The HSA is like a bank or investment account, not an insurance program; there's no claim process; you just withdraw the money whenever you want at your say-so. There is only an IRS audit process if they think you acted against the rules of the HSA.

For keeping receipts, we have a process where we dump our eligible receipts into a folder on the NAS and have the scanner/printer setup with a one-button "medical scan" that also dumps paper bills into that folder. You only need receipts to substantiate your position during an audit if they decide to do one, so a big pile of receipts and a spreadsheet with the annual amounts is enough for my taste.

For a reduction of taxes at our full federal tax bracket plus our state income rate, it's worth keeping a folder on the NAS and pushing a button on the scanner a couple handful of times per year.

> Is there a chance the rules could change and the medical care has to be recent?

There's always a theoretical chance, but any prior (or likely then-current year) medical bills would almost surely still remain eligible for reimbursement. The worst case that I can see as being likely is a rule change to require that a 2026 expense would have to be claimed by April 15, 2027. But I wouldn't expect that and think there's precedent that they couldn't change the reimbursement eligibility for expenses incurred prior to the law change. US v Carlton is one where specifically a one-year period of retroactive change was found to be "supported by a legitimate legislative purpose furthered by rational means" which suggests to me (IANAL) that longer periods of retroactive change would likely be found to violate due process.