Is Pilates HSA/FSA Eligible? What You Actually Need to Know

Written By Nicole Sheldrake

I get asked this a lot: "Can I use my HSA or FSA to pay for Pilates classes?"

I wish the answer was a simple yes! But the real answer is: it depends, and I want to walk you through it honestly rather than just tell you what you want to hear.

The general rule

The IRS is pretty clear on this one. General fitness classes, including Pilates, don't automatically qualify for HSA/FSA reimbursement: https://www.irs.gov/individuals/frequently-asked-questions-about-medical-expenses-related-to-nutrition-wellness-and-general-health

Health club dues and fitness activities aimed at improving your overall health fall outside what these accounts are meant to cover.

So if you're coming to class for strength, mobility, or just to feel good in your body (all wonderful reasons!), that's considered general wellness in the eyes of the IRS, not a qualified medical expense.

The exception

If you have a diagnosed medical condition, perhaps something like hypermobility spectrum disorder (HSD), hypermobile Ehlers-Danlos Syndrome (hEDS), a specific injury, or a chronic pain condition, and your doctor is willing to write a Letter of Medical Necessity connecting Pilates directly to your treatment plan, your classes may become eligible.

This letter doesn't have to come from an MD. Physical therapists are widely recognized for this, and a naturopathic doctor may qualify too, though that depends on your state's licensing rules and your specific plan administrator, so it's worth confirming with both before you count on it.

Schedule a lesson or class

A few things worth knowing before you go down this road:

  • I can't determine eligibility for you. That decision sits between you, your doctor, and your HSA/FSA plan administrator.

  • If you want to pursue this, the first step is asking your doctor whether they're willing to write that letter, then checking with your plan administrator on exactly what documentation they need.

  • If you use your HSA/FSA card and the expense later gets flagged as ineligible, the tax responsibility lands on you as the account holder, not on me or the studio.

A cautionary note on "guaranteed approval" services

You may come across companies online that promise to get you a Letter of Medical Necessity through a quick online questionnaire. I'd encourage some caution here.

The IRS has publicly flagged this exact business model (https://www.irs.gov/newsroom/irs-alert-beware-of-companies-misrepresenting-nutrition-wellness-and-general-health-expenses-as-medical-care-for-fsas-hsas-hras-and-msas), and outcomes are not guaranteed. If you go this route, go in with clear eyes about the risk.

What I can do

I'm always happy to provide a receipt or invoice for your records.

And if you do get a Letter of Medical Necessity from your doctor, let me know. I'm glad to answer questions about how our sessions fit into your care.

Questions? Reach out anytime: nicole@sheldrakepilates.com

-Nicole

Schedule a free Discovery Call

P.S. If you want to read the actual rules from the IRS about this, they are in Publication 502:

https://www.irs.gov/publications/p502

Two specific sections are most relevant:

Nicole Sheldrake https://www.sheldrakepilates.com
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