HSA reimbursement for international health care?

[MustacheAndaHalf]

I'm wondering if costs encountered in other countries can be reimbursed from an HSA as qualified medical expenses.  Some people travel to Mexico for dental work, or to India for serious, expensive medical care.  On these forums, there's Americans who moved to Canada, UK and Australia.  Can medical expenses in foreign countries qualify as medical expenses for HSA purposes?  Has anyone tried?

[iluvzbeach]

I used mine to pay for an emergency room visit while in Italy. You might want to review IRS Publication 502, but I’m not aware of anything that says the medical care received must be in the U.S. 

[elysianfields]

I'm with @iluvzbeach on this.  Medical care is medical care, whether in the U.S. or abroad.

[2Birds1Stone]

PTF as we plan on spending significant time abroad during our lifetime and have HSA accounts.

[Adventine]

PTF as we plan on spending significant time abroad during our lifetime and have HSA accounts.

Same, would definitely be interested in hearing from others who have successfully done this.

[lhamo]

Cigna has a pretty thorough list -- we had platinum level health insurance as expats under Cigna, and I would trust their take on the question:

https://www.cigna.com/individuals-families/member-resources/hsa-fsa-hra-payments/eligible-expenses

[MustacheAndaHalf]

I used mine to pay for an emergency room visit while in Italy. You might want to review IRS Publication 502, but I’m not aware of anything that says the medical care received must be in the U.S.

In IRS pub 502, I only found one very limited section mentioning other countries:

"Medicines and Drugs From Other Countries
In general, you can't include in your medical expenses the cost of a prescribed drug brought in (or ordered and shipped) from another country. You can only include the cost of a drug that was imported legally. For example, you can include the cost of a prescribed drug the Food and Drug Administration announces can be legally imported by individuals.

You can include the cost of a prescribed drug you purchase and consume in another country if the drug is legal in both the other country and the United States."
https://www.irs.gov/publications/p502#en_US_2020_publink1000179071

Which I read to mean you can be reimbursed for legal drugs bought and used in the same country.  But importing a drug between countries requires it be on some FDA list.