Not open yet

Care for a chronically ill parent can already count as medical care.

Letters are not open yet. When they open, a licensed physician will review each case and, only when clinically appropriate, sign an IRS §213(d) Letter of Medical Necessity. Until then, estimate what paying pre-tax could be worth for you.

Nothing is for sale today, there is no turnaround promise, and no opening date is set. Letters open only once a physician is reviewing real cases.

Does this care fit the rule? 2-minute check → Sample letter & savings estimate

We cannot promise your plan administrator will approve any specific expense — eligibility depends on IRS rules and your plan's terms. When letters open, the physician decides whether to write one; what you spend on care remains your decision.

On device
Savings estimate
Not open
Letters, for now
Physician
Would sign or decline each case
§7702B
The rule it follows

HSA Letter in 15 seconds

Text version:
  1. Paying for Mom's care after tax? A paid caregiver helps with bathing, dressing and meals.
  2. That care can count as medical. If she is chronically ill and care follows a plan of care: IRS §213(d).
  3. Planned: a physician decides. Not open yet. A physician can say no; your plan has the last word.
  4. Today: estimate what it is worth. Your spend times your tax rate, run on your device.
  5. HSA Letter. Know the HSA rule for their care. hsaletter.com

How it will work

Not open yet. When letters open: a short intake, a physician review, and a letter only if the physician finds it appropriate.

01

Start with the care

Who needs help, with what, and for how long. Not a purchase. The 2-minute check you can run today asks the same questions.

02

A physician reviews

A licensed physician reads your case, checks it against the rule, and decides whether a letter is appropriate. No rubber-stamping.

03

A letter, only if appropriate

If the physician decides to sign, you would get a letter that sets out the points the rule asks for. If not, no letter is issued.

04

Submit to your plan

Send the letter and your receipts to your HSA or FSA plan. Your plan administrator makes the final determination. You can keep the papers together in your ComfortCard family file, on your own device.

See a sample letter.

This is a representative sample — clearly watermarked, with names and details fabricated for illustration. When letters open, each would be written from your own intake, and only a physician who agrees with it would sign it. Move the slider to see what those pre-tax dollars are actually worth.

[Physician name], DO
Internal Medicine · Telehealth
State-licensed physician
NPI: SAMPLE
License #SAMPLE
Date: SAMPLE

Re: Letter of Medical Necessity — qualified long-term care services

Patient: Sample Patient · DOB 0·/0·/19·· · Care requested: Personal care assistance (bathing, dressing, meals) from a licensed home care agency, not a relative

To whom it may concern:

I am the treating physician for the above patient. Based on my clinical evaluation, I certify that the patient is a chronically ill individual as 26 U.S.C. §7702B(c)(2) defines the term, and that the services below are required by that individual and are provided under the plan of care I have prescribed.

Certification (dated: SAMPLE)

  • Diagnosis: Parkinson disease with progressive gait and balance impairment (ICD-10 G20.x).
  • Unable to perform bathing and dressing without substantial assistance, and expected to need it for at least 90 days.
  • Certified within the last 12 months; to be renewed each year.

Plan of care

Help with bathing and dressing four mornings a week and with meal preparation, from a caregiver employed by a licensed home care agency, for 12 months, reassessed at the next visit. The written plan of care is attached.

[Signature line — blank in this sample]
[Physician name, credentials]
Unsigned sample. A real letter would carry the physician’s own name, license number and NPI, and only if they chose to sign.
ILLUSTRATIVE SAMPLE ONLY. Not a real patient, diagnosis, or physician signature. Issuance of any letter depends on individual clinical review; not all requests qualify. This sample does not guarantee plan approval.

What paying pre-tax could be worth

When care qualifies as medical care, paying it from an HSA or FSA means paying it pre-tax. Here’s the estimate on your spend.

$2,400
Estimated tax saved / yr
$720
Estimate only, if your plan administrator approves the expense.
Start with the co-op.care assessment →

Estimate only. Savings = eligible spend × your tax rate, assuming the expense is approved by your plan administrator. This is not tax advice.

Care for a chronically ill loved one is medical care by statute

This is the part most people get backwards, and it decides whether a letter holds up.

A letter cannot turn a personal expense into a medical one. In March 2024 the IRS said so directly — notes based on self-reported information do not convert food, wellness or exercise spending into medical care, and real documentation requires a visit with the diagnosing and treating provider, in person or by telehealth.

But qualified long-term care services are already medical care under IRS §213(d) via §7702B(c), when two conditions hold: the person is chronically ill, and the services follow a plan of care prescribed by a licensed health care practitioner. Nothing is being converted. The certification is what the law asks for.

The standard we apply. Unable to perform at least two activities of daily living for 90 days or more without substantial assistance, or requiring substantial supervision because of severe cognitive impairment. Certified within the last 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 sits comfortably inside the definition.

What we decline. General fitness and wellness. Food and supplements for general health. Any request that arrives as “write me a letter so I can pay for this.” And anyone who does not meet the standard above — we tell you up front. A review that never says no is not a review.

Check this first. HSA funds cover you, your spouse, and your tax dependents. If you are paying for a parent, they generally need to qualify as your dependent — it is the question that most often decides whether any of this works.

Check your situation against this standard, point by point → Seven questions, on your device, with a printable list of what the paperwork needs. Then practice asking the doctor for an honest assessment.

General information, not tax or legal advice. Eligibility depends on IRS rules, your plan’s terms and your circumstances.

One more rule — and it is the one that most often voids a good letter

Everything above is about who certifies. This is about who delivers the care.

Under §213(d)(11), payment for long-term care is not treated as paid for medical care when 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 fix it.

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 that from an HSA — however real the need, however genuine the visit, however well-written the letter. We would rather you know that now.

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 — so for a family caregiver, getting licensed changes how the care they already give is treated.

“Relative” follows §152(d)(2)(A)–(G): children, siblings, parents, grandparents, aunts and uncles, nieces and nephews, in-laws. General information, not tax advice.

Checking one purchase, not paid care?

This page is about paid care for a chronically ill person. For a single product or service, the ComfortCard covered-care check asks about the person and the help they need, not about the purchase, and it says no when the answer is no.

Open the covered-care check at comfortcard.org →

A letter should read like a chart note, not a brochure.

When letters open, one would set out the diagnosis, the clinical reasoning, the care requested, the expected benefit and the duration, for the physician to edit or decline. No template-speak and no marketing claims. Plan administrators can tell the difference.

This page stores nothing about you. The calculator runs on your device.

Common questions

Will my HSA/FSA always approve this?

No service can promise that. Each plan administrator makes the final determination based on IRS rules, your plan document, and the documentation provided. When letters open, an LMN in §213(d) format, written only if a physician agrees after reviewing your case, is the kind of documentation plans look for. It supports a claim; it does not decide it.

Who signs the letters?

When letters open: a licensed physician, under the appropriate state license, who reviews each case and signs only when it is clinically appropriate, or declines. No ghost-signing. The physician's own name and license number would appear on any letter they sign.

What if I'm denied a letter?

When letters open, if the physician finds a letter is not appropriate, you would be told why. We would rather decline than write something that won't hold up.

What does the rule ask for in writing?

Two things: a licensed health care practitioner's certification, dated within the last 12 months, that the person is chronically ill, and a plan of care that practitioner prescribes for the help being paid for. The 2-minute check lists which of these your case is missing.

How long does a certification last?

The rule asks for a certification dated within the last 12 months, renewed each year (26 U.S.C. 7702B(c)(2)). Your plan may ask for its own renewal as well, so check your plan document.

Is this medical advice?

When letters open, each letter would reflect a physician's clinical judgment. It's not a substitute for a care relationship with your regular provider. The physician is not prescribing any drug and is not taking over your primary care.

The 5-year picture: what tax-free compounding actually builds

The rule asks for a certification dated within the last 12 months, renewed each year. HSA money you invest grows tax-free, and stays tax-free when it pays for qualified medical expenses. Adjust the inputs to see the compounding effect over five years.

2026 IRS HSA contribution limits: $4,400 self-only and $8,750 family (IRS Rev. Proc. 2025-19), plus $1,000 more if you are 55 or older. Investment growth shown at a conservative 6% annualized return — consistent with balanced index fund historical averages but not a guarantee. Not financial advice.

$3,000
$500$9,750 max (family, 55+)
$2,400
$0$9,750
Year Tax saved on contribution Of that, on care paid from the HSA (not added again) Investment growth (6%) Total benefit
5-year total — — — —

Total benefit = tax saved on contributions + investment growth. Investment growth assumes the balance not spent is invested at 6% annually — a historical approximation, not a guarantee. The "tax saved on contribution" reflects the federal marginal rate only; state tax savings would increase the total. The care column shows how much of the contribution saving comes from the dollars you spend on qualified care. It is part of that saving, not extra: care paid from the HSA uses the same pre-tax dollars you put in, so the total counts them once.

Where to go next

Letters are not open yet, and no opening date is set. Pick the need that matches yours. Each link goes to a page that is open today.

Does the rule fit?Seven questions on your device, then a printable list of what the paperwork needs. Find paid careThe co-op.care assessment, for care from someone who is not a relative. You give the care yourselfSupport for a family caregiver. The rule treats a relative's care differently. Keep the papersThe ComfortCard family file holds receipts and letters on your own device. One purchase, not paid careThe covered-care check asks about the person and says no when the answer is no. Plan their wishesCare Wishes: fifteen short cards, tapped not typed, kept on your device.

Calculations run on your device.