How Paying for Treatment Abroad Works: HSA, FSA, IRS

Who you pay, what to get in writing before you pay, and what U.S. insurance and tax rules (HSA, FSA, IRS Publication 502) say about treatment abroad.

Last updated: October 16, 2026

You pay the clinic, not xcuro

xcuro does not bill you for medical services (Terms of Service). Patients do not pay xcuro for guidance or clinic matching; xcuro receives compensation from participating clinics when a patient chooses to proceed with treatment through one of our partners (How xcuro is compensated).

Your payment agreement for treatment is between you and the clinic. Prices shown on xcuro are estimates supplied by clinics; they may change and depend on your individual medical assessment (Terms of Service). The final price is the one the clinic confirms to you in writing.

Know what the price includes

CDC's Yellow Book advises medical tourists to make sure they understand which services are included in the cost of their procedure (CDC Yellow Book). Before paying anything, ask the clinic to put in writing:

the total price and the currency (U.S. dollars or local currency);
what is included: surgeon, anesthesia, hospital or surgical center, overnight stays, tests, medicines, garments, follow-up visits;
what is not included and what it would cost (for example, extra nights, extra tests, treatment of complications);
the deposit: how much, when it is due, and whether and when it is refundable;
the cancellation and refund policy, including if the clinic or surgeon decides you are not a candidate after your in-person exam;
accepted payment methods, and any card, currency-conversion or transfer fees;
whether you will receive an itemized invoice and receipts in English.

Keep every receipt. If you plan to use an HSA, the IRS requires you to keep records showing that distributions were used only for qualified medical expenses (IRS Publication 969).

Will U.S. insurance pay?

Usually, do not count on it. CDC says follow-up care for complications "might be expensive and might not be covered by your health insurance," and advises travelers to review their health insurance policies to see what, if anything, is covered and to plan for paying for additional care out of pocket (CDC). Medicare "usually doesn't cover health care while you're traveling outside the U.S.," with some exceptions (Medicare.gov).

Call your insurer before you travel and ask, in writing, two questions: does the plan cover the procedure abroad, and does it cover treatment in the U.S. for complications of a procedure done abroad?

HSA, FSA and IRS Publication 502

Here is what the IRS publications say. This is general information, not tax advice; ask a tax professional or your plan administrator about your case.

What counts as medical care. The IRS defines medical expenses as the costs of diagnosis, cure, mitigation, treatment or prevention of disease, and for the purpose of affecting any part or function of the body (IRS Publication 502).
HSA. Qualified medical expenses for an HSA are, in general, amounts paid for "medical care" as defined in Internal Revenue Code section 213(d). Money taken out for other purposes is subject to income tax and may be subject to an additional 20% tax; that additional tax does not apply after you are disabled, reach age 65, or die (IRS Publication 969).
Health FSA. Qualified medical expenses are those specified in your plan that would generally qualify for the medical and dental expenses deduction (IRS Publication 969). Check your plan's own rules.
Cosmetic surgery. Generally you can't include the cost of cosmetic surgery, meaning procedures aimed at improving appearance that don't meaningfully promote the proper function of the body or prevent or treat illness or disease. The IRS gives face lifts, hair transplants, hair removal (electrolysis) and liposuction as examples. Cosmetic surgery can be included if it is necessary to improve a deformity arising from, or directly related to, a congenital abnormality, an accident or trauma, or a disfiguring disease (for example, breast reconstruction after cancer surgery) (IRS Publication 502).
Medicines bought abroad. In general, you can't include the cost of a prescribed drug brought in or shipped from another country. You can include the cost of a prescribed drug you buy and use in another country if the drug is legal in both that country and the United States (IRS Publication 502).
Travel. Transportation "primarily for and essential to medical care," including plane fares, can be included. Lodging away from home can be included only if all IRS conditions are met, including that care is provided by a doctor in a licensed hospital or equivalent facility and there is no significant element of personal pleasure, recreation or vacation in the trip. The amount is capped at $50 per night per person, and meals aren't included (IRS Publication 502).

We did not find a separate rule in Publication 502 for medical care received in another country; its specific rule about other countries concerns medicines. Your HSA or FSA administrator may ask for an itemized invoice, so request one from the clinic.

FAQ

Do I pay xcuro anything?

No. Patients do not pay xcuro for guidance or clinic matching (methodology), and xcuro does not bill you for medical services (Terms).

Can I pay in installments?

Payment terms are set by the clinic, not by xcuro. Ask the clinic directly and get the terms in writing.

Can I use my HSA for surgery abroad?

The IRS rules depend on whether the expense counts as "medical care," not on a list of countries. Cosmetic surgery generally does not qualify (IRS Publication 502). Confirm with your HSA administrator or a tax professional before you pay.

Is the deposit refundable?

That depends on the clinic's policy. Ask for it in writing before you pay.

Sources

All sources accessed October 2026.

IRS Publication 502, Medical and Dental Expenses: irs.gov/publications/p502
IRS Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans: irs.gov/publications/p969
CDC Travelers' Health – Medical Tourism: wwwnc.cdc.gov/travel/page/medical-tourism
CDC Yellow Book – Medical Tourism: cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html
Medicare.gov – Travel outside the U.S.: medicare.gov/coverage/travel-outside-the-u.s.
xcuro Terms of Service and Methodology

How paying for treatment abroad works