Generally, you cannot use your Health Savings Account (HSA) to pay for cosmetic dentistry. However, every rule has exceptions.
You can use your HSA to pay for necessary dental work. The treatments must aim to improve or maintain oral health.
Some dental procedures are both necessary and cosmetic. They keep your mouth healthy and improve your appearance.
What criteria do HSA administrators use to approve claims?
Learn the answer and see how it applies to you. Four examples that could be necessary or cosmetic are implants, braces, veneers, and tooth whitening.
HSA for Dental Implants
You can use your HSA to pay for dental implants. They can be both necessary and cosmetic, improving your smile by replacing missing or cracked teeth.
Many insurance plans see dental implants as cosmetic because dentures are the cheaper alternative. But an HSA follows different rules.
IRS Publication 502 lists what medical and dental expenses qualify.
Covered Implants
Dental implants usually qualify for HSA reimbursement. Publication 502 explicitly supports this coverage.
Publication 502 states, “You can include in medical expenses the amount you pay for artificial teeth.” Since dental implants are artificial teeth, your HSA administrator should approve most claims.
Contribution Limits
Your HSA plan administrator might deny your claim if you don’t have enough funds. Dental implants can cost $50,000 or more for a full-mouth replacement. However, the annual contribution limits are much lower.
- $4,300 for individuals
- $8,550 for family coverage
Maximizing your HSA tax savings requires a plan. Patients who replace multiple teeth can reimburse themselves in future years if they keep their high-deductible health plan.
HSA for Dental Braces
You can use your HSA to pay for dental braces, even though they have cosmetic benefits. A beautiful smile with aligned teeth improves appearance and self-confidence.
Publication 502 states, “Treatment to alleviate dental disease includes X-rays, fillings, braces, extractions, and dentures.” You must show that the orthodontia “alleviates dental disease.”
Metal Braces for Teens
Most HSA plan administrators will approve claims for metal braces to correct severe misalignment in teenage patients. This plan’s low cost, ideal age, and necessary treatment fit the criteria.
- Metal appliances are the least costly treatment alternative.
- Teenage years are ideal for straightening teeth before bones harden in adulthood.
- A handicapping malocclusion is a severe misalignment of the teeth and jaws that impairs oral function.
Your orthodontist should document the malocclusion using a scoring system like the Handicapping Labio-Lingual Deviation Score or the Salzmann Index.
Premium Braces for Adults
HSA plan administrators are more likely to deny claims when adult patients select premium braces. Expect resistance for two main reasons.
First, premium braces cost more than metal appliances. Adult patients pay extra for cosmetic benefits.
- Invisalign clear aligners are virtually invisible. They enhance your appearance during treatment.
- Lingual braces attach to the back of the teeth. They improve appearance since they are hidden from view.
Second, adults who skipped orthodontic treatment during their teens may not have a severe condition. Adult patients with a Class 1 malocclusion may not qualify.
- Class 1 malocclusion is the most common. The bite is normal, with a slight overlap of the upper teeth.
- Class 2 malocclusion, called retrognathism or overbite, occurs when the upper jaw and teeth severely overlap the bottom jaw and teeth.
- Class 3 malocclusion, or underbite, occurs when the lower jaw juts forward, causing the lower teeth to overlap the upper teeth.
HSA for Dental Veneers
Your HSA covers dental veneers less frequently. Custom-made shells that fit over your teeth are typically cosmetic. They usually improve appearance, not oral health.
Most plan administrators will reject veneer claims unless you can demonstrate that they alleviate dental disease.
Necessary Veneers
An HSA might pay for dental veneers to correct a disfiguring disease, injury, or congenital abnormality. Collaborate with your dentist to compose a letter of necessity and submit it to the administrator.
Some of these conditions might fit the IRS criteria.
- Personal injuries leading to broken or chipped teeth
- Disfiguring diseases causing eroded tooth enamel
- Acid reflux
- Celiac disease
- Enamel Hypoplasia
Veneer payment plans can help you get started while waiting for approval. However, the plan administrator may delay decisions when treatments fall into a gray area.
Cosmetic Veneers
Your HSA will reject claims for dental veneers deemed cosmetic. Most patients seek this treatment to improve appearance and confidence, not oral health.
These reasons for getting veneers do not qualify.
- Fill in gaps between teeth
- Cover coffee or red wine stains
- Change the shape or length of teeth
- Adjust minor misalignments
HSA for Tooth Whitening
Your HSA is least likely to cover tooth whitening. This procedure is the most difficult to prove necessary rather than cosmetic. A brighter smile improves appearance but does little for oral health.
However, some patients may have a chance.
Necessary Whitening
Your HSA might pay for tooth whitening if you can overcome an explicit IRS prohibition. Publication 502 states, “You can’t include in medical expenses amounts paid to whiten teeth.”
However, the statement references another section on cosmetic surgery: “You can include expenses to improve a deformity from a disfiguring disease.”
Removing stains caused by prescription medications might qualify.
- Bacterial Infections: Antibiotics
- High Blood Pressure: Antihypertensives
- Severe Allergies: Antihistamines
Cosmetic Whitening
Your HSA will not cover most tooth whitening treatments to address discoloration caused by coffee, red wine, sodas, smoking, or chewing tobacco.
IRS Publication 502 explicitly excludes this service. You cannot overcome the explicit exclusion without linking the whitening to a disease-related condition.
