For the categories where the default answer is no but the rules leave room, a letter from a clinician is the mechanism that moves the answer. There is an entire small industry built on being vague about what that document is. This page is not vague about it.
There is no Magellan letter service, and there will not be one. This page exists so that you can walk into your own clinician’s office already knowing what the form asks for — nothing more than that.
In IR-2024-65 the IRS warned about companies selling doctor’s notes for a fee, stating that notes based merely on self-reported health information do not convert non-medical wellness expenses into medical care. If a website offers to sell you a letter for a flat fee after a questionnaire, the IRS has already told you in writing what it thinks of the resulting document.
Nobody can write this letter except a clinician who has actually evaluated you. What you can do is walk in with the paperwork already organised, so the conversation takes two minutes instead of twenty. The ledger tool in the Magellan app assembles those fields into a one-page request sheet you take to your own clinician, with the clinical judgement left blank where it belongs.
| Field | Why it is there |
|---|---|
| Your name and date of birth | Every administrator form starts here. |
| The diagnosed condition | Named, specific, and diagnosed by a physician. Not "low energy" — the actual diagnosis. Many forms want an ICD-10 code. |
| The specific item, by name | Itemised. "Supplements" is rejected; "magnesium glycinate 400 mg nightly" is not. A letter cannot bless a whole shopping cart. |
| How the item treats that condition | The causal sentence. This is the part that is actually clinical judgement, and the part a questionnaire cannot manufacture. |
| Duration of treatment | Start and end dates. Most administrators cap a letter at 12 months and want it renewed annually; some read an undated letter as expiring a year after it was written. |
| Signature, printed name, credentials, licence number, phone | An unsigned letter is not a letter. |
Administrator forms typically also carry an attestation that the treatment is medically necessary for the named condition and is not for general health and not cosmetic. That sentence is doing real work — it is why a clinician cannot sign one for a supplement you are taking for general wellness.
The second of those is the one worth internalising. The letter documents medical necessity where the rules already leave room. Where the rules leave none — food and protein powder being the standing example — no signature changes the outcome.
Four categories in this project's reference data sit in the letter-required zone, and they are not equally well founded. Supplements are letter-required on the face of Pub. 502 itself — that is IRS-based. Exercise equipment is letter-required because custodians decided so; no IRS document addresses it at all. Knowing which of those two you are dealing with changes how much weight the letter is carrying.
| Category | Medical care | Card | Basis |
|---|---|---|---|
| 💊 Dietary supplements & vitamins | Letter needed | Letter needed | IRS |
| 🤰 Prenatal vitamins | Letter needed | Yes | Practice |
| 🦴 Glucosamine / chondroitin | Letter needed | Yes | Practice |
| 🚴 Fitness / exercise equipment | Letter needed | Letter needed | Practice |
| 🥗 Nutritional counseling / dietitian | Letter needed | Letter needed | IRS |
| 📦 Something else | Letter needed | Letter needed | Practice |
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.
Open the HSA / FSA ledger in the Magellan app →