Why
Publication 502 has a one-line entry for artificial teeth: you can include the amount you pay for them. Its dental treatment entry also names X-rays, extractions and dentures as treatment to alleviate dental disease.
The publication doesn't use the word implant. An implant and the crown on it replace a missing tooth, which is what an artificial tooth is. The same reasoning covers bridges and partial dentures.
The work an implant needs along the way, such as X-rays and extractions, is dental treatment in its own right. A bone graft isn't named, but Publication 502 allows legal operations that aren't cosmetic surgery, which covers a graft done so the implant can be placed.
What to keep
- The treatment plan showing each stage and its cost.
- A receipt or statement for each payment, since implants are usually billed over several months.
- The explanation of benefits, if a dental plan paid part.
Watch out for
- You can reimburse only what you paid yourself, after any dental plan payment or discount.
- Whitening the surrounding teeth to match the new one doesn't count.
If you plan to reimburse yourself later
IRS Notice 2004-50, Q&A 39, sets no deadline, as long as the expense came after your HSA was established and your records show it wasn't paid by another source or deducted on a tax return. See what records the IRS expects and how long to keep them. Paying now and reimbursing years later is the HSA shoebox strategy.