FSA & HSA Medical Mileage Guide: 2026 Rates & Rules
Did you know your daily vehicle commute can be reimbursed with pre-tax dollars? Under IRS Section 213(d), transportation incurred primarily for and essential to medical care is a fully eligible medical expense under both Healthcare FSAs and HSAs.
Despite this rule, millions of dollars in tax savings are forfeited every year because plan holders do not realize they can log and claim mileage for routine doctor checkups, orthodontic adjustments, therapy sessions, and prescription pickups.
1. What Medical Trips Qualify for Reimbursement?
To qualify, the primary intent of the trip must be to receive diagnosed healthcare services for yourself, your spouse, or your tax dependents:
| Transportation Category | Qualifying Eligible Expenses | Ineligible Disqualified Travel |
|---|---|---|
| Personal Vehicle Trips | 20.5¢/mile for driving to doctors, dentists, optometrists, physical therapy, and pharmacies | Trips to general fitness gyms, health food stores, or non-prescription grocery shopping |
| Tolls & Parking | 100% of hospital parking garage fees, clinic meters, and highway tolls | Traffic/parking violation fines, vehicle insurance, general car depreciation or repairs |
| Commercial Transit | Uber/Lyft rides, taxi fares, bus, subway, or train tickets to verified appointments | Vacation travel disguised as medical retreat or general well-being trips |
| Medical Lodging | Up to $50/night per person (patient + 1 caregiver) for out-of-town medical care | Luxury resort stays or personal recreation meals during travel |
2. How Much Can You Save? (Annual Example)
Medical travel adds up quickly, especially for households managing ongoing treatments like physical therapy or braces (see our Braces Payment Strategy):
- 20 Mental Health Therapy Sessions: 15 miles round-trip = 300 miles ($61.50)
- 12 Orthodontist Adjustments: 10 miles round-trip = 120 miles ($24.60)
- 12 Pharmacy Prescription Pickups: 5 miles round-trip = 60 miles ($12.30)
- Hospital Parking & Tolls: $75.00 out-of-pocket receipts
- Total Reimbursable Value: $173.40 in Tax-Free Cash
3. Required IRS Mileage Log Template
Because you cannot swipe an FSA debit card at a gas pump, medical travel must be submitted as a manual reimbursement claim through your administrator's portal (e.g., Alight, HealthEquity, Optum, WEX). Maintain an itemized log with these five fields:
| Date | Provider / Destination | Medical Purpose | Miles | Amount (20.5¢) |
|---|---|---|---|---|
| 03/12/2026 | Valley Dental Associates, Suite 200 | Root Canal Treatment | 18 miles | $3.69 |
| 04/05/2026 | CVS Pharmacy #4102 | Prescription Antibiotic Pickup | 6 miles | $1.23 |
| 05/18/2026 | Regional Physical Therapy Center | Post-Surgical Knee Rehab | 24 miles | $4.92 |
4. How to Ensure Claims Are Approved Without Rejection
- Attach Matching Proof of Appointment: Pair your mileage log with the doctor's visit summary, pharmacy receipt, or Explanation of Benefits (EOB) showing the date matches your travel date.
- Keep Parking & Toll Receipts: Retain credit card receipts or ticket stubs for all toll roads and parking garages.
- Save Digital Invoices for Rideshare: For Uber or Lyft trips, download the in-app PDF receipt showing the pickup location, destination healthcare address, and total fare.