Wait... your HSA can do that?

Surprising ways to stretch a Health Spending Account (and why more Canadians should) 

Most people hear “HSA” and picture a glorified massage plan. But if you’re a small business owner or an advisor in Canada, you should know: Health Spending Accounts can do a heck of a lot more than reimburse basic dental cleanings and physio. 

Like… a lot more. 

Here are some of the most unexpected (but totally legit) ways HSAs can help Canadians get the care they actually need and want — and why it might be time to rethink what your benefits plan is really doing for you. 

Travel and out-of-town medical care 

If you live outside a major city, you already know that accessing healthcare isn’t always a short drive away. Whether it’s an MRI, a specialist consult, or fertility treatments, getting to the care you need often means hitting the road — and racking up expenses. 

But here’s the good news: if your destination is at least 40 km away, that transportation expense can be eligible through an HSA for you and an attendant. And if it’s at least 80 km? You may be able to add in meals, hotel stays and even parking costs if a doctor says it’s medically necessary. 

So, whether you're in Northern Ontario heading to Toronto for treatment or crossing the border for an MRI, your HSA can ease the financial burden — and make the journey a little lighter. 

Tuition for kids with learning disabilities 

Let’s say your child is struggling in school. The kind of struggle that doesn’t get solved with a little extra homework — we're talking diagnosed learning challenges like ADHD, dyslexia, or anxiety disorders that affect their ability to thrive in a traditional classroom. 

Now imagine you find a private school that gets it — one that offers smaller class sizes, trained specialists, and tailored support. Sounds perfect… except for the $20,000 tuition. 

Here’s where the HSA surprise kicks in: if the school is designed to meet the needs of a diagnosed condition and you’ve got a letter from a licensed practitioner, you may be able to claim that tuition through your HSA. Yes — it’s CRA-approved. 

The same goes for tutoring, psychoeducational assessments, and other supports for dependants with learning disabilities. For a parent trying to do what’s best for their child, this isn’t just a benefit, it’s a game-changer. 

Fertility treatments (and even surrogacy support) 

Fertility care in Canada is notoriously under-covered — emotionally and financially. IVF alone can cost $10,000 to $20,000 per cycle, and many private plans don’t cover it at all. 

But through an HSA? It’s eligible.  

With a medical prescription, treatments like in vitro fertilization (IVF), intrauterine insemination (IUI), and the associated medications can be eligible expenses. You can even claim certain costs related to surrogacy — as long as it’s a medical expense incurred by the intended parent, not the surrogate themselves. 

For employees or entrepreneurs facing the complex world of fertility, this is more than a perk — it’s a financial lifeline that traditional benefits rarely provide. 

Laser eye surgery 

If you wear glasses or contacts, you’ve probably dreamed of ditching them for good. But laser eye surgery can be pricey — especially since many traditional benefits plans don’t cover it at all or bury it under lifetime limits. 

That’s where an HSA quietly becomes a hero. Corrective vision surgery (like LASIK or PRK) is eligible under CRA rules and can be reimbursed tax-free through your HSA. No annual caps. No multi-year waiting periods. 

You get the freedom to see clearly — and the financial freedom to get it done on your terms. 

Braces, orthodontics, & Invisalign 

Here’s a plot twist: you don’t need to be a teenager to benefit from orthodontics. 

Whether your 12-year-old needs braces or you’ve finally decided it’s your time for Invisalign, HSAs can be used to reimburse orthodontic treatments — with no co-pays, no exclusions for adult care, and no weird 50% maximums.

And yes, retainers, spacers, and even surgical orthodontics may qualify if they’re prescribed for medical reasons. 

For families with growing kids or adults ready to invest in their own smile, this is the kind of benefit flexibility that actually makes a difference. 

Gender-affirming healthcare 

Most traditional benefits plans weren’t built with trans and nonbinary people in mind. That’s changing — slowly — but many still exclude essential gender-affirming care or bury it in red tape. 

Health Spending Accounts skip the gatekeeping. With the right documentation, an HSA can be used to reimburse things like:

• Hormone replacement therapy (HRT) 
• Voice therapy 
• Gender-affirming surgeries 
• Travel related to accessing specialized care 

Not only are these expenses eligible under CRA rules, but they’re also reimbursable tax-free. For a business owner committed to inclusive care — or an advisor helping clients build benefits that reflect real people’s lives — this kind of flexibility is a huge win. 

Service animal training & ongoing care 

If someone on your team uses a service animal — whether for vision, mobility, PTSD, or severe anxiety — an HSA can help. We’re not just talking about initial training, either. 

You may be able to claim: 

• Training and certification 
• Vet bills 
• Food 
• Maintenance and care 

And while emotional support animals are a bit trickier (they don’t always meet CRA’s threshold), some expenses — like the therapy or assessment used to prescribe one — may still be eligible. 

This is one of those benefit areas that’s rarely thought about… until you really need it. 

Home renovations for accessibility 

Making a home safe and accessible isn’t cheap — but if it’s medically necessary, it may be eligible through an HSA. 

Think: 

• Ramps and lifts 
• Stair glides 
• Lowered counters 
• Bathroom grab bars 
• Widened doorways 

These aren’t aesthetic upgrades — they’re functional improvements that allow people to live with dignity and independence. If a licensed practitioner signs off that they’re required for a medical condition or disability, they can be eligible. 

Bonus: you may be able to combine this with the federal Home Accessibility Tax Credit for double the impact. 

Unexpected expenses that are totally eligible 

There’s a surprisingly long list of devices, supplies, and miscellaneous expenses that qualify under CRA’s eligible expenses — and yes, you can often use your HSA for them. 

A few you probably didn’t expect: 

• Air purifiers (if prescribed for allergies or asthma) 
• CPAP machines and accessories 
• Hospital beds for home use 
• TENS machines for chronic pain 
• Breast pumps 
• Wigs for medical-related hair loss 
• Back braces 
• Crutches, canes, walkers, and wheelchairs 
• Medical marijuana 
• Phototherapy equipment 
• Health and dental insurance premiums 

The common thread? A medical practitioner’s recommendation. Once that’s in place, these items are all fair game. 

And when someone on your team needs one, you’ll be glad you didn’t cap their benefits with a rigid, cookie-cutter plan. 

Rethinking what “coverage” should actually mean 

Most benefit plans are built for predictability — not for reality. 
But real life is messy. It’s complicated. And it rarely fits neatly into a benefits brochure. 

That’s why HSAs feel so different. They don’t assume what your people need. They give them the power to decide and the flexibility to access it. 

And when your plan can pay for a child’s tuition, a fertility journey, laser eye surgery, or gender-affirming care? That’s not just good business. That’s human. 

Get in touch with us with any HSA-related questions. You can also find us at LinkedIn, Facebook, or Instagram.