Generally yes. HSA and FSA money can pay for qualified medical expenses as defined by the IRS, and IRS Publication 502 doesn't require that care be received in the US. A medically necessary procedure in Colombia can qualify. So can transportation primarily for that care and, within a $50-per-night cap, lodging.
The limits matter just as much: cosmetic procedures, meals, most medications you bring home, and vacation-style extras don't qualify. Below is how each cost is treated and how to document it.
On this page
- The IRS test: qualified medical expenses
- What a medical trip's costs look like under the rules
- Flights and local transportation
- Lodging: the four conditions and the $50 cap
- Cosmetic procedures and medications bought abroad
- HSA vs FSA: same rules, different mechanics
- Documents to keep, and a worksheet
- Frequently asked questions
01The IRS test: qualified medical expenses
Both accounts follow the same core definition: a qualified medical expense is money paid for the diagnosis, cure, mitigation, treatment or prevention of disease, or for treatment affecting any structure or function of the body. IRS Publication 502 is the reference list. It's written for the itemized medical deduction, but HSA and FSA rules point to the same definition.
Two features make a foreign procedure work under that definition:
- Location isn't the test. The publication describes what the care is, not where it happens.
- Legality is a test. Pub 502 excludes payments for illegal operations or treatments. A procedure that's legal where you receive it, and the kind of care that would qualify at home, is on firmer ground.
Verify before you rely on it
Figures below come from IRS Publication 502 (the edition for preparing 2025 returns). The IRS updates it every year. Check the current edition at irs.gov/pub502 before you withdraw funds, and confirm your situation with a tax professional.
02What a medical trip's costs look like under the rules
Here's how the typical cost buckets of a medical trip line up against the Pub 502 rules.
| Cost | Generally qualifies? | Condition or limit |
|---|---|---|
| Surgeon, anesthesia, hospital or clinic fees | Usually yes | Medically necessary care, legal where performed |
| Pre-op tests, imaging, follow-up visits | Usually yes | Part of the medical care |
| Airfare, airport transfers, taxis to the clinic | Usually yes | Primarily for and essential to medical care |
| Hotel or apartment while receiving care | Partly | Capped at $50 per night per person, strict conditions |
| Meals during the trip | No | Only meals that are part of inpatient care |
| Medications bought and used in Colombia | Sometimes | Must be legal in both Colombia and the US |
| Medications brought or shipped home | Generally no | Pub 502 generally excludes drugs imported from another country |
| Cosmetic surgery | Generally no | Unless it corrects a deformity from a congenital abnormality, injury or disfiguring disease |
| Sightseeing, extra vacation days | No | Personal, not medical |
03Flights and local transportation
Pub 502 lets you include transportation primarily for, and essential to, medical care. For a planned procedure abroad, that generally covers your round-trip airfare and local transport to and from the clinic or hospital.
The key word is primarily. If the trip is really a vacation with a procedure added on, the travel costs become hard to defend. A few things that help show a medical purpose:
- Your surgery date and pre-op appointments drive the travel dates
- The length of stay matches the surgeon's written recovery and follow-up instructions
- You keep the itinerary, boarding passes and ground transport receipts
What about a companion?
Pub 502 allows transportation costs for a parent who must go with a child who needs care, and for a nurse or other person who gives injections, medications or other treatment the patient needs while traveling. A companion who's just keeping you company is a harder case. If your surgeon states in writing that you can't travel alone after the procedure, keep that letter, and ask a tax professional whether your companion's costs can be included.
04Lodging: the four conditions and the $50 cap
Lodging is where people most often go wrong. Pub 502 allows lodging while away from home only if all of these are true:
- Primarily for and essential to medical careThe stay exists because of the treatment.
- Care from a doctor in a licensed hospital or similar facilityThe medical care is provided by a doctor in a licensed hospital or a medical care facility related to or equivalent to one.
- Not lavish or extravagantReasonable lodging for the circumstances.
- No significant element of personal pleasureNo real recreation or vacation component in the travel.
Even when those conditions are met, the amount is capped at $50 per night for each person. Lodging for someone traveling with the patient can count too (for example, a parent with a sick child), for a combined $100 per night in that case. Anything above the cap comes out of your own pocket, not the HSA.
Watch out
Recovery stays are often longer than the time you're actually receiving care. Days spent sightseeing before or after don't qualify, and meals outside inpatient care never qualify. Keep a simple calendar showing which nights tie to which appointments.
05Cosmetic procedures and medications bought abroad
Cosmetic procedures
Pub 502 says you generally can't include the cost of cosmetic surgery, meaning procedures aimed mainly at improving appearance that don't meaningfully promote body function or prevent or treat illness. The exception: surgery needed to correct a deformity from a congenital abnormality, a personal injury from an accident or trauma, or a disfiguring disease. The publication's own example is breast reconstruction after mastectomy for cancer. If your procedure sits near the line (for example, a functional nose procedure combined with cosmetic changes), ask the surgeon to itemize the medically necessary portion separately, and get tax advice before paying from an HSA.
Medications
Pub 502 is specific here:
- Drugs you buy and use in another country can qualify if they're legal in both that country and the US.
- Drugs you bring or order into the US from another country generally don't qualify (with narrow FDA-permitted exceptions).
In practice: post-op medications you take while in Colombia may qualify. A supply you buy there to take home generally doesn't, even if it's cheaper.
06HSA vs FSA: same rules, different mechanics
HSA (Health Savings Account)
- The money is yours and rolls over year to year
- You can pay directly or reimburse yourself later, for expenses incurred after the HSA was opened
- No plan administrator approves each claim, but you're responsible if the IRS asks
- Non-qualified withdrawals are taxable, and generally carry an additional tax if you're under 65
FSA (Flexible Spending Account)
- Owned by your employer's plan, with plan-year deadlines
- Unused money may be forfeited, unless your plan offers a grace period or limited carryover
- The administrator substantiates claims and can ask for more paperwork, including English translations
- Some plans restrict or closely review foreign claims. Read your plan summary.
Because the HSA lets you reimburse later, a common approach is to pay for the trip on a card, keep perfect records, then reimburse yourself from the HSA once you're sure each item qualifies. With an FSA, check the claim deadline and documentation rules before you travel. A rejected foreign claim close to the end of the plan year is hard to fix.
07Documents to keep, and a worksheet
Treat this as an audit file you may need years from now. For an HSA, there's no fixed deadline to reimburse yourself, so the records have to last.
- Itemized factura electrónica (or equivalent invoice) from each provider, showing patient name, date, services and amounts
- A plain-English translation of invoices and key medical records, if your FSA administrator asks or you want to be safe
- Proof of payment: card statements or bank transfer records, with the exchange rate on the day you paid
- A brief letter or record showing medical necessity, especially for anything near the cosmetic line
- Flight receipts, boarding passes and ground transport receipts
- Lodging receipts with dates, plus a calendar linking nights to appointments
- Pharmacy receipts and prescriptions for medications used in Colombia
- A summary sheet listing each expense, amount in USD and which account paid it
Eligible from HSA/FSA = medical care + qualifying transportation + (qualifying nights × $50 per eligible person, or actual cost if lower) + medications bought and used abroad that are legal in both countries
- Medical care (all providers)From itemized invoices, in USD
- Transportation primarily for careFlights, transfers, taxis to appointments
- Qualifying lodging nightsNights tied to care, capped per person
- Medications used in ColombiaLegal in both countries, with receipts
- Total you plan to pay from the account
Frequently asked questions
Can I use my HSA for surgery in Colombia?
Generally yes, if the procedure is a qualified medical expense under IRS Publication 502 (medically necessary, not cosmetic, legal where performed). Keep itemized invoices and proof of payment, and confirm your situation with a tax professional.
Can I pay for my flights with HSA money?
Transportation primarily for and essential to medical care can qualify, which generally includes airfare to and from your procedure. Extra legs or days for vacation don't qualify.
How much hotel cost can I pay from an HSA or FSA?
Pub 502 caps lodging at $50 per night per person, and only if the stay is primarily for medical care from a doctor in a licensed hospital or equivalent facility, isn't lavish, and has no significant element of personal pleasure. Meals outside inpatient care don't qualify.
Is cosmetic surgery abroad HSA-eligible?
Generally no. The exception is surgery to correct a deformity from a congenital abnormality, an injury or a disfiguring disease, such as breast reconstruction after cancer surgery.
Can I buy cheaper medications in Colombia with my HSA and bring them home?
Generally no. Pub 502 excludes drugs brought or ordered into the US from another country, with narrow exceptions. Medications you buy and use in Colombia can qualify if they're legal in both countries.
What if I already paid out of pocket?
With an HSA, you can generally reimburse yourself later for qualified expenses incurred after the account was opened, as long as you keep records. With an FSA, follow your plan's claim deadlines and documentation rules.
General information only. This article explains how medical pricing, billing and coverage work. It is not medical, legal, tax or insurance advice. Prices, rules and limits change; confirm current details with the provider, your insurer, the official source cited, or a licensed professional before you decide.
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