A plain blood panel is the easy case — diagnostic testing sits squarely inside §213(d) medical care. The interesting part of this category is not the panel; it is the box the panel sometimes arrives in.
Only part of the cost, or only in a narrow case.
Reimbursable without a letter.
Only part of the cost, or only in a narrow case.
Diagnostic testing is squarely §213(d) medical care. The wrinkle is bundled consumer kits: a 2019 private letter ruling split a DNA kit between its medical (genotyping, lab services) and non-medical (ancestry) components and required an allocation of the price. A private ruling binds only the taxpayer who asked for it. A plain blood panel is the easy case.
Classification is at the expense-category level, comes from this project's HSA reference data, and is not a Magellan determination about any individual product. Your plan administrator decides what your plan reimburses.
In 2019 a private letter ruling split a consumer DNA kit between its medical components — genotyping, laboratory services — and its non-medical components, such as an ancestry readout, and required the price to be allocated between them. Only the medical portion counted. A private letter ruling binds only the taxpayer who requested it and is not precedent for anyone else, but the reasoning tells you exactly what shape of product creates the question.
The practical test: is the thing you bought only a lab result? If a kit sells you a lab result plus something that is not a lab result — a coaching subscription, a lifestyle report, an ancestry panel — then there is an allocation question sitting inside the price, and your administrator will have a view on it. A single-analyte mail-in panel does not have that problem.
Each test in this catalogue is linked to the peer-reviewed literature on what the marker actually predicts, which is a separate question from whether you can pay for it with pre-tax money. Lp(a) is arguably a once-in-a-lifetime test; ApoB is the number to ask for; hs-CRP is the one most often over-read. Read those before you read a price.
The catalogue's diagnostic tests, each linked to the research on what the marker predicts. The classification above is at the expense-category level and is not a determination about any individual kit — in particular, bundled consumer kits raise the allocation question described above.
18 PubMed citations · $79
Large Mendelian randomization studies, prospective cohorts and meta-analyses — in one pooling…
19 PubMed citations · $152
Large meta-analyses, prospective cohorts, and Mendelian randomization studies establish…
19 PubMed citations · $99
Across large prospective cohorts and meta-analyses, higher hs-CRP is consistently associated…
22 PubMed citations · $54.95
In prospective cohort studies and pooled analyses spanning dozens of cohorts, higher blood…
16 PubMed citations · $79.99
Higher fasting insulin and HOMA-IR reflect greater insulin resistance, a central feature of…
18 PubMed citations · $55
Across large cohorts and meta-analyses, cystatin C-based eGFR is at least as accurate as…
The reference data records the card answer for lab testing as yes and the medical-care answer as partial — the partiality is the bundling problem, not a letter problem.
Whatever the category, three limits hold on every letter:
What the IRS documents say, what custodians actually do, and the three questions hiding inside "is it eligible?"
All fifteen expense categories scored against the three tests, with the citation behind each one.
A dated, printable spend-down plan — and the trap the internet tells you to walk into every December.
Twenty-two questions with the citation attached to each answer.
What one is, the six fields administrators look for, and the three things a letter cannot do.
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