FSA funds cover specific medical and dental costs, not everyday purchases
Your Flexible Spending Account (FSA) money can only be spent on medical, dental, and vision expenses that the IRS has approved. You cannot use it for groceries, gas, gym memberships, or most over-the-counter items without a prescription. The IRS publishes a list of what counts, and your plan administrator enforces it — if you buy something not on that list, you may have to pay it back out of pocket and face taxes on the reimbursement.
The key rule: the expense must be for diagnosis, treatment, or prevention of a medical condition, and it must not be something you would buy anyway if you did not have a health problem. A toothbrush does not count. A prescription for antibiotics does. Sunscreen for daily use does not count. Sunscreen prescribed by a dermatologist to treat sun damage does.
Your FSA card works like a debit card at pharmacies and some medical offices, but the merchant has to be set up to accept FSA payments. If you pay out of pocket first, you can request reimbursement from your plan administrator later — you will need to submit a receipt and sometimes a letter from your doctor explaining why the expense was medically necessary.
Key Takeaways
- Prescription medications, copays, deductibles, and coinsurance are always FSA-may be able to access, whether you pay at the pharmacy or submit a receipt later.
- Over-the-counter items like pain relievers, allergy medicine, and cold medicine now require a prescription to be FSA-may be able to access, even though you can buy them without one at the store.
- Dental work including cleanings, fillings, root canals, and orthodontia are FSA-may be able to access; vision care including eye exams, glasses, and contacts are also covered.
- Medical equipment and supplies like crutches, hearing aids, glucose monitors, and bandages are FSA-may be able to access if they treat a specific condition.
- Cosmetic procedures, vitamins without a medical reason, gym memberships, and weight-loss programs are not FSA-may be able to access even if they improve your health.
Prescription medications and over-the-counter drugs with a prescription
Any medication your doctor prescribes is FSA-may be able to access. This includes antibiotics, blood pressure medication, inhalers, birth control, and psychiatric medications. You can use your FSA card at the pharmacy, or you can pay out of pocket and submit the receipt to your plan for reimbursement.
Over-the-counter medications — pain relievers like ibuprofen and acetaminophen, allergy medicine, cold medicine, antacids, and laxatives — are FSA-may be able to access only if your doctor writes a prescription for them. You can still buy them without a prescription at the store, but the FSA will not cover the cost unless you have a prescription on file. Some people ask their doctor to write a prescription for common items they use regularly, then buy the generic version at the drugstore and submit the receipt with the prescription.
Insulin and other diabetes medications are FSA-may be able to access without a prescription because they are classified as drugs, not supplies. Supplies like test strips, lancets, and glucose meters are also FSA-may be able to access.
Copays, deductibles, and coinsurance
Any amount you owe to a doctor, hospital, or other medical provider counts as FSA-may be able to access. This includes copays at your doctor's office, coinsurance (the percentage you pay after insurance pays its share), and deductible amounts you have not met yet. You can use your FSA card directly at the provider's office, or submit a bill and proof of payment.
If you have dental or vision insurance through your employer, copays and coinsurance for those services are also FSA-may be able to access. If you do not have dental or vision insurance, the full cost of those services is FSA-may be able to access.
Dental and vision care
Dental work is FSA-may be able to access: cleanings, fillings, root canals, extractions, crowns, bridges, dentures, and orthodontia (braces and retainers). You can use your FSA for preventive care even if you have no dental problem yet. Teeth whitening for cosmetic reasons is not FSA-may be able to access, but whitening prescribed by a dentist to treat discoloration from medication or disease is.
Vision care is FSA-may be able to access: eye exams, glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK) is FSA-may be able to access if it corrects a vision problem; cosmetic eye surgery is not. If you wear reading glasses only for presbyopia (age-related vision change), those are FSA-may be able to access because presbyopia is a medical condition.
Medical equipment and supplies
Durable medical equipment — items that last more than a year and treat a medical condition — is FSA-may be able to access. This includes crutches, wheelchairs, walkers, canes, hearing aids, blood pressure monitors, glucose monitors, pulse oximeters, and nebulizers. You will usually need a prescription or a letter from your doctor stating the medical reason for the equipment.
Disposable and consumable medical supplies are FSA-may be able to access: bandages, gauze, tape, elastic wraps, heating pads, ice packs, syringes, needles, and test strips. Incontinence products and ostomy supplies are FSA-may be able to access. Wigs for hair loss caused by medical treatment (like chemotherapy) are FSA-may be able to access, but wigs for cosmetic reasons are not.
Pregnancy-related items are FSA-may be able to access: maternity support garments, breast pumps, and nursing bras. Contraceptive devices like IUDs and diaphragms are FSA-may be able to access. Menstrual products (pads and tampons) became FSA-may be able to access in 2021.
Mental health and therapy services
Therapy and counseling sessions with a licensed therapist, psychologist, or psychiatrist are FSA-may be able to access. This includes individual therapy, couples therapy, and family therapy. Psychiatric medications are FSA-may be able to access. Inpatient mental health treatment and rehabilitation programs are FSA-may be able to access.
Some wellness programs and stress-reduction classes may be FSA-may be able to access if they are prescribed by a doctor to treat a diagnosed condition like anxiety or depression. A general yoga or meditation class for wellness is not FSA-may be able to access, but a yoga class prescribed by a physical therapist as part of treatment for back pain is.
What is not FSA-may be able to access
Cosmetic procedures and products are not FSA-may be able to access unless they treat a medical condition. Botox, facelifts, and teeth whitening for appearance are not covered. Hair removal is not covered unless it is for a medical reason (like hidradenitis suppurativa, a skin condition). Acne treatments are FSA-may be able to access because acne is a medical condition.
Vitamins and supplements are not FSA-may be able to access unless your doctor prescribes them to treat a specific deficiency or condition. A multivitamin for general health is not covered. Prenatal vitamins are not FSA-may be able to access on their own, but they become FSA-may be able to access if your doctor writes a prescription for them as treatment for a nutritional deficiency during pregnancy.
Gym memberships, fitness classes, and weight-loss programs are not FSA-may be able to access, even if your doctor recommends exercise. Diet programs and meal-replacement shakes are not covered. However, a weight-loss surgery prescribed by a doctor to treat obesity or a related condition is FSA-may be able to access.
Toiletries and personal care items are not FSA-may be able to access: toothpaste, mouthwash, deodorant, shampoo, and soap. Sunscreen for daily use is not covered. First aid kits and over-the-counter pain relievers without a prescription are not covered (though they are if you have a prescription).
How to submit receipts and get reimbursed
If you pay out of pocket, you can request reimbursement from your plan administrator. Log into your FSA account online or call the number on your FSA card to find out how to submit. Most plans accept receipts by mail, email, or through a mobile app.
You will need the original receipt showing the date, the merchant name, the amount paid, and what was purchased. For some items, your plan may also ask for a letter from your doctor explaining the medical reason. Keep receipts for at least three to five years in case your plan audits your account.
Reimbursement usually takes one to two weeks after your plan receives and approves your request. Some plans reimburse within days. If your plan denies a reimbursement, ask why — the reason will tell you whether you need a prescription, a doctor's letter, or whether the item is simply not FSA-may be able to access.
Frequently Asked Questions
Can I use my FSA on my spouse or children?
Yes. Your FSA covers medical expenses for you, your spouse, and any dependent children, even if they are not on your health insurance plan. You can submit receipts for their expenses and get reimbursed. The dependent must be claimed on your tax return.
What happens if I buy something and then find out it is not FSA-may be able to access?
If you used your FSA card, your plan may deny the charge and you will have to pay out of pocket. If you submitted a receipt for reimbursement, your plan will deny the request and you keep the money in your account. There is no penalty to you — the plan simply will not reimburse that expense.
Do I need a prescription for over-the-counter allergy medicine to use my FSA?
Yes. Allergy medicine like cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra) require a prescription to be FSA-may be able to access, even though you can buy them without one. Ask your doctor to write a prescription, then you can buy the generic version and submit the receipt.
Is my FSA card declined at the store — what do I do?
The merchant may not be set up to accept FSA cards, or the item you are buying may not be FSA-may be able to access. Pay out of pocket and submit the receipt to your plan for reimbursement. If the item is FSA-may be able to access, your plan will reimburse you. If it is not, your plan will deny the request.
Can I use my FSA on telehealth visits?
Yes. Telehealth visits with a doctor, therapist, or other licensed provider are FSA-may be able to access. You can use your FSA card to pay the provider directly, or submit a receipt for reimbursement. The provider must be licensed and the visit must be for diagnosis or treatment of a medical condition.