This asks about the person and the help they need, not about a purchase. That's the difference that matters: the tax code treats certain long-term care as medical care already — it was never something a letter turns on.
What you've described fits qualified long-term care — which the tax code already treats as medical care, not something a letter converts. That's the solid ground.
The real next step isn't a form. Certification needs an actual encounter — a visit, in person or by video, with the practitioner who signs, and a plan of care that matches the help you described. There is no letter without that. It's what makes the documentation hold up years later.
See how certification works →Want the point-by-point paperwork list for paid care? The HSA Letter check goes through the rule and ends in a printable list, on your device (carrying the answers you just gave).
We'd rather tell you now than write something that fails later. Based on your answers, the care here doesn't meet the test for qualified long-term care.
That doesn't mean the care isn't real or isn't worth paying for — only that it isn't treated as a medical expense under these rules today. If the situation changes and the need becomes lasting, the answer can change with it.
See other ways ComfortCard helps →Pre-tax accounts can only be spent on you, a spouse, or someone who qualifies as your tax dependent. If a parent or another adult isn't your dependent, the account can't be used for their care — no matter how real the need is.
Care can still be arranged and paid for — and other programs may pay or support you even when the HSA can't. It simply isn't a pre-tax expense in this case.
See what you qualify for →Everything you described meets the standard for a chronically ill individual. But the tax code looks at who delivers the care as well as who needs it — and care provided by a spouse or relative is specifically treated as not a medical expense, even when the need is real and the work is constant.
We'd rather tell you now than take a fee and have it disallowed later. Two things are still true: the care is real, and there are programs that will pay or support you for it — the VA, Medicaid self-direction, paid leave, and a credentialed-caregiver path that changes this answer. A two-minute scan finds the ones that fit.
See what you qualify for →Next: six questions give you a plan and a one-page summary for the family doctor, on a related site: clinicalswipe.com/caregivers
A letter cannot make a personal expense medical. It can document care that already is.
In March 2024 the IRS issued an alert about companies that misrepresent wellness and general-health spending as medical care. It was explicit that notes based on self-reported information don't convert personal spending into medical care, and that real documentation requires a visit with the treating provider. We agree with that, and we built to it.
Where the ground is solid is long-term care. Qualified long-term care services are already medical care under §213(d)(1)(C) by way of §7702B(c) — when the person is chronically ill and the services follow a plan of care prescribed by a licensed practitioner. Nothing is being converted. The certification is what the law asks for. Read the full standard →
When a lifestyle program treats a diagnosed disease, it can count as medical care. Case by case, never for general health.
IRS Publication 502 (2025) lets you include “amounts you pay to lose weight if it is a treatment for a specific disease diagnosed by a physician (such as obesity, hypertension, or heart disease).” Treatment at a health institute counts “only if the treatment is prescribed by a physician and the physician issues a statement that the treatment is necessary to alleviate a physical or mental disability or illness of the individual receiving the treatment.”
Gym, health club and spa membership dues can’t be included, though “separate fees charged there for weight loss activities” can. Nutritional supplements, vitamins and herbal supplements can’t, “unless they are recommended by a medical practitioner as treatment for a specific medical condition diagnosed by a physician.” Diet food can’t. Special food counts only if “The food doesn’t satisfy normal nutritional needs, The food alleviates or treats an illness, and The need for the food is substantiated by a physician,” and only for “the amount by which the cost of the special food exceeds the cost of a normal diet.”
The letter describes the plan the person will actually follow, because a plan nobody keeps pays for nothing. A licensed physician signs it for that one person or declines; AI only drafts. That review is planned, not open, and your plan administrator makes the final call. Read Publication 502 →
Colorado does not have one. A few states give family caregivers a tax credit for part of what they spend on a relative’s care, each with income limits and its own rules.
If you file your state taxes in Oklahoma, Nebraska, North Dakota or, from tax year 2027, Connecticut, you may be able to claim back part of what you spend, up to $2,000 a year in most cases ($3,000 in Oklahoma and Nebraska when the person is a veteran or has dementia). Paid help at home, such as a home care aide, can count in several of them. Oklahoma and Nebraska have a statewide total, so a credit can come out smaller than the full amount.
Georgia gives a credit of up to $150, and Missouri up to $500 for a caregiver who lives with the person and registers with the state first.
Read the rules on each state’s own page: Oklahoma · Nebraska · North Dakota · Connecticut · Georgia · Missouri
General information, not tax or legal advice. Eligibility depends on IRS rules, your plan's terms, and your circumstances. The check itself runs entirely in your browser and stores nothing; only an email you choose to leave is ever sent.