HSA/FSA strategies for fertility treatment
What's eligible, how to time contributions, and where people leave money on the table.
What's eligible
Per IRS Publication 502, fertility treatments — IVF, IUI, monitoring, medications, fertility surgeries, egg/sperm storage when used for medical infertility — are qualified medical expenses for both HSA and FSA. Non-medical egg freezing (purely elective fertility preservation) is in a grey area; consult a tax advisor.
HSA: max it, invest it, save receipts
2026 HSA contribution limits: $4,400 individual, $8,750 family. HSA funds roll over forever and can be invested. A common strategy: contribute the maximum, pay treatment costs out of pocket, save every receipt, and reimburse yourself years later — meanwhile the HSA grows tax-free.
FSA: use it or lose it
2026 healthcare FSA limit: $3,300. Unlike an HSA, FSA funds typically expire at year-end (some plans allow $660 carryover or a 2.5-month grace period). If you'll have major fertility expenses next plan year, increase your FSA election during open enrollment.
Donor and surrogacy expenses
The IRS has historically not allowed HSA/FSA reimbursement for donor or surrogate compensation costs paid for a non-spouse, but recent private letter rulings have created some openings for same-sex couples. Talk to a tax professional before assuming.
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Cited figures (cycle counts, dollar ranges, mandate lists) reflect publicly available data as of early 2026. Always confirm specific numbers against the linked sources before relying on them — pricing, protocols, and laws change.
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