Eligibility & what businesses qualify

Not every product is automatically eligible for HSA/FSA spending. This page explains how product eligibility works, what types of businesses are a good fit for Truemed, and how customer eligibility is determined.

Product eligibility criteria

Under IRS guidelines, HSA and FSA funds can be used for qualified medical expenses: costs related to the diagnosis, cure, mitigation, treatment, or prevention of disease. Products not automatically classified as medical expenses can still qualify if:

• A Letter of Medical Necessity (LMN) from an independent licensed healthcare provider confirms the product is being used to treat, mitigate, or prevent a specific diagnosed medical condition.
• The product is primarily for medical care, not general wellness.
• The condition is diagnosed by a qualified healthcare provider.

Truemed evaluates each merchant’s product catalog during the partnership process. Products that Truemed commonly works with include fitness equipment, gym memberships, sleep technology, supplements and nutrition products, recovery and mobility tools, and health monitoring devices.

Truemed does not partner with products that cannot be connected to the treatment or prevention of a medical condition through credible clinical rationale.

Eligibility outcomes

Products Truemed approves fall into one of two categories, and the category determines what your customer experiences at checkout. This applies to every integration: Shopify, WooCommerce, BigCommerce, Stripe, the API, and post-purchase reimbursements.

Pre-approved

Pre-approved products are eligible for HSA/FSA purchase without an LMN. Customers buy them directly with HSA/FSA funds, with no medical necessity screening required.

If a cart contains only pre-approved items, checkout is faster and includes no health survey.

Eligible with LMN

These products may qualify for HSA/FSA spending only if the customer completes a medical necessity flow and receives a Letter of Medical Necessity. They’re typically products whose eligibility depends on the customer’s condition, symptoms, or intended medical use.

When a cart includes these items, the checkout flow adds a health survey that is tailored to the specific items in the cart and collects what a provider needs to assess medical necessity.

Mixed carts

If a cart contains both pre-approved and LMN-eligible items, a health survey still appears, but only because of the LMN-eligible portion.

If a customer adds an ineligible item, Truemed supports a split payment:

• The customer can pay up to the eligible total using their HSA/FSA card through Truemed.
• The customer pays at least the ineligible total with a regular credit or debit card.

A customer who chooses to put some eligible items on a personal card anyway can still seek reimbursement later using their LMN for those items.

Who qualifies

Merchants

To partner with Truemed, a business must sell products that can be medically substantiated, operate in or sell to U.S.-based customers, and complete Truemed’s onboarding process. Truemed conducts a compliance evaluation of your product catalog before onboarding. If you’re unsure whether your products qualify, contact merchants@truemed.com.

Customers

Customer eligibility is determined individually through Truemed’s clinical intake process. The customer must have an active HSA or FSA, complete a health survey, and be evaluated by an independent licensed healthcare provider. If the provider determines medical necessity, an LMN is issued. If the customer does not qualify, no LMN is issued, and for payment integration customers, the HSA/FSA transaction is reversed (the customer can still purchase with a personal card).

Not every customer will qualify. This is why all marketing messaging must treat eligibility as conditional (“may be eligible,” “if you qualify”) rather than guaranteed. See the Compliance article for full messaging guidelines.