Name: Using HSAs for fitness and wellness
Uploaded: 2025-12-22T18:27:39.983Z
Duration: 6 min 25 s
Description: A health tech startup is testing the limits of how Americans can spend pre-tax healthcare dollars. Truemed lets consumers use pre-tax HSA and FSA dollars on everything from Peloton to Eight Sleep and it just raised $34 million led by Andreessen Horowitz.

A health tech startup is testing the limits of how Americans can spend pre-tax healthcare dollars. Truemed lets consumers use pre-tax HSA and FSA dollars on everything from Peloton to Eight Sleep and it just raised $34 million led by Andreessen Horowitz.

Companies are developing technology to help Americans use health savings accounts (HSAs) for fitness and wellness expenses, such as exercise equipment and healthy foods, provided they have a letter of medical necessity from a licensed practitioner. This approach builds on longstanding IRS guidance that allows HSA spending for interventions aimed at treating, reversing, or preventing chronic conditions, as long as certain criteria are met.

While the IRS does not permit HSA spending for general health, eligibility is determined by individual risk factors and practitioner recommendations. The process requires compliance with telemedicine laws and plan administrator approval. The company highlighted in the article emphasizes that health should be a bipartisan issue and aims to increase awareness of using HSAs for root-cause health interventions.

Using HSAs for fitness and wellness

Yeah, we're not cash flow positive yet, but that's because we see a huge market opportunity here. For the first time, truly, in my lifetime, certainly in the last couple of decades, I think Americans are waking up to the idea that something in our health care system is fundamentally broken. And Americans, for the first time, are talking about more than just drug pricing or the cost of health care, but they're talking about how do you fundamentally make Americans healthy. And I think that that is our focus, is we have a traditional health care system that pays once people are sick. We're sort of asking the question, how do you incentivize people to invest in their health to fix many of the chronic conditions that are decimating Americans at the root through effective lifestyle interventions? And so our plans with the funding are just to invest more in marketing awareness, things like that. And as I understand it, you hire Open Loop to have letters written. They basically hire people to write letters that would allow people to buy machines, buy better food and so on with their health savings accounts money. Is that how it works? So 21 years ago, HSA accounts were basically created so that individuals could better afford health care. And for 21 years, the IRS has been explicit that if you have a condition that you're working to treat, reverse or prevent, a practitioner can basically decide to write you a letter of medical necessity. This has been happening for 20 plus years. We've basically just built modern technology that makes that process easier so that, you know, your average person can access many of these lifesaving lifestyle root cause interventions. Justin, we were talking about this in the editorial meeting this morning. It makes sense, obviously, I'd rather spend money on preventative measures than have to spend money on my health after I get sick or diseased. But what are the guarantees that the IRS is going to accept this stuff? Because if I go and buy, you know, some kind of weight lifting machine equipment or a special mattress to help me sleep better and improve my health, I still need to be sure that the IRS is going to approve my use of the HSA on that. Yeah, so it's a good question. So individuals, again, like I said, have been using these accounts for two plus decades. And, you know, the whole question I think that we have to be asking is what is an effective treatment for many of the chronic conditions that are decimating Americans? You know, 90 percent of our health care spending is going towards chronic conditions that are related to lifestyle in some way, shape or form. And so I think that the question we have to be asking is, like, clinically, what is the best intervention for someone working to treat, reverse or prevent obesity? Like, yes, it might be a GLP-1 for certain people, but for people that are at risk or something like that, it may be an exercise intervention. It may be, you know, a sleep intervention or things like this. And there are thousands of studies that show that these effective lifestyle interventions are often better interventions than putting someone on a statin or a GLP-1 for the rest of their lives. Justin, that part's understood. I'm just saying, like, if I buy a thousand dollar piece of equipment and then I get a letter from you justifying that and I use that letter to OK the spending to come out of my HSA account, what are the chances that the IRS says, no way, Jose, a doctor's letter is not good enough? Yeah, it's good. So as long as the letter satisfies the condition, you know, it's written by a practitioner within their scope of practice. It follows state telemedicine laws. You know, it is up to the individual basically to be telling the truth when they talk about these things that they're working to treat, reverse or prevent. It's up to the third party administrator to make sure that that is, like, appropriate within someone's plan. But frankly, you know, as long as those two conditions are satisfied, the IRS has been very explicit that things like prevention of obesity count, that exercise equipment and fitness regimens count, all assuming that you have the risk factors that, you know, around treating, reversing or preventing chronic conditions, which sadly, like, 93 percent of Americans do. So your web page is almost like a storefront. You even have foodstuffs up there, everything from steaks to broth, which I believe is a company that you had also founded as well at one point. How do you have HSA dollars available for that? How do you make that IRS compliant? The IRS has sent out alerts about your business model, for example. Will they continue to do that? Does that concern you for your clients? Yeah, so the IRS has been explicit that it is dependent on the individual. And so the IRS has sent out a notice saying that basically things like exercise, supplements, diet, they don't count for general health, which is totally true. What I think has changed is 20 years ago, the average American was not at risk of chronic disease. You know, we didn't have 90 percent of our health care spend 20 years ago going towards, you know, managing the symptoms of chronic conditions. And so I think, again, the thing that is changing is today the average American is sick. You know, we have almost 80 percent overweight, obese through rate. Chronic disease markers are 93 percent of them have at least one metabolic marker of chronic disease. And I think that the thing to to think about is like for a specific individual that has the risk factors and wants to treat, reverse or prevent a chronic condition is something like a medically tailored meal, an exercise regimen, things like this. Are they clinically effective interventions? And does a doctor recommend them for the individual to treat a certain condition at the root cause? And if the answer is yes, it is up to that individual and the practitioner to determine that, as well as like the plan administrator. Justin, your former partner, your founding partner, Callie Means, has left the company, left TruMed and now works for RFK Jr. at the HHS. His sister has been nominated for Surgeon General of the United States of America by the Trump administration. How should investors understand your relationship with, you know, the HHS and the administration? Sure. So we started this company during the Biden administration, you know, and my co-founder left and divested when politics became a distraction. Like, frankly, we think that politics is distracting and like health is one of the topics that should be the most bipartisan issue, period. You know, health should not be political. And we think that everyone should be using these tax advantage counts that were started 20 years ago to invest in treating, reversing and preventing many of the chronic conditions that is decimating Americans' health today.

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