Interested in using your FSA or HSA account to pay for your Pilates training?  Your healthcare provider can write an ‘exercise prescription’ referring you to use Pilates training to alleviate a specific condition.   Here’s what you need to do:

Evaluate how you’ve been feeling physically over the last year

  • Has your range of motion lessened, or do you have ongoing or intermittent pain in your: feet, knees, hips, back, neck, shoulder or hands? 
  • Do you have a chronic condition: arthritis, fibromyalgia, bursitis, bulging disc, osteoporosis, etc?
  • Have you been diagnosed with obesity, heart disease or diabetes?
  • Have you had a surgery or medical treatment that has left you with ongoing muscle pain or limits in your range of motion?

Any of these conditions may benefit from a Pilates Exercise RX. 

Make an appointment with a Licensed Healthcare Provider

Doctors, chiropractors, acupuncturists, naturopaths, and osteopaths can all write prescriptions for exercise.  You’ll need to see someone who is licensed by your state.  When in doubt, simply ask before your appointment if they are able to write an exercise prescription for someone with a specific condition.  You’ll need to have an appointment for them to assess and give their professional opinion that your specific condition would improve with exercise.  It’s ok to combine a treatment with a request for an Exercise RX.

What to expect the Exercise Prescription to say

Very similar to a pharmaceutical RX, the Exercise RX will typically list 1) a type of exercise training; 2) an amount of training and 3) an overall time frame.  It should sound something like this:  “For treatment of xxxxx condition, Pilates exercise training #/week for # months”  Hold onto this RX with your tax documents!

Check your FSA or HSA documentation to determine whether you need to supply a copy of the Exercise RX to them

 If you’re set up where you are reimbursed after the fact, it’s likely that you’ll need to supply a copy.  If you use an HSA debit card, simply file the RX away with your personal tax info.  You don’t need to supply it when you submit your taxes, but you do need to have it if you are audited.

Make an appointment to start your Pilates training

For those training with me  — at Nike WHQ or in at the Ageless Pilates studio in NW Portland — shoot me an email with your date & time preferences.   For those training with another Pilates trainer, simply ask them if they can accept an HSA/FSA credit card.

If you have an HSA credit card, use that when you purchase your sessions.  If you get reimbursed for an HSA or FSA, keep your receipt to submit to your plan administrator.


What about using my regular Health Insurance?  I cannot bill insurance for Pilates training.  To have Pilates training covered as a ‘medical expense’ you would need to find a Physical Therapist who also offers Pilates Training. 

What’s the difference between using insurance, filing a medical expense and accessing HAS/FSA funds?

  • Insurance companies make their own rules on what they cover.  If they cover exercise prescriptions, they usually require the exercise to be with a Physical Therapist.
  • Acceptable medical expenses on your taxes are determined by the IRS.  Pilates training, so far, is only covered for treatment of arthritis.  Go figure.  For more info: see IRS publication 502.
  • The acceptable use of HAS/FSA funds is much looser than taking a Medical Deduction.  The IRS has stated it will not publish a comprehensive list of acceptable items or treatments, but it does publish general guidelines.  The rule of thumb on this: have a written RX from a licensed healthcare provider, for a specific condition.  For more information: see IRS Publication 969.

Can you write off your gym membership as a medical expense if you need to lose weight?  No.  This is too general for the IRS; you need a specific Exercise RX for a specific condition.

So, Pilates training still costs me something out of pocket?  Yes.  An Exercise RX would simply help you pay for training with pre-tax funds.  If you’ve been putting funds away in your FSA or HSA without a specific use in mind, this may be a good use of those funds.  FSA monies need to be spent in the year that they’re allocated, HSA funds can roll-over to the next year.