The IRS has posted frequently asked questions (FAQs) related to certain medical expenses under Section 213 of the Internal Revenue Code.

The FAQs address whether certain costs under this section—those related to nutrition, wellness, and general health—may be paid for or reimbursed under a health savings account (HSA), health flexible spending arrangement (FSA), Archer medical savings account (Archer MSA), or health reimbursement arrangement (HRA).

Section 213 generally allows a deduction for expenses paid during the taxable year for medical care if certain requirements are met. Expenses for medical care under the section also are eligible to be paid or reimbursed under an HSA, FSA, Archer MSA, or HRA. If any amount is paid or reimbursed under any of those accounts, a taxpayer cannot also deduct the amount as a medical expense on the taxpayer's federal income tax return.

The FAQs state that the cost of a dental exam, an eye exam or a physical exam can be paid or reimbursed because they provide a diagnosis of whether a disease or illness is present. The cost of a program to treat a drug-related substance use disorder and the cost of a smoking cessation program can be paid or reimbursed because such programs treat a disease. The cost of nutritional counseling or a weight-loss program can be paid or reimbursed, but only if these programs treat a specific disease diagnosed by a physician. The cost of a gym membership can be paid or reimbursed, but only if the membership was purchased for the sole purpose of affecting a structure or function of the body (such as a prescribed plan for physical therapy to treat an injury) or for the sole purpose of treating a specific disease diagnosed by a physician. But the cost of exercise for the improvement of general health cannot be paid or reimbursed because the exercise, even if recommended by a doctor, is only for the improvement of general health, not a specific disease. 

In addition, the cost of food or beverages purchased for weight loss or other health reasons can be paid or reimbursed, but only if (1) the food or beverage doesn't satisfy normal nutritional needs, (2) the food or beverage alleviates or treats an illness, and (3) the need for the food or beverage is substantiated by a physician. The cost of nonprescription (over-the-counter) drugs and medicine can be paid or reimbursed, but their cost is not deductible under Section 213 of the Code, except for insulin. Finally, the cost of nutritional supplements can be paid or reimbursed, but only if the supplements are recommended by a medical practitioner as treatment for a specific medical condition diagnosed by a physician. 

“Medical expenses must be primarily to alleviate or prevent a physical or mental disability or illness,” said the IRS. “They don't include expenses that are merely beneficial to general health.”