Short answer: You should keep HSA receipts for as long as the account is open, and at least three years after the tax return that reported the distribution—since you may need them to prove the expense was qualified if the IRS asks.
Unlike FSAs and HRAs, HSA withdrawals are not reviewed or approved in real time. That means it is your responsibility to keep documentation showing that each HSA distribution was used for a qualified medical expense.
There is no requirement to submit receipts when you use your HSA. However, if the IRS audits your tax return, you may be asked to prove that an HSA withdrawal was qualified. In that case, you must be able to show that the expense was eligible, incurred after your HSA was established, and not reimbursed from another source.
Because HSA reimbursements can be delayed indefinitely, many people keep receipts for as long as the HSA remains open. In addition, standard IRS audit rules generally allow the IRS to review tax returns for at least three years after filing, which is why keeping receipts beyond reimbursement is important.
If you plan to pay medical expenses out of pocket now and reimburse yourself years later, long-term recordkeeping becomes especially critical.
Common recordkeeping methods include saving digital copies of receipts, using an HSA provider’s receipt-upload tools, or maintaining a spreadsheet noting the date, amount, provider, and description of each expense.
Sources
- IRS, Publication 969 – Health Savings Accounts (Recordkeeping and Distributions): https://www.irs.gov/forms-pubs/about-publication-969
- IRS, Instructions for Form 8889 – Health Savings Accounts: https://www.irs.gov/instructions/i8889
Content history
Originally published: March 27, 2025
Last reviewed: January 27, 2026