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Letter of Medical Necessity: What It Is and How It Works
The one-page document that makes wellness purchases HSA and FSA eligible: what it says, who can issue it, how checkout handles it, and what to keep for your plan.
A letter of medical necessity is a short document from a licensed healthcare provider stating that a product or service supports a specific health need for you. The IRS requires one before most wellness purchases can be paid for with HSA or FSA dollars. It names the item, the health need, and the provider, and at Kove it is arranged in about two minutes at checkout through Truemed.
Why does a letter of medical necessity exist?
HSA and FSA money is tax-advantaged, so the IRS draws a line around what it can buy. Obvious medical items, bandages, thermometers, prescriptions, are eligible outright. Everything in the gray zone, which includes most wellness devices, becomes eligible only when a licensed provider documents that the purchase addresses a specific health need for that specific person. The letter is that documentation. Without it, a wellness purchase made with HSA or FSA funds risks being disallowed by your plan, taxed, and in some cases penalized.
What does the letter actually say?
A proper letter of medical necessity contains four things:
- The item or service being recommended, named specifically.
- The health need it addresses, stated as the condition or concern the provider identified.
- The recommendation itself: that the item is appropriate to treat, mitigate, or prevent that need, which is the IRS's own language for the standard.
- The provider's identity and credentials, since only a licensed healthcare provider can issue one.
It is usually one page. There is no magic format, and your plan administrator, not the store, is the audience.
Who can issue one?
Any licensed healthcare provider operating within their scope: physicians, nurse practitioners, and other licensed clinicians. It does not have to be your own doctor. That detail is what makes the modern checkout flow possible: an independent licensed provider can review your health information and issue the letter remotely, the same way telehealth visits work.
How the process works at Kove
- Choose Truemed as your payment option at checkout.
- Complete a short health survey, about two minutes.
- An independent licensed provider reviews your answers. If the purchase is appropriate for your health needs, they issue the letter. If it is not, they decline, which is the system working honestly rather than a formality.
- Pay with your HSA or FSA card directly, or pay with a regular card and submit the letter plus your receipt to your plan administrator for reimbursement.
The letter arrives digitally. Nothing about the survey obligates you, and no letter is issued for a purchase that does not fit.
What should you do with the letter?
Keep it with the receipt, ideally wherever you keep tax records, for as long as you keep those. Plans rarely ask for documentation up front, and occasionally ask later; the letter-plus-receipt pair is the complete answer if they do. If you paid out of pocket and are claiming reimbursement, you submit both to your plan administrator, through whatever portal or form your plan uses.
What a letter does not do
- It does not make a purchase eligible retroactively in every plan. Some administrators accept letters issued after the purchase; others want the letter dated on or before it. Your plan's rules decide.
- It does not override your plan administrator, who always has the final say on any claim.
- It is not a diagnosis, a prescription, or medical advice, and neither is this page. Kove does not provide medical or tax advice; see our medical disclaimer.
Which purchases is this worth doing for?
The two minutes cost the same on a $40 accessory and a $2,000 device, so the pre-tax saving scales with the price. Someone in a 30 percent combined bracket keeps roughly $150 on a $500 purchase and roughly $600 on a $2,000 one. The categories that commonly qualify at Kove: red light therapy, PEMF mats, saunas and heat, cold plunge equipment, air purification, and biological age testing, all gathered in the HSA/FSA eligible collection. The full mechanics live on the HSA and FSA page.
Frequently asked questions
Do I need to see my own doctor to get a letter of medical necessity?
No. Any licensed provider can issue one, and the checkout flow connects you with an independent licensed provider who reviews your survey. No appointment or separate visit.
How long is a letter of medical necessity valid?
Most plans treat a letter as valid for one year from its date, then expect a fresh one for new purchases. Your plan administrator's rules govern.
Does insurance accept the same letter?
Different systems. This letter satisfies HSA and FSA rules; health insurance coverage decisions run through their own processes. A letter for one does not commit the other.
Can I get a letter for something I already bought?
Sometimes. Some plan administrators accept a letter issued after the purchase, others do not, so ask yours before assuming either way.
What if the provider declines?
Then that purchase is not eligible for you right now. You can still buy normally, and the decline costs nothing. An honest no is what keeps the whole system legitimate.
Is there a cost for the letter at Kove?
The survey and review are part of the Truemed checkout flow, with no separate fee added by Kove. Truemed is for qualified customers; HSA/FSA tax savings vary. Details at truemed.com/disclosures.
The short version
The letter is one page of documentation that turns a qualifying wellness purchase into a pre-tax one. A licensed provider decides honestly, checkout handles the paperwork, and you keep the letter with the receipt. Browse what commonly qualifies in the HSA/FSA eligible collection, with free US shipping and the Price Beat guarantee.
