Are Mattresses HSA/FSA Eligible? Complete Guide (2026)

💡 Quick Answer: Yes, mattresses are HSA and FSA eligible when you have a Letter of Medical Necessity from a licensed healthcare provider. Under IRS Publication 502, mattresses qualify as medical expenses when used to prevent, manage, or reverse a health condition like chronic back pain, sleep apnea, or arthritis. Your LMN must be dated before your purchase. Once you have it, you can buy any mattress brand and save 25-40% using pre-tax HSA/FSA funds.

If you’re dealing with a qualifying health condition (or trying to prevent one), Crates Health gets you approved in 48 hours. No doctor visit, no weeks of waiting, no hassle.

Why Mattresses Qualify as Medical Expenses

Here’s what your HR department probably didn’t tell you: the IRS recognizes mattresses as qualified medical expenses when they serve a medical purpose.

IRS Publication 502 states that medical expenses include “the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and for the purpose of affecting any part or function of the body.” That’s government-speak for: if your mattress addresses a real health condition, it qualifies.

The key requirement? Your mattress must “primarily alleviate or prevent a physical or mental defect or illness.” It can’t be “merely beneficial to general health.”

The Science: Why Your Mattress Actually Matters for Your Health

The IRS isn’t being generous here, there’s real science behind why mattresses qualify as medical devices for certain conditions.

Sleep isn’t just downtime. It’s when your body repairs tissue, consolidates memories, regulates hormones, and clears metabolic waste from your brain. Research published in the Journal of Orthopaedic and Traumatology found that 15-30% of adults report sleep disorders, and low back pain is identified as one of the main causes of poor sleep quality.

Here’s where your mattress comes in: the wrong sleeping surface directly impacts spinal alignment, pressure point distribution, and sleep quality. When your mattress is too soft, too firm, or just worn out, your body can’t maintain proper alignment during the 6-9 hours you’re horizontal each night.

Cleveland Clinic research found that medium-firm mattresses can improve sleep quality by 55% and significantly reduce chronic back pain. A separate study in Sleep Science and Practice demonstrated that mattresses designed to reduce spinal curvature in side sleepers significantly decreased pain while lying down and improved overall comfort.

The timeline matters too. Oklahoma State University research found that the average mattress in their study was 9.5 years old, and participants experienced better sleep on almost any new mattress compared to their old one. Cleveland Clinic recommends replacing your mattress every 9-10 years as your body’s needs change.

Connecting the Dots: From Sleep Science to Medical Conditions

Poor sleep quality doesn’t just make you tired. It’s a contributing factor in nearly every major health condition:

• Chronic pain – Pain disrupts sleep, and poor sleep increases pain sensitivity, creating a feedback loop
• Cardiovascular disease – Fragmented sleep increases heart disease risk by up to 48%
• Metabolic disorders – Sleep deprivation increases diabetes risk by 37%
• Mental health – Poor sleep quality increases depression risk by 300%
• Immune function – Sleep is when your body repairs and recovers

When your mattress prevents proper sleep or proper spinal alignment, it’s not just causing discomfort. It’s potentially contributing to serious medical conditions. That’s why the IRS allows mattresses as medical expenses, when properly documented, they’re preventing or treating real health problems.

What You Need: A Letter of Medical Necessity

The LMN is your official documentation that proves your $2,000 mattress isn’t a luxury purchase but a medical intervention. A licensed healthcare provider documents that your mattress is medically necessary for preventing, managing, or treating your specific condition.

The IRS specifically allows expenses for items that “prevent, manage, and reverse” health conditions. This is huge because you don’t need an existing diagnosis. If you’re trying to prevent the progression of chronic back pain or sleep disorders, you qualify.

Medical Conditions That Qualify You for HSA/FSA Mattress Coverage

Way more conditions qualify than most people think. If you have any of the following, you likely qualify for HSA/FSA coverage:

Chronic Pain and Musculoskeletal Conditions:

• Chronic lower back pain (affects over 20% of adults)
• Arthritis and joint disorders
• Fibromyalgia
• Herniated or degenerative disc disease
• Sciatica and sciatic nerve pain
• Spinal stenosis
• Neck pain and cervical disorders
• Osteoarthritis
• Rheumatoid arthritis
• Ankylosing spondylitis

Sleep Disorders:

• Obstructive sleep apnea
• Central sleep apnea
• Chronic insomnia and sleep-onset disorders
• Sleep maintenance disorders (frequent waking)
• Restless leg syndrome
• Periodic limb movement disorder
• Circadian rhythm disorders
• Narcolepsy-related sleep disruption

Digestive and Respiratory Conditions:

• Acid reflux and GERD (gastroesophageal reflux disease)
• Hiatal hernia
• Chronic sinusitis
• Post-nasal drip
• Chronic obstructive pulmonary disease (COPD)

Circulatory and Vascular Conditions:

• Poor circulation and peripheral vascular disease
• Lymphedema and chronic swelling
• Varicose veins
• Deep vein thrombosis (with elevation requirements)

Skin and Wound Conditions:

• Pressure sores or ulcers
• Bed sores (prevention or treatment)
• Chronic skin conditions affected by pressure

Recovery and Rehabilitation:

• Post-surgical recovery requiring specific positioning
• Post-injury rehabilitation
• Spinal surgery recovery
• Joint replacement recovery

Women’s Health:

• Pregnancy-related back pain
• Pelvic pain disorders
• Endometriosis with sleep disruption

Neurological Conditions:

• Multiple sclerosis with mobility issues
• Parkinson’s disease
• Peripheral neuropathy
• Spinal cord injuries

Other Qualifying Conditions:

• Scoliosis and spinal deformities
• Chronic fatigue syndrome
• Ehlers-Danlos syndrome
• Hypermobility disorders
• Any condition where sleep quality directly impacts symptom severity

The common thread? All of these conditions either disrupt sleep quality or are worsened by poor spinal alignment during sleep. If your mattress can help prevent, manage, or reverse symptoms, it qualifies under IRS Publication 502.

Best HSA/FSA Eligible Mattresses by Brand (2026)

All major mattress brands are HSA/FSA eligible with a Letter of Medical Necessity. The trick is matching the right mattress to your specific condition.

Brand	Price Range	Type	Firmness	Trial Period	Warranty	Best For
Purple	$1,299-$4,299	Hybrid with gel grid	Medium to Medium-Firm	100 nights	10 years	Pressure relief, cooling, back pain
Nectar	$699-$2,199	Memory foam	Medium-Firm	365 nights	Lifetime	Budget-friendly pressure relief
Saatva	$1,395-$2,695	Innerspring/Hybrid	Plush Soft to Firm	365 nights	Lifetime	Traditional feel, back support
Helix	$849-$2,349	Hybrid	Soft to Extra Firm	100 nights	10-15 years	Customized firmness
Leesa	$799-$2,099	Foam/Hybrid	Universal Medium	100 nights	10 years	All sleep positions
Tempur-Pedic	$2,199-$4,999	Memory foam	Soft to Firm	90 nights	10 years	Severe chronic pain

Budget tier ($700-$1,200): Nectar and Leesa offer excellent value with up to a year-long trial period. That’s enough time to make absolutely sure the mattress helps your condition.

Mid-range ($1,200-$2,500): Purple, Helix, and Saatva bring advanced features like zoned support and cooling technology that target specific medical issues.

Premium ($2,500+): Tempur-Pedic leads in pressure relief technology. If you’re dealing with severe fibromyalgia or arthritis, this is where you want to be.

Mattress Type Guide: Match Your Condition

Different mattress types address different health conditions. Here’s how to choose:

Mattress Type	Key Benefits	Best Medical Applications	Avoid If
Memory Foam	Pressure relief, contouring, motion isolation	Arthritis, fibromyalgia, joint pain, side sleepers	You sleep hot
Hybrid	Balanced support + pressure relief, cooling	Back pain, combination sleepers, couples	Strict budget
Innerspring	Firm support, airflow, responsive	Sleep apnea, stomach sleepers	Pressure point sensitivity
Latex	Durability, natural materials, responsive	Allergies, eco-conscious needs	Chemical sensitivities

Memory Foam Mattresses

Memory foam excels at pressure relief by molding to your body. Research from the American Chiropractic Association shows memory foam can reduce pressure points by up to 50% compared to traditional innerspring mattresses.

Best for:

• Arthritis sufferers needing joint pressure relief
• Fibromyalgia patients sensitive to pressure points
• Side sleepers with shoulder and hip pain
• Anyone needing motion isolation (your partner’s movements won’t wake you up)

Memory foam responds to body heat and weight, creating a customized sleep surface. If you wake up with joint pain, this is your starting point.

Hybrid Mattresses

Hybrid mattresses combine innerspring support coils with foam comfort layers. You get the pressure relief of foam with the support and cooling of coils.

Best for:

• Chronic back pain requiring both support and cushioning
• Combination sleepers who change positions
• Hot sleepers needing airflow
• Heavier individuals needing durable support

Studies from the Sleep Foundation show hybrids can improve sleep quality by 25% for people with chronic back pain compared to all-foam alternatives.

Innerspring Mattresses

Traditional innerspring provides firm, responsive support with excellent airflow. Modern designs use pocketed coils that reduce motion transfer while maintaining that bouncy feel.

Best for:

• Sleep apnea patients who need elevated sleeping positions
• Stomach sleepers requiring firm, flat support
• Anyone who prefers traditional mattress feel
• Hot sleepers prioritizing cooling

Latex Mattresses

Latex offers responsive support with natural materials. You get bounce similar to innerspring but with better pressure relief and durability.

Best for:

• Allergies (natural latex is antimicrobial and dust mite resistant)
• Need for eco-friendly, sustainable materials
• Combination sleepers wanting responsive support
• Long-term value (latex lasts 12-15 years)

HSA/FSA Eligible Mattress Accessories

Your HSA/FSA benefits don’t stop at the mattress. Here’s what else qualifies:

Mattress Toppers

Toppers qualify when they provide additional support or pressure relief for a health condition.

Price Range: $100-$500

Types:

• Memory foam toppers (2-4 inches thick) for pressure relief
• Latex toppers for responsive support
• Cooling gel toppers for temperature regulation
• Egg crate foam for basic cushioning

The Eight Sleep Pod is an advanced option with active temperature control, particularly beneficial for conditions affected by sleep temperature.

Best uses:

• Adding pressure relief to an existing firm mattress
• Improving an older mattress before replacement
• Testing different firmness levels affordably
• Customizing hotel beds when traveling

Adjustable Bases

Adjustable beds let you elevate your head, feet, or both. This addresses multiple health conditions through positioning alone.

Price Range: $800-$3,000

Medical Benefits:

• Elevating head for sleep apnea and acid reflux
• Raising legs for circulation and swelling
• Zero-gravity position for back pain relief
• Anti-snore positions for sleep disorders

Research published in Sleep & Breathing shows that elevating the head of the bed by just 7.5 degrees can reduce sleep apnea severity by up to 31.8% and improve oxygen saturation. The Mayo Clinic recommends elevating the head 6-9 inches for acid reflux relief.

Mattress Protectors

Medical-grade protectors qualify when they address allergies, bed bugs, or protect against fluids during medical treatment.

Price Range: $50-$200

Types:

• Hypoallergenic protectors for dust mite allergies
• Waterproof protectors for incontinence
• Bed bug encasements
• Antimicrobial protectors for immune conditions

Cervical Support Pillows

While this guide focuses on mattresses, cervical pillows often complement mattress purchases for neck pain and spinal alignment conditions.

Price Range: $40-$150

For comprehensive pain management, consider pairing your mattress with Therabody massage devices, Normatec compression therapy, or Hyperice percussion therapy.

How to Get Your Letter of Medical Necessity for a Mattress

There are two paths here. Let’s be honest about both.

The Traditional Route

Timeline: 3-6 weeks
Cost: $150-$300+ (copay + visit)

The Process:

1. Schedule appointment with your doctor (wait 2-4 weeks)
2. Attend in-person or telehealth visit
3. Discuss your sleep and pain issues
4. Hope doctor agrees to provide LMN
5. Get signed documentation
6. Submit to HSA/FSA administrator
7. Wait for approval
8. Finally purchase mattress (your LMN must be dated before purchase)

The Reality:

• Multiple week wait times for appointments
• High copay costs
• No guarantee your doctor will provide the LMN
• Administrative headaches
• Coordination nightmares with mattress purchase timing

The Streamlined Route (Crates Health)

Timeline: 48 hours
Cost: Included with platform

The Process:

1. Complete online health assessment (5 minutes)
2. Licensed provider reviews your information
3. Receive LMN within 48 hours
4. Purchase your mattress
5. One-click reimbursement submission via Crates

The Reality:

• No doctor visit required
• Fast 48-hour turnaround
• Licensed healthcare providers issue your LMN
• 12-month validity with auto-renewal
• Crates handles all HSA/FSA paperwork and reimbursement

Factor	Traditional	Crates Health
Timeline	3-6 weeks	48 hours
Upfront Cost	$150-$300+	$0
Doctor Visit	Required	Not required
Paperwork	You handle it	We handle it
Reimbursement	Manual submission	One-click
LMN Validity	Single use	12 months, auto-renews

Your LMN must be dated before your mattress purchase to qualify for HSA/FSA reimbursement. This timing requirement makes a fast, reliable process crucial.

How Much You’ll Save: Real Numbers by Tax Bracket

Understanding your exact savings helps justify investing in a quality mattress. HSA and FSA accounts use pre-tax dollars, so you save your marginal tax rate on every purchase.

Tax Savings by Bracket (2026)

Your Tax Bracket	$1,000 Mattress	$1,500 Mattress	$2,000 Mattress	$3,000 Mattress
12%	Save $120	Save $180	Save $240	Save $360
22%	Save $220	Save $330	Save $440	Save $660
24%	Save $240	Save $360	Save $480	Save $720
32%	Save $320	Save $480	Save $640	Save $960

Real Examples

Example 1: Mid-Range Purchase
You’re in the 22% tax bracket and buy a $1,500 Nectar mattress plus a $200 cooling topper.

• Total purchase: $1,700
• Tax savings: $374
• Actual cost: $1,326

Example 2: Premium Purchase
You’re in the 24% tax bracket and buy a $2,500 Purple mattress plus a $1,200 adjustable base.

• Total purchase: $3,700
• Tax savings: $888
• Actual cost: $2,812

Example 3: Budget Purchase
You’re in the 12% tax bracket and buy a $900 Leesa mattress.

• Total purchase: $900
• Tax savings: $108
• Actual cost: $792

Additional Savings Factors

State Income Tax: If you live in a state with income tax, add your state rate to your federal rate for total savings. California residents in the 22% federal bracket save an additional 9.3% state tax, totaling 31.3% savings.

FICA Taxes: HSA contributions (but not FSA) also avoid 7.65% FICA taxes, increasing total savings to 30-40% for many people.

Long-Term Value: Mattresses last 7-10 years. Your one-time tax savings spreads across thousands of nights of improved sleep and pain reduction.

How to Purchase a Mattress with Your HSA/FSA

The purchase process is straightforward once you know the sequence. The key is getting your LMN first.

Step-by-Step Purchase Process

Step 1: Get Your Letter of Medical Necessity
Your LMN must be dated before your purchase date. Get this first through Crates Health or your healthcare provider.

Step 2: Research and Select Your Mattress
Use the brand comparison and type guides above to identify the best mattress for your condition. Take advantage of trial periods (90-365 days) to ensure it actually helps.

Step 3: Purchase the Mattress
Buy using a personal credit card. Most mattress retailers don’t accept HSA/FSA cards directly, so you’ll purchase first and seek reimbursement.

Step 4: Collect Your Documentation
Save these items:

• Itemized receipt showing mattress purchase
• Your Letter of Medical Necessity
• Any delivery or setup receipts

Step 5: Submit for Reimbursement
If you use Crates Health, the platform handles one-click reimbursement submission. Otherwise, submit documentation manually through your HSA/FSA provider’s portal.

Step 6: Receive Your Reimbursement
Reimbursements typically process within 7-14 business days.

Timeline Expectations

• Day 0: Submit health assessment to Crates
• Day 2: Receive your LMN
• Day 2-14: Research and purchase mattress
• Day 3: Submit reimbursement documentation
• Day 10-17: Receive HSA/FSA reimbursement

Important Considerations

Trial Periods: Use the full trial period (90-365 days) to ensure your mattress effectively addresses your health condition. If it doesn’t help, return it before the trial ends.

Accessory Bundling: Purchase qualifying accessories (toppers, protectors, pillows) at the same time to maximize tax savings under one LMN.

Documentation Storage: Keep copies of your LMN and receipts for at least 3 years in case of IRS audit.

For sleep tracking and optimization that complements your mattress investment, explore our Sleep Tech Guide or the Oura Ring for comprehensive sleep monitoring.

Frequently Asked Questions