Can I use my HSA for my spouse’s eye drops?

Yes, usually. IRS Publication 969 says HSA distributions can pay qualified medical expenses for you, your spouse and your dependents, as long as insurance or another source hasn’t covered them. Since the CARES Act, over-the-counter medicines count, so lubricating eye drops like Quell qualify without a prescription. The expense has to be incurred after your HSA was set up, and you should keep the receipt with your tax records.

Whose expenses an HSA can pay

IRS Publication 969 (2025) is the IRS guide to health savings accounts. It defines qualified medical expenses as amounts paid for the account holder, the account holder’s spouse and any dependent, but only to the extent the amounts aren’t compensated for by insurance or otherwise. The publication spells it out as you and your spouse, all dependents you claim on your tax return, and certain other people you could have claimed.

So the account belongs to one person, but the spending can cover the household. A bottle of eye drops for your husband or wife is handled the same way as a bottle for yourself.

Do over-the-counter eye drops qualify?

They do. The CARES Act changed the rules for HSAs, health FSAs, Archer MSAs and HRAs so that over-the-counter medicines can be reimbursed without a prescription, for amounts paid after December 31, 2019. The IRS described that change in its newsroom announcement at the time, and Publication 969 still counts OTC medicine, whether or not prescribed, as a covered expense.

Quell is an over-the-counter lubricating eye drop. The label’s Uses line reads: For use as a protectant against further irritation or to relieve dryness of the eye. That makes it the kind of OTC medicine the rule covers. Our guide on why OTC eye drops count for HSA and FSA has the background.

The rules that still apply

• Timing: Publication 969 says expenses incurred before you establish your HSA aren’t qualified medical expenses. A bottle bought for your spouse last year, before the account existed, can’t be reimbursed from it now.
• No double dipping: you can’t also deduct the same purchase as an itemized medical expense on Schedule A.
• Not reimbursed elsewhere: if your spouse already got the cost back from their own FSA or another plan, your HSA can’t pay it again.
• Wrong use costs money: the publication says a distribution not used for qualified medical expenses is taxable, and you may owe an additional 20 percent tax on it.

If your spouse has separate health coverage or their own account, the details can get more involved. Publication 969 or your HSA administrator is where to check how your situation is handled.

Paying for your spouse’s eye drops, step by step

• Before ordering, ask your spouse to check the egg and bird caution on the label: Caution should be used in those with egg or bird allergies — For use in the eyes only. Our guide to egg or bird allergies and Quell explains it.
• Pay with your HSA debit card at checkout if it’s accepted, or pay another way and reimburse yourself from the HSA afterward, if your plan allows it.
• Ship it to your spouse’s address or your own; checkout needs no account, and the shipping address can be anyone’s in the US.
• Save the order confirmation email, which lists the date, items and total.
• Note in your records who the purchase was for, in case your administrator asks.

If the bottles are going to a different address, such as a spouse working out of town for the winter, our guide on ordering eye drops for someone else covers the address and email choices.

What about a spouse’s own HSA or FSA?

Couples sometimes have two accounts. Either one can generally pay for the other’s qualified expenses within the rules above, but a single purchase can only be reimbursed once. Pick one account for each order and keep its receipt with that account’s records. If one spouse has a health FSA with a use-it-or-lose-it deadline, it can make sense to spend from that one first; our guide on spending FSA money before the year ends walks through it.

Dependents, and what the label covers

Publication 969 extends the same rule to dependents, so an HSA can pay for a qualifying dependent’s eye drops too. That’s a tax question only. Quell’s label doesn’t give directions for children, so a dependent child’s eye care questions belong with their doctor or pharmacist, and our guide to eye drops and children explains what the label does and doesn’t say.

For an adult spouse, the label’s directions read: Apply 1 drop 3 times per day in each eye. It also says: Stop use and ask a doctor if you feel eye pain or changes in your vision, if irritation or redness continues, or if the condition worsens or persists for 72 hours. Paying from an HSA doesn’t change any of that.

Records your HSA expects you to keep

Publication 969 says you must keep records showing that distributions went only to qualified medical expenses, that those expenses weren’t paid or reimbursed from another source, and that you didn’t take them as an itemized deduction. Keep them with your tax records; they aren’t attached to your return. A folder in your email for Quell confirmations is usually enough. If you misplace one, order lookup or our guide on getting a receipt helps.

This is a summary of IRS publications, not tax advice. For your specific case, especially with two accounts or separate coverage, ask your HSA administrator or a tax professional.