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When it comes to using pre-tax health accounts like health savings accounts (HSAs), flexible spending accounts (FSAs), and health reimbursement arrangements (HRAs), you may assume that all medical expenses are automatically covered. However, certain expenses require additional documentation to be considered eligible. That鈥檚 where a letter of medical necessity (LMN) comes in.

If you鈥檝e ever been told you need one, or you鈥檙e wondering when it鈥檚 required, this guide will explain what an LMN is, why it鈥檚 important, and how to obtain one.

What is a letter of medical necessity?

A is a document written by a licensed healthcare provider that verifies a specific treatment, service, or product is medically necessary for a patient鈥檚 health. It鈥檚 typically required when an expense isn鈥檛 automatically deemed eligible under but can be considered eligible with a doctor鈥檚 confirmation.

In simple terms, an LMN serves as proof that a treatment or item isn鈥檛 just for general wellness鈥攊t鈥檚 essential for managing a diagnosed medical condition.

When do you need a letter of medical necessity?

Not all healthcare expenses require an LMN, but you鈥檒l need one for certain treatments, services, or items that are on the IRS鈥檚 “maybe” list鈥攅xpenses that could be eligible if prescribed for a medical condition rather than for general health or personal preference.

Here are some common examples of expenses that often require an LMN:

• Massage therapy 鈥� Covered if prescribed to treat a medical condition like chronic pain, not just for relaxation.
• Nutritional counseling or special diets 鈥� Eligible if required for a medical condition like diabetes or celiac disease.
• Gym memberships or exercise programs 鈥� Covered only if prescribed for a medical reason, such as cardiac rehabilitation or physical therapy.
• Orthopedic shoes or inserts 鈥� May require an LMN to confirm they are needed for a foot or joint condition.
• Weight loss programs 鈥� Eligible if prescribed by a doctor for a condition like obesity, hypertension, or diabetes.
• Alternative therapies (acupuncture, chiropractic care, etc.) 鈥� Often eligible but may require an LMN depending on the condition being treated.

How to obtain a letter of medical necessity

If you need an LMN, :

1. Consult your healthcare provider 鈥� Ask your doctor, specialist, or other licensed medical professional to write the letter. They must clearly state why the treatment, service, or item is medically necessary for your condition.
2. Ensure it includes key information 鈥� An LMN should include:
   • Your name and diagnosis
   • The recommended treatment, service, or item
   • A statement explaining why it鈥檚 medically necessary
   • The provider鈥檚 name, credentials, and signature
   • The date of issuance
3. Submit it to your HSA, FSA, or HRA administrator 鈥� Before making a purchase, check with your account provider to see if an LMN is required. If so, submit it as part of your reimbursement request or claims process.

How long is an LMN valid?

Most LMNs are valid for one year, though some plans may require renewal sooner. If you need ongoing treatment, check with your provider to ensure you have an up-to-date LMN each year.

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The information in this blog post is for educational purposes only. It is not legal, tax or investment advice. For legal, tax or investment advice, you should consult your own legal counsel, tax and investment advisers. 

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