A physician-signed Letter of Medical Necessity certifies that home care or companion care for a chronically ill person is medically necessary, which is what HSA and FSA reimbursement requires. General fitness and wellness are declined.
At a 30% combined federal and state tax rate, $59/mo in pre-tax HSA spending costs about $41/mo out of pocket.
| Line item | Annual |
|---|---|
| co-op.care membership | $708/yr ($59/mo) |
| HSA pre-tax savings (30% bracket) | −$212/yr |
| Effective cost after tax savings | ~$496/yr (~$41/mo) |
Standalone LMN without membership: $199 flat. If your care spend is $1,000+/yr, the LMN pays for itself in the first year. HSA savings assume you pay membership fees from your HSA account using the LMN to establish eligibility. Actual savings depend on your tax bracket and plan rules.
No appointment required. The physician reviews your intake asynchronously and delivers a signed letter.
Answer a short intake about the care situation — who needs care, what conditions are present, and what type of support is needed at home.
A licensed physician (MD or DO) reviews your intake. If the medical necessity is supportable, they sign the Letter of Medical Necessity — typically within 48 hours.
Submit the signed letter to your HSA or FSA administrator. Use your account to pay for eligible expenses. Renew annually.
A two-minute check that asks about the person and the help they need — not about a purchase — and gives an honest no when it should. It runs in your browser and stores nothing.
LMN included. Full care coordination for aging parents — matching, scheduling, care plans, and ongoing physician oversight.
A physician encounter, and documentation only where the clinical picture supports it. Strongest for care of a chronically ill loved one. We decline requests that do not meet the standard, and we say so before you pay.
This is the part most people get backwards, and it is the difference between a letter that holds up and one that does not. A letter cannot turn a personal expense into a medical one. But qualified long-term care services are already medical care under the tax code — and the statute names the documentation it wants.
Two conditions have to be met. The services must be required by a chronically ill individual, and they must be provided pursuant to a plan of care prescribed by a licensed health care practitioner. That is the whole mechanism. We are not converting anything; we are producing the certification and plan of care the statute already asks for.
“Chronically ill” has a precise meaning, and it is the standard we apply: certified as unable to perform at least two activities of daily living for at least 90 days without substantial assistance, or requiring substantial supervision because of severe cognitive impairment. Certification within the previous twelve months, renewed annually.
Personal and maintenance care count when they are part of that plan of care — which is why help with bathing, dressing, meals and supervision for a parent with dementia sits comfortably inside the definition, while a gym membership does not.
What we decline. General fitness and wellness. Food and supplements for general health. Anything where the request arrives as “I want a letter so I can pay for X” rather than a clinical picture. And anyone who does not meet the chronic-illness standard above — we will tell you before you pay, not after.
One thing to check first. HSA funds can pay for you, your spouse, and your tax dependents. If you are paying for a parent, they generally need to qualify as your dependent. We ask this at intake because it is the question that most often decides whether any of this works.
General information, not tax or legal advice. Eligibility depends on IRS rules, your plan’s terms, and your own circumstances.
One more rule, and it is the one that most often voids an otherwise perfect letter. Everything above is about who certifies. This is about who delivers the care.
Under §213(d)(11), payment for long-term care services is not treated as paid for medical care if the care is provided by your spouse or a relative — and the statute closes the obvious workaround by adding “directly or through a partnership, corporation, or other entity.” Routing a family member’s work through an LLC does not cure it.
What this means plainly: paying a non-relative professional caregiver for a chronically ill parent is the ordinary, workable case. But a daughter who leaves her job to care for her mother cannot be paid for it from an HSA — no matter how real the need, how genuine the encounter, or how well-written the letter. We would rather you know that now than after you have paid us.
The one carve-out is licensure. The statute excludes a relative’s care “unless the service is provided by a licensed professional with respect to such service.” A family member who holds a nursing or aide license, working within it, is not excluded. If you are a family caregiver, becoming licensed changes how the care you already give is treated.
“Relative” here follows §152(d)(2)(A)–(G): children, siblings, parents, grandparents, aunts and uncles, nieces and nephews, in-laws. General information, not tax advice.
IRS Section 213(d) allows HSA and FSA funds to pay for expenses that treat or mitigate a diagnosed medical condition. Many wellness services qualify — but the connection to a specific condition must be documented. That is what an LMN does.
Some categories — physical therapy, acupuncture — are already recognised medical expenses and generally need no letter. Others sit far closer to the line, and a letter alone will not move them across it. In March 2024 the IRS specifically warned that notes based merely on self-reported information do not convert a personal expense into medical care, and that documentation requires a real visit with the diagnosing and treating provider. We do not write those letters. General fitness, wellness and food expenses are declined.
| Category | Typical annual spend | Common conditions | LMN required? |
|---|---|---|---|
Home care & companion care Personal care, ADL support, supervised living assistance |
$5,000 – $40,000 | Dementia, fall risk, COPD, post-surgical recovery | LMN required |
Chiropractic care Spinal adjustment, musculoskeletal treatment |
$600 – $3,600 | Back pain, neck pain, sciatica, headaches | Generally no LMN |
Physical therapy PT sessions, home exercise programs |
$1,200 – $6,000 | Post-surgical rehab, orthopedic injuries, neurological conditions | Generally no LMN |
Acupuncture Licensed acupuncturist sessions |
$600 – $3,000 | Chronic pain, nausea, migraines, arthritis | Generally no LMN |
Nutrition counseling & medical meal plans Registered dietitian, therapeutic diet programs |
$600 – $2,400 | Obesity, diabetes, cardiovascular disease, eating disorders | LMN required |
Home modifications for medical need Grab bars, ramps, stair lifts, walk-in shower conversions |
$500 – $10,000 | Fall risk, mobility impairment, wheelchair use, post-surgical recovery | LMN required |
One letter covers one category for 12 months. A separate letter is needed for each additional category. HSA plan administrator makes the final eligibility determination.