Why
Publication 502 doesn't mention veneers, so two of its general rules decide the answer.
The cosmetic surgery rule excludes any procedure directed at improving appearance that doesn't meaningfully promote the proper function of the body or prevent or treat illness or disease. Veneers chosen to change the color, shape or spacing of healthy teeth would fall under it, the same way teeth whitening did in Revenue Ruling 2003-57.
The dental treatment rule allows amounts paid to prevent or alleviate dental disease. A veneer or crown that restores a tooth damaged by decay or injury is on firmer ground, because it treats a dental problem. The cosmetic rule also has its own exception for a procedure needed to improve a deformity that comes from a congenital abnormality, an accident or trauma, or a disfiguring disease.
The IRS hasn't ruled on veneers by name. What your dentist's records say about why the work was needed is what you'd rely on.
What to keep
- The dentist's treatment notes, or a letter saying what condition the veneer treats, such as decay, a fracture or enamel loss.
- An itemized bill showing each tooth and procedure, plus the explanation of benefits if a dental plan paid part.
- X-rays or photos taken before treatment, if the dentist has them.
Watch out for
- On a full smile makeover, only the teeth with a documented dental problem have an argument.
- If your dental plan denied the veneer as cosmetic, expect to need the dentist's records to show otherwise.
- Whitening doesn't count, even when it's done alongside restorative work.
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.