HSAs, FSAs, and HRAs — What’s Eligible

These accounts let you use pre-tax dollars to pay for medical and fertility-related expenses. The trick is understanding the rules—each account has different contribution limits, rollover rules, documentation requirements, and reimbursement restrictions. When used correctly, these accounts can reduce out-of-pocket costs across IVF, medications, donor cycles, monitoring, surrogacy-related medical care, and legal work tied to medical necessity.

Where It Fits:
Right after you get your clinic’s treatment plan and a cost estimate—before you begin paying out-of-pocket.

What It Changes:

• Lowers taxable income
• Reduces medication and procedure costs by 20–35% depending on tax bracket
• Smooths cash flow when aligned with cycle timing
• Allows predictable budgeting for scattered costs (labs, monitoring, emergency meds)

How Upstream Decisions Affect Downstream Results:

• Choosing the wrong account type may block reimbursement later
• Missing enrollment windows eliminates access for a full year
• Delayed documentation slows reimbursement, affecting treatment timelines
• Mislabeling expenses can trigger denials and long appeals

Who It Helps

You’re a good fit for this pathway if you have:

• A high-deductible health plan and access to an HSA
• An employer offering an FSA or HRA, especially with fertility-friendly eligibility
• A treatment plan requiring medications, procedures, or monitoring over several months
• Surrogacy-related medical costs that can be tied to medical necessity
• Plans for multiple cycles or embryo banking where tax savings compound
• Donor eggs, donor sperm, or gestational carrier care supported by medical need

You may need a different strategy if:

• You have no employer-sponsored benefits and are self-insured
• You are paying for non-medical surrogacy expenses (agency, compensation, travel) that aren’t eligible
• You anticipate major life changes that reduce tax advantages (extended leave, job change)
• our plan excludes fertility benefits entirely and you cannot demonstrate medical necessity

Step-by-Step

A simple sequence with timing checkpoints that reduce risk and stress:

1. Confirm which accounts you have (HSA, FSA, HRA)
   Check employer documents, portals, and open enrollment options.
2. Identify eligible fertility and surrogacy-related expenses
   Include diagnostics, monitoring, medications, egg/embryo/sperm handling, embryo storage, genetic tests, IVF procedures, and medically necessary surrogacy costs.
3. Request an itemized cost estimate
   Match clinic timelines with contribution schedules and reimbursement cycles.
4. Submit required documentation early
   Some plans require letters of medical necessity or itemized receipts before approving reimbursement.
5. Time contributions around treatment cycles
   Ensure funds are available before medication ordering, retrievals, frozen transfers, or surrogacy-related medical milestones.
6. Track every expense in real time
   Use your portal or app to avoid missing deadlines, especially for FSAs.
7. File claims immediately
   Faster submissions reduce the risk of denials and improve cash flow.

Pros & Cons

Pros

• Significant tax savings (often thousands per cycle)
• Smooth, predictable reimbursement
• Eligible for a wide range of fertility expenses
• HSAs accumulate and roll over indefinitely
• HRAs may cover expenses not included in your insurance benefits

Cons

• FSAs have use-it-or-lose-it constraints
• Some plans exclude donor or surrogacy-related care
• Documentation can be cumbersome
• Reimbursement delays can affect treatment timing
• Not all clinics provide itemized receipts automatically

Costs & Logistics

Line Items That Typically Qualify:

• Diagnostic labs and ultrasounds
• IVF, ICSI, retrieval, transfer procedures
• Anesthesia
• Fertility medications
• Cryopreservation (eggs, embryos, sperm)
• Embryo storage
• Genetic testing when medically indicated
• Medically necessary gestational carrier-related care (screenings, labs, transfer-related care)

May Qualify With Documentation:

• Donor egg or sperm when medically necessary
• Psychological screening
• Legal fees directly tied to medical eligibility or consent requirements

Usually Not Eligible:

• Surrogacy agency fees
• Surrogate compensation
• Donor compensation
• Travel, lodging, or childcare unless explicitly allowed by IRS rules or plan design

Key Logistics:

• HSA: best long-term value; funds roll over indefinitely
• FSA: time-sensitive; spend within the plan year or grace period
• HRA: employer-funded; rules vary widely and can be more generous
• Keep every invoice, EOB, and receipt
• Track prior authorizations for procedures tied to reimbursement
• Align HSA/FSA contributions with cycle milestones (e.g., retrieval, FET, surrogacy medical clearances)

What Improves Outcomes

Actions that materially change results:

• Getting itemized estimates early
• Securing letters of medical necessity before claims
• Aligning cycle calendars with contribution timing
• Using portals to upload documents immediately
• Checking eligibility lists before paying out-of-pocket
• Keeping all documentation organized for fast dispute resolution

Actions that rarely improve outcomes:

• Arguing eligibility without written support
• Submitting incomplete receipts
• Waiting until end-of-year to spend FSA funds
• Over-contributing without a treatment timeline

Case Study

A real-world path from confusion to clarity

A couple planning IVF had an FSA, an HSA, and a partial fertility benefit but weren’t sure which expenses qualified. Initially they paid for labs and medications out-of-pocket, assuming “none of this is covered.” After reviewing eligibility rules, they:

1. Identified $6,800 in eligible expenses
2. Obtained a medical necessity letter for IVF with ICSI
3. Filed FSA claims immediately and used their HSA for medications
4. Adjusted contributions to fund upcoming frozen transfers

Outcome:

• They saved over $1,900 in taxes
• Reimbursement delays disappeared
• Treatment pacing improved thanks to predictable cash flow

Mistakes to Avoid

Common traps and how to dodge them:

• Missing enrollment windows — set reminders during open enrollment.
• Assuming all surrogacy or donor expenses are ineligible — some are eligible with documentation.
• Not requesting itemized invoices — needed for nearly all claims.
• Waiting until cycle day 1 to check available funds — medications often require same-day payment.
• Ignoring plan-specific rules — FSA/HRA rules vary dramatically by employer.
• Letting FSA funds expire — track spend against cycle milestones.

FAQs

Q. Are IVF and embryo freezing eligible expenses?

Ans : Yes, when medically necessary and supported by documentation.

Q. Can I use HSA or FSA funds for donor eggs or sperm?

Ans : Yes, if medically necessary. Some plans require extra documentation.

Q. Are surrogacy costs eligible?

Ans : Only the medical portions tied to the intended parent’s medical care—not agency or compensation costs.

Q. Do genetic tests qualify?

Ans : Many do, especially if linked to a medical diagnosis or physician recommendation.

Q. What if a reimbursement is denied?

Ans : You can appeal with receipts, treatment plans, or a medical necessity letter.

Q. Can I use these accounts and insurance together?

Ans : Yes—HSAs/FSAs/HRAs cover the remainder after insurance processes the claim.

Next Steps

• Free 15-min nurse
• consult Upload your labs for review
• Get a personalized cost breakdown for your case

Related Links

• Financing insurance benefits
• Intended Parents
• Become a Surrogate
• Fixed‑Cost Packages
• SART
• CDC ART
• ASRM