What an FSA covers: the basic rule
Your Flexible Spending Account (FSA) can pay for medical expenses that your health insurance does not cover, but only those that meet the IRS definition of a may have access to medical expense. The IRS publishes a list of what counts, and it is narrower than many people expect. If you buy something your FSA does not cover, you cannot get reimbursed, and you cannot move that money to another use.
The rule is straightforward: the expense must be for diagnosis, cure, mitigation, treatment, or prevention of disease, or for treatment of a bodily function. Cosmetic procedures, general wellness items, and anything that improves your appearance without treating a medical condition do not may have access to, even if they make you feel better.
Key Takeaways
- FSA funds cover doctor visits, prescription medications, dental work, vision care, and medical equipment like crutches or glucose monitors, but not over-the-counter items unless prescribed by a doctor.
- Cosmetic procedures, gym memberships, vitamins, and general wellness products do not may have access to, even if recommended by a health professional.
- Some over-the-counter medications and supplies now may have access to without a prescription, including pain relievers, allergy medicine, and menstrual products, but rules changed in 2020 and vary by item.
- Your FSA plan document may be more restrictive than the IRS rules, so check with your plan administrator before spending.
- If you buy something that does not may have access to and try to reimburse it, you may face taxes, penalties, and an audit flag on your account.
Medical care and prescriptions that always may have access to
Doctor visits, hospital stays, surgery, and mental health treatment all may have access to. This includes copays, coinsurance, and deductibles you pay out of pocket. Prescription medications prescribed by a doctor may have access to, as do insulin and other diabetes supplies. Physical therapy, occupational therapy, and speech therapy are covered when ordered by a medical professional.
Dental work qualifies: cleanings, fillings, root canals, orthodontia, and extractions. Vision care qualifies: eye exams, glasses, contact lenses, and laser eye surgery. Hearing aids and hearing tests may have access to. Chiropractic care, acupuncture, and other treatments ordered by a licensed practitioner may have access to if they treat a diagnosed condition.
Medical equipment and supplies
Durable medical equipment qualifies when prescribed by a doctor: crutches, wheelchairs, walkers, blood pressure monitors, glucose monitors, and oxygen equipment. Bandages, gauze, and medical tape may have access to. Elastic bandages, knee braces, and back braces may have access to. Pregnancy tests, ovulation kits, and contraceptives may have access to.
Menstrual products now may have access to without a prescription as of January 2020. Pain relievers, allergy medicine, antacids, cold medicine, and anti-diarrheal medication now may have access to without a prescription, also as of 2020. However, your specific FSA plan may still require a prescription for some of these items, so check your plan document or call your plan administrator before you buy.
What does not may have access to, even if recommended
Vitamins, supplements, and herbal products do not may have access to unless prescribed by a doctor to treat a specific medical condition. A general recommendation to "take vitamin D" does not count; a prescription for vitamin D to treat diagnosed deficiency does. Cosmetic procedures do not may have access to: Botox, dermal fillers, teeth whitening, hair removal, and cosmetic surgery are not covered, even if a doctor performs them.
Gym memberships, fitness classes, and general wellness programs do not may have access to. Weight loss programs do not may have access to unless they treat obesity as a diagnosed disease and are prescribed by a doctor. Sunscreen does not may have access to as a preventive expense. Toiletries, deodorant, and personal hygiene products do not may have access to. Over-the-counter medications that are not on the IRS list do not may have access to without a prescription.
Over-the-counter items: the 2020 rule change
Before 2020, you needed a prescription from a doctor to reimburse any over-the-counter medication or supply through your FSA. The CARES Act changed that in January 2020, and now many over-the-counter items may have access to without a prescription. The list includes common pain relievers (ibuprofen, acetaminophen, aspirin), allergy medicine (antihistamines, decongestants), antacids, anti-diarrheal medication, laxatives, and menstrual products.
However, not every over-the-counter item qualifies. Cough drops, throat lozenges, and some cold remedies still do not may have access to without a prescription. Your plan administrator can tell you which specific products are covered under your plan. When you buy an over-the-counter item, keep the receipt and the product packaging, because your plan may ask you to prove it qualifies before reimbursing you.
How to know if something qualifies before you buy
Your FSA plan document lists what your specific plan covers. This document is more restrictive than the IRS rules, so something the IRS allows may still be excluded by your plan. Call your plan administrator or check your plan's website before you spend money on anything you are unsure about. Many plans have a searchable database of covered items.
If you buy something and later find out it does not may have access to, you cannot get reimbursed. If you try to reimburse an ineligible expense, the IRS may flag your account for audit. Keep all receipts and product packaging for at least three years in case your plan asks for proof that an item qualifies.
Frequently Asked Questions
Can I use my FSA to buy over-the-counter pain relievers without a prescription?
Yes, as of 2020 you can reimburse over-the-counter pain relievers like ibuprofen and acetaminophen without a prescription. However, your specific plan may have additional rules, so check your plan document or call your administrator to confirm. Keep your receipt and packaging as proof.
Does my FSA cover vitamins and supplements?
Not unless a doctor prescribes them to treat a specific diagnosed condition. A general recommendation to take a vitamin does not count. If your doctor writes a prescription for vitamin D to treat a deficiency, that prescription qualifies, but the same vitamin bought over the counter without a prescription does not.
Can I use FSA money for cosmetic procedures like teeth whitening?
No. Cosmetic procedures do not may have access to for FSA reimbursement, even if a dentist or doctor performs them. Teeth whitening, Botox, dermal fillers, and cosmetic surgery are not covered. If a procedure treats a medical condition rather than appearance, it may may have access to — ask your plan administrator.
What happens if I try to reimburse something that does not may have access to?
Your plan may deny the reimbursement, or it may process it and later ask for the money back. If the IRS audits your account and finds ineligible expenses, you may owe taxes and penalties on that money. Keep receipts for everything you reimburse so you can prove it qualifies if asked.
Does my FSA cover gym memberships or fitness classes?
No, general fitness and gym memberships do not may have access to. Weight loss programs do not may have access to unless a doctor prescribes them to treat diagnosed obesity as a medical condition. Even then, your plan may require documentation from the doctor before reimbursing.