Letter of Medical Necessity for a Fidelity HSA
Fidelity’s eligible-expense guidance allows gym memberships with a Letter of Medical Necessity — with one rule people miss: the membership should not predate the physician’s recommendation. A membership you already had is treated as something you were paying for anyway; the letter needs to come first.
What Fidelity requires
- A Letter of Medical Necessity tying the membership to a diagnosed condition
- The letter dated BEFORE the membership period you reimburse (the timing rule)
- Records: the letter plus itemized receipts, kept in case of IRS review
The steps, in order
- Get the letter before you buy or renew the membership
- Pay out of pocket — gym terminals typically decline benefits cards
- Reimburse yourself from the HSA (Fidelity HSAs are self-substantiated: no upfront claim review)
- Keep the letter and receipts — with an HSA, the documentation is tested at IRS review, not at withdrawal
Source: Fidelity: HSA and FSA eligible expenses. Policies change and employer plan designs vary — your administrator makes the final reimbursement decision. This page is general information, not tax or medical advice.
A board-certified physician reviews your health profile and, when clinically appropriate, issues a signed Letter of Medical Necessity the same day — with the diagnosis, ICD-10 code, duration, NPI and license your administratorlooks for. $69, full refund if a letter isn’t issued. The eligibility check is free.
Check if I qualify →Common questions
The IRS test is whether the expense exists because of the medical condition. A membership you already carried fails that test for the months before the letter existed. Reimburse from the letter’s date forward.
No. HSA withdrawals usually aren’t reviewed upfront; the expense is only tested if the IRS looks. That is exactly why the letter needs to be genuinely solid, not just to exist.
FSAs are substantiated upfront, so a weak letter fails fast. The same letter standard — diagnosis, expense, duration, signature — covers both.