5-Step Guide to Using Your HSA/FSA for Meditation Apps (And Getting That LOMN)
Let's be honest. If you're anything like me—a founder, a creator, a marketer—your brain is your most valuable asset. It's also probably the most overworked, over-caffeinated, and borderline-crispy part of your entire operation. My stress levels have stress levels. And I'm willing to bet yours do, too.
So, you do the smart thing. You download a meditation app. You subscribe to Calm. You get cozy with Headspace. You try to find five minutes of peace between a product launch and a Q4 budget forecast. And it... helps. It really does.
Then, another bill hits your inbox. The $70 annual subscription. At the same time, you're looking at your HSA or FSA account, that little pot of tax-free money you've been dutifully funding, and you think... "Why am I paying for this twice?" Why is my actual health (my brain) not a "health expense"?
I had this exact thought last year, staring at my FSA balance ticking down to zero. And it sent me down a rabbit hole. The good news? You can absolutely use your HSA or FSA funds to pay for meditation apps.
The bad news? It requires fighting a "mini-boss" called the Letter of Medical Necessity (LOMN).
It sounds intimidating. It sounds like a bureaucratic nightmare designed to make you give up. But as an operator, I've learned that "bureaucratic nightmares" are just processes you haven't written a good SOP for yet. Well, consider this your SOP.
A Quick, Important Disclaimer: I'm an operator and a writer, not a tax advisor or a doctor. This is my playbook, pieced together from IRS pubs, administrator guidelines, and a lot of caffeine. Your situation is unique. Please, please, please run this by your CPA and, obviously, your doctor before you go on a spending spree. This is for informational purposes, not financial or medical advice. Cool? Cool.
So, What's the Catch? HSA vs. FSA vs. LOMN
Okay, let's level-set. You probably know this, but it's critical.
- An HSA (Health Savings Account) is your money, forever. It rolls over, you can invest it, it's a beautiful tax-advantaged retirement vehicle. You need a High Deductible Health Plan (HDHP) to have one.
- An FSA (Flexible Spending Account) is "use it or lose it" money. Your employer sets it up, and that pre-tax cash vanishes at the end of the year (or grace period). This is the one that really lights a fire under you to find eligible expenses.
Both of these accounts can only be used for "Qualified Medical Expenses" (QMEs). This is the magic phrase defined by the IRS. A band-aid? Yes. Your prescription? Yes. A gym membership just to get ripped? No.
Here's the problem: By default, the IRS considers a meditation app subscription to be for "general health and wellness." This puts it in the same bucket as vitamins and that yoga class you swore you'd go to. And general wellness items are not QMEs.
This is where the Letter of Medical Necessity (LOMN) comes in. The LOMN is a formal letter from a licensed healthcare provider (your doctor, a psychiatrist, a psychologist) that legally re-categorizes that "general wellness" item into a specific medical treatment for a diagnosed medical condition.
With an LOMN, your $70 Calm subscription transforms from a "nice-to-have" into a "medically necessary treatment for anxiety," and that is a Qualified Medical Expense.
Why Your Brain is Worth the Paperwork (The "Medical" Part)
I get it. Walking into your doctor's office to ask for a prescription for an app feels... a little Silicon Valley. You might feel like you're trying to pull a fast one. You're not.
The science on this is no longer "woo-woo." It's rock-solid. Chronic stress, the kind we live with every day, isn't just a feeling. It's a physiological state that unleashes cortisol, causes inflammation, screws up your sleep, and leads to a cascade of diagnosable conditions.
- Generalized Anxiety Disorder (GAD)
- Insomnia
- Depression
- Panic Disorders
- Even stress-induced Hypertension
Mindfulness-based stress reduction (MBSR), which is the core mechanic of these apps, is a clinically-validated treatment for these conditions. There are hundreds of studies. Johns Hopkins, Harvard, and the Mayo Clinic all have programs and research showing that guided mindfulness can be as effective as some medications for managing anxiety and mild depression.
You're not asking for a "wellness app." You're asking for a non-pharmacological tool to treat a medical condition, just as you would ask for physical therapy for a bad back.
The 5-Step Playbook: Getting Your Letter of Medical Necessity
Alright, here's the operator's manual. This is the exact process. Don't skip a step.
Step 1: Identify Your Medical Condition (The Diagnosis)
You cannot get an LOMN for "feeling stressed." You must have a diagnosed condition. If you've ever talked to your doctor about anxiety, insomnia, depression, or even panic attacks, you're already on the right track. If you haven't, your first step is to have that conversation.
This is the non-negotiable foundation. The LOMN must list a specific medical diagnosis.
Step 2: Schedule a Specific Appointment
Do not try to add this as a "by the way..." at the end of your annual physical. Your doctor is busy and will brush you off. Book a dedicated appointment (a telehealth visit is perfect for this) with the specific purpose of "discussing a treatment plan for my anxiety/insomnia."
If you have a therapist or psychiatrist, they are even better for this, as this is their exact specialty. But a Primary Care Physician (PCP) can absolutely do it.
Step 3: Have "The Talk" (See the script below)
This is the part everyone dreads, but it's simple. You'll explain your symptoms, state that you've been using an app and it's working, and ask if they would be willing to "prescribe" it as part of your treatment plan via an LOMN.
Step 4: Secure the Letter (The 5 Golden Requirements)
Your doctor will likely say, "Sure, what do you need in the letter?" Don't make them guess. Your administrator's compliance department is looking for exactly five things. If you're missing one, it'll get kicked back. Your LOMN must have:
- Patient's Name: Your full, legal name.
- The Specific Diagnosis: "Generalized Anxiety Disorder" (ICD-10 code is even better, like F41.1).
- The Specific Treatment: "Annual subscription to the Calm meditation app." Be specific! Not "a meditation app."
- The Medical Necessity: Why this app for this diagnosis? A simple sentence like, "This subscription is medically necessary to treat the patient's anxiety by providing mindfulness-based stress reduction."
- The Duration: This is key. An LOMN is almost always only good for one year. So, the letter should say, "This prescription is valid for 12 months from the date of this letter."
Pro-Tip: I literally type this up in a template, email it to my doctor's portal, and say "If you agree, could you please put this on your letterhead and sign it?" 9 times out of 10, they do. It saves them 15 minutes of work.
Step 5: Submit to Your Administrator (NOT the IRS)
You don't send this to the IRS. You send it to your HSA/FSA administrator—the company that manages your account (like Optum, WageWorks, HealthEquity, etc.). Most have a simple "Upload Document" portal. You'll submit your LOMN once for the year. It stays on file, and now any expense for that item is pre-approved.
How to Talk to Your Doctor (Without Sounding Crazy)
This is where the rubber meets the road. My first time asking for this, I was so nervous, I mumbled and I'm pretty sure I sounded like I was trying to hack the government. The doctor was confused. It was a mess.
Here's the script I use now. It's clear, confident, and frames it in their language: "treatment" and "outcomes."
Your Simple LOMN Script: You: "Hi Dr. [Name]. We've talked before about my [anxiety/insomnia/stress] and how it's affecting me. I've been actively trying to manage it without just jumping to medication." You: "For the last few months, I've been consistently using the [Calm/Headspace] app for guided meditation, and it's genuinely helping. My [symptom, e.g., 'panic attacks are less frequent' or 'I'm falling asleep faster'] has improved." You: "I learned that because it's directly treating my [diagnosis], the subscription can be covered as a 'qualified medical expense' from my HSA/FSA. The only requirement is a Letter of Medical Necessity from you." You: "Would you be comfortable writing a letter that prescribes the [Calm/Headspace] subscription for one year as part of my treatment plan for [diagnosis]?"
That's it. You're not being pushy. You're not a "drug-seeker." You're a proactive patient who has found a tool that works and is now just handling the administrative backend. It reframes the whole conversation.
Which Meditation Apps are HSA/FSA Eligible? (Calm, Headspace, & More)
This is a trick question. Technically, no app is "HSA-eligible" out of the box.
It is your LOMN that makes the expense eligible. You could, in theory, get an LOMN for a $5 white-noise app if your doctor prescribed it for tinnitus-related insomnia. It's all about the LOMN.
That said, some apps are more common and easier to justify.
Tier 1: The "Big Two" (Calm & Headspace)
These are the most common. They are well-known, have a huge library of content specifically for anxiety, stress, and sleep, and are basically the Kleenex/Band-Aid of the meditation world. Your doctor has heard of them. Your administrator has seen them. This is the easiest path.
Tier 2: The "Therapy-Lite" Apps (Talkspace, BetterHelp, etc.)
This is almost a different category. These apps, which provide actual tele-therapy, are already qualified medical expenses. You don't even need an LOMN for the therapy part. However, they often bundle mindfulness and meditation content. If you're paying for Talkspace, you are almost certainly fine to use your HSA/FSA card, and it's a much simpler process.
Tier 3: The Niche Apps (Insight Timer, Waking Up, etc.)
Can you use your HSA for Sam Harris's Waking Up app? Yes... if you have an LOMN for it. The challenge here is that it's less common. Your doctor might not know it, and the name "Waking Up" sounds more philosophical than medical. You'll have an easier time if you stick to the "Big Two," but the principle remains the same. If your doctor prescribes it specifically, you're good to go.
The Money Part: How to Actually Pay or Get Reimbursed
Okay, LOMN is on file with your administrator. Now what? You have two ways to do this, and one is much better than the other.
Path 1: The Reimbursement (Most Common)
This is the safest, most-audits-proof way.
- You pay for the annual subscription on your personal credit card (to get those sweet, sweet points).
- The app emails you an itemized receipt. Make sure it says "Annual Subscription," the date, and the amount.
- You log in to your HSA/FSA portal and submit a new claim for reimbursement.
- You attach two documents: (1) The itemized receipt and (2) Your LOMN. (Even if it's already on file, I attach it every time. Be undeniable.)
- In 3-5 business days, the administrator cuts you a check or direct-deposits the money back into your bank account.
Path 2: The HSA/FSA Debit Card (The Dream, with a Catch)
The dream is to just swipe your little HSA/FSA debit card on the Calm checkout page and be done. This can work, but it's risky.
Why it fails: HSA/FSA cards work by checking a "Merchant Category Code" (MCC). A pharmacy has a "pharmacy" code. A doctor's office has a "healthcare" code. Calm's payment processor? It might be "Digital Goods - Media" or "Online Software." The card might see this, not recognize it as a medical code, and auto-decline.
If it works: Great! But you are NOT done. If you get audited by the IRS (or just your administrator), they will ask for the receipt and the LOMN for that transaction. You must save your LOMN and the email receipt for that purchase. I keep a folder in my Google Drive labeled "HSA Reciepts [YEAR]" just for this. Do not throw away the LOMN just because the card worked.
Common Mistakes That Will Get Your Claim Denied
I've seen people get this wrong. Don't be them. Avoid these traps.
- The "General Wellness" Trap: You just swipe your HSA card on the Headspace website without an LOMN. The transaction might go through, but if you get audited, the IRS will make you pay that money back plus a 20% penalty plus income tax on it. It's a disaster.
- The Vague LOMN: Your doctor writes a note that just says, "Meditation is good for Patient X's stress." Denied. It needs the specific diagnosis, the specific app, and the duration.
- The "Family Plan" Problem: Your LOMN is for you. You can't use it to justify buying the Calm Family Plan and expensing the whole thing. The LOMN only covers the person diagnosed.
- Forgetting to Renew: The LOMN is good for one year. When your Headspace subscription renews next year, you need a new LOMN for that plan year. Set a calendar reminder.
- Buying the "Lifetime" Plan: This is a gray area, but most administrators want to see an annual subscription that maps to your annual LOMN. Paying $400 for a "lifetime" plan might get flagged as an ineligible capital expense. Stick to the annual plan.
Trusted Resources (The Ones the IRS Listens To)
Don't just take my word for it. Here are the primary sources and research that back this all up. Bookmark these.
Infographic: Your LOMN Approval Flowchart
This process can feel like a maze. I sketched out a simple flowchart to visualize the "yes/no" path to getting your app covered. This is the entire process on one screen.
HSA/FSA for Meditation App: Approval Flowchart
Frequently Asked Questions (HSA/FSA for Mental Wellness)
I get a lot of DMs about this. Here are the most common questions, answered directly.
1. Can I really use my HSA for the Calm app?
Yes, but only if you have a Letter of Medical Necessity (LOMN) from a healthcare provider. The LOMN must state that the Calm app is specifically prescribed to treat a diagnosed medical condition (like anxiety, insomnia, etc.). Without an LOMN, it's considered a "general wellness" expense and is not eligible.
2. What's the difference between an LOMN and a prescription?
Functionally, for this purpose, nothing. An LOMN is the prescription. It's the formal term for a doctor's order for a service or item that isn't a traditional pharmaceutical drug. You need it to prove to your administrator that this is a medical expense.
3. How long is a Letter of Medical Necessity valid for?
Almost always one year (12 months). Your FSA/HSA administrator expects the LOMN to cover the current plan year. When your app subscription renews next year, you will need to get a new, updated LOMN from your doctor for that plan year. Set a calendar reminder!
4. Will my HSA/FSA administrator just accept my LOMN?
Yes, if it's valid. They are not doctors and cannot question your diagnosis. They are compliance officers. Their only job is to check the boxes: (1) Is this a real letter from a real doctor? (2) Does it list the patient? (3) Does it list a diagnosis? (4) Does it list a specific treatment? (5) Does it list a duration? If you check those boxes, you will be approved.
5. Can I just pay for Headspace with my HSA card directly?
You can try, but it's risky. The card might be declined if the merchant code isn't recognized as "medical." Even if the transaction goes through, you are still 100% required to have an LOMN and a receipt on file. If you are audited, "the card worked" is not a defense. The safest method is to pay out-of-pocket and submit for reimbursement.
6. What happens if I get audited by the IRS?
If you followed the steps, you're fine. The IRS will ask for proof that your expense was qualified. You will provide them with a copy of your LOMN and the itemized receipt from the app. They will see that the dates line up, check the box, and move on. This is why you must keep your records (I save a PDF of both in a cloud folder) for at least 3-5 years.
7. Is therapy (like Talkspace) also HSA/FSA eligible?
Yes, and it's much simpler. Mental health therapy and psychiatric services are always considered qualified medical expenses. You do not need a special LOMN to pay for your Talkspace or BetterHelp co-pays or subscriptions with your HSA/FSA card. It's treated the same as a regular doctor's visit.
8. Can I use my FSA for a meditation app I already paid for this year (before I got an LOMN)?
This is tricky. Generally, the LOMN makes the expense eligible from the date the LOMN is written. You usually cannot "back-date" eligibility. The best practice is to get your LOMN first, then pay for the subscription. You can always try to submit it, but be prepared for it to be denied.
9. What if my doctor says no?
This is rare if you approach it professionally. If they seem hesitant, it's usually because they're confused about the request. Re-frame it: "To be clear, I'm not asking for a 'pass.' I'm asking for this to be part of my documented treatment plan for my anxiety, which we've already discussed." If they still refuse, you can always seek a second opinion from another provider or a mental health specialist.
Final Thoughts: Is This 5-Step Hassle Even Worth It?
I can see you looking at this list of steps and thinking, "This is... a lot. For $70?"
And you're right. It's a hassle. It's 30-60 minutes of administrative work. If you're a founder making $500/hour, this is not a good ROI on your time. You are not wrong.
But for me, it stopped being about the $70. It was about the principle.
We live in a system that is finally, finally starting to acknowledge that mental health is health. That the burnout we feel in our brains is just as real as a broken arm. Using your HSA/FSA for a meditation app is a small, quiet, bureaucratic way of staking that claim. You are telling the system—your doctor, your administrator, the IRS—that your mental well-being is a medical necessity.
The $70 you save (or, more accurately, the ~$20-$30 you save in taxes) is just the bonus. The real win is successfully navigating the system to take care of your most important asset.
So, my challenge to you: Book the 15-minute telehealth appointment. Use the script. Get the letter. Take back your tax-free money. Your brain—and your budget—will thank you for it.
HSA/FSA-Eligible Meditation Apps, Letter of Medical Necessity, qualified medical expense, get Calm covered HSA, Headspace FSA stress
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