 5th percentile)
They then calculated the reduction in mortality over a decade.
Here’s what’s interesting - going from low to below average is a 50% decrease in mortality over the span of a decade. This means that if you stay in the low category your odds of mortality are DOUBLE the below average patient. Going up from low to above average brings you to a 60-70% overall decrease in mortality. And just to blow your mind a little more, if you are comparing the elite and the low categories, it is a 5x difference in mortality.
Now let’s put this in comparison. Smoking and diabetes equates to a 40% increase over a decade. That is less than having a low VO2 max compared to a BELOW Average - which is a 100% increase.
We haven’t even gotten into strength training. We’ll have to save that for another time, but please, please lift weights. Yes, you. Everyone should lift weights.
Okay, let’s get back on track. I just had to show how important exercise is to your health. So, all that being said, you would think a letter of medical necessity would be the easiest thing in the world to obtain.
TLDR; exercise is a huge driver for longevity and health.
How to Get a LMN?
Letters of Medical Necessity come from your doctor.
Here are some things to make sure are on your LMN:
- The need for help or problem
- How the exercise equipment will help the issue
- How the exercise equipment will be used
In full transparency, you may encounter some trouble with certain providers. As the space is evolving, some providers may not be quite as aware or as accommodating when looking to buy fitness equipment.
Here’s an excerpt from the FSA store website:
“Exercise equipment are any machines or equipment used for physical exercise. This includes treadmills, weights, and more (Harvard Health Publishing). Exercise equipment must be used to treat a specific medical condition in order to be considered eligible for reimbursement under a consumer-directed health care account. Exercise equipment used for general health and wellbeing is not eligible for reimbursement.
Some specific medical conditions may require exercise equipment, which a doctor can determine and prescribe. Examples of specific medical conditions for which a doctor may prescribe exercise equipment include obesity, diabetes, high blood pressure, and more. Weight loss plans are not an acceptable reason for reimbursing the cost of exercise equipment.”
Hopefully you can see the contradictions and the ambiguity here. For example, “a doctor can prescribe exercise equipment [which] include[s] obesity” and then, “Weight loss plans are not an acceptable reason.”
Huh?!
If it was up to me, HSA and FSA funds would be not only allowed, but encouraged to be used on fitness equipment; some, may not see it this way. Don’t be discouraged if your doctor says no. Certainly make sure you are legally within the bounds of your account, as companies like Truemed may try to shortcut this process by getting an LMN that may later get rejected.
Unfortunately, we can’t tell you exactly what will and won’t count, as #1) we aren’t doctors and #2) we don’t know your current health situation. The only benefit to me writing your LMN is that at least you could read it. I’m convinced doctors are required to take “Illegible Writing 101” in med school.
All jokes aside, in the coming years, our hope is that the barricades continue to fall around purchasing fitness equipment with HSA & FSA funds. But as of now, it is possible, especially if you have a pre-existing condition. Be sure to consult your provider to determine eligibility.
I’ve Got a LMN, Now What?
Let’s go!
Now, you are good to purchase the equipment or products listed on your LMN. Make sure to stay within the bounds of the letter as each LMN will be slightly different and vary on the patient.
But assuming your letter is for fitness equipment, you can now use your LMN and you HSA and/or FSA funds to purchase that fitness equipment you’ve been eyeing. That $200 barbell is essentially now $140. That treadmill that was $2500, well now you are looking at 1750. These savings are huge if you are eligible!
You can either use your HSA or FSA debit card or pay from personal funds and reimburse yourself from your accounts.
BE SURE, you keep all receipts and any letters of medical necessity received. You will need to have these if you need to prove your eligibility.
Sources
Attia, Peter. “How does VO2 max correlate with longevity?” Peter Attia, 17 May 2022, https://peterattiamd.com/how-does-vo2-max-correlate-with-longevity/.
Fidelity Investments. “What is an HSA and how does it work? | Fidelity.” Fidelity Investments, 13 May 2025, https://www.fidelity.com/learning-center/smart-money/what-is-an-hsa.
FSA Store. “Exercise Equipment: FSA Eligibility.” FSA Store, https://fsastore.com/fsa-eligibility-list/e/exercise-equipment?srsltid=AfmBOoqdqMit96f9qKDVVVq8D_P1dVUCAiHxhFimQM09CIdNWOvvZo6M.
Helhoski, Anna. “Flexible Spending Account (FSA) Explained.” NerdWallet, 31 January 2025, https://www.nerdwallet.com/article/health/what-is-flexible-spending-account.
Truemed. “How to Get a Doctor’s Note for HSA Eligibility in 2024.” Truemed, 6 December 2024, https://www.truemed.com/blog/how-to-get-a-letter-of-medical-necessity-for-hsa.
Truemed. “What Is a Letter of Medical Necessity (LMN)?” Truemed, 27 March 2025, https://www.truemed.com/blog/what-is-a-letter-of-medical-necessity-lmn.