FSA money covers medical expenses your insurance doesn't pay for, plus some items insurance won't cover at all
Your Flexible Spending Account (FSA) can pay for copays, deductibles, prescription medications, and medical equipment — essentially anything related to diagnosing, treating, or preventing a health condition. But the IRS has specific rules about what counts. Items must be for you, your spouse, or your dependents, and they must be medically necessary rather than general wellness products.
The catch is that "medically necessary" has a narrower meaning than you might expect. Vitamins are out unless prescribed by a doctor for a specific deficiency. Toothpaste is out. A gym membership is out, even if your doctor recommends exercise. But prescription eyeglasses, hearing aids, and crutches are in. The IRS publishes a list, but it's not exhaustive — when you're unsure, your FSA plan administrator can tell you whether a specific item qualifies before you spend the money.
Key Takeaways
- FSA funds cover copays, deductibles, prescription drugs, and medical equipment that treat or prevent a diagnosed health condition.
- Over-the-counter medications now may have access to without a prescription, but vitamins, supplements, and general wellness items do not.
- Dental and vision expenses — including exams, cleanings, glasses, and contacts — are FSA-may be able to access.
- Your FSA plan administrator maintains the official list of what qualifies, and you can ask before you spend.
Prescription medications and over-the-counter drugs
All prescription medications may have access to, regardless of what they treat. That includes birth control, antidepressants, blood pressure medication, and antibiotics. You pay with your FSA debit card at the pharmacy, or you submit a receipt for reimbursement.
Over-the-counter medications now may have access to without requiring a doctor's prescription first. This includes pain relievers (ibuprofen, acetaminophen), cold and allergy medicine, antacids, and anti-diarrheal medication. The change came in 2020 and applies to most FSA plans, though you should confirm with your plan administrator if you have an older or unusual plan.
Vitamins and supplements do not may have access to unless a doctor prescribes them for a specific medical condition — for example, a prescription for vitamin D because of a documented deficiency. A general multivitamin you buy on your own does not count, even if you take it daily.
Copays, deductibles, and coinsurance
FSA money can pay any out-of-pocket cost your health insurance requires you to cover. This includes copays at the doctor's office, the deductible you pay before insurance kicks in, and coinsurance (the percentage you pay after insurance pays its share). You can use FSA funds to cover these costs for yourself, your spouse, and your dependents.
This is one of the most straightforward uses of an FSA. Many people set aside FSA money specifically to cover their annual deductible, knowing they'll hit it early in the year.
Dental and vision care
Dental exams, cleanings, fillings, root canals, and orthodontia all may have access to. You can use FSA money for braces, retainers, and the dentist's portion of any procedure. Dental insurance copays and deductibles also count.
Vision care includes eye exams, prescription glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK) qualifies. Sunglasses do not, even if they're prescription, because they're considered general eyewear rather than medical treatment.
Medical equipment and supplies
Crutches, wheelchairs, walkers, hearing aids, and blood pressure monitors all may have access to. Diabetic supplies — test strips, lancets, and glucose monitors — are FSA-may be able to access. Bandages, elastic wraps, and over-the-counter braces (knee braces, wrist supports) count as long as they're treating an actual condition, not preventing a potential one.
Pregnancy tests and contraceptive devices may have access to. Menstrual products now may have access to as well, following a 2020 rule change. Medical alert systems and certain home medical equipment also count, though you may need documentation that a doctor prescribed it.
Mental health and therapy
Copays for therapy, counseling, and psychiatric visits are FSA-may be able to access. If you see a therapist or psychiatrist, your FSA can cover your share of the cost. Medications prescribed for mental health conditions (antidepressants, anti-anxiety medication, mood stabilizers) also may have access to.
Some FSA plans cover certain wellness programs if they're part of a treatment plan for a diagnosed condition — for example, a smoking cessation program prescribed by your doctor, or a weight-loss program prescribed to treat obesity. General wellness classes or gym memberships do not may have access to, even if recommended for overall health.
What does not may have access to
General health and wellness items are out: vitamins (unless prescribed), gym memberships, fitness equipment, and cosmetic procedures. Sunscreen does not may have access to. Toothpaste and mouthwash do not may have access to. Shampoo and conditioner do not may have access to, even medicated versions, unless a dermatologist prescribes them for a specific scalp condition.
Cosmetic procedures — including teeth whitening, Botox, and hair removal — do not may have access to. However, reconstructive surgery after an injury or illness does may have access to. The distinction is whether the procedure treats a medical condition or improves appearance for its own sake.
Childcare, pet care, and household items never may have access to, even if they support your health indirectly. Travel to medical appointments does not may have access to, though mileage reimbursement under certain employer plans may.
How to know if something qualifies
Your FSA plan comes with a summary document that lists common may be able to access expenses. Your plan administrator — usually a benefits company hired by your employer — maintains the official list and can answer specific questions. Before you spend FSA money on something you're unsure about, contact them. They can tell you yes or no, and if the answer is no, you'll know not to use FSA funds.
Keep receipts for everything you buy with FSA money. If your plan audits your spending, you'll need to show that the items were medically necessary. The receipt should show what you bought; if it doesn't, ask the pharmacy or store for an itemized receipt.
Frequently Asked Questions
Can I use FSA money for my family members?
Yes, but only for your spouse and dependents claimed on your tax return. You cannot use FSA funds for an adult child, a parent, or anyone else, even if you pay for their medical care. The person must be a dependent under IRS rules.
Does FSA cover the full cost of prescriptions?
FSA covers the full cost of any prescription medication, but only up to the amount you've set aside in your account. If your prescription costs $200 and you've only contributed $150 to your FSA for the year, you pay the remaining $50 out of pocket.
Can I use FSA for telehealth visits?
Yes. Copays for telehealth appointments with doctors, therapists, and other licensed providers are FSA-may be able to access, just as in-person visits are. The visit must be with a licensed provider treating an actual medical condition.
What happens if I buy something and later find out it doesn't may have access to?
You'll have to pay back the FSA from your own pocket. Some plans allow you to request a reimbursement review if you think an item should may have access to, but the plan administrator has the final say. This is why asking before you spend is worth the phone call.
Does FSA cover medical bills from past years?
Yes. You can submit receipts for medical expenses from the current year and, depending on your plan, sometimes from the previous year. Check your plan documents for the exact deadline, but most plans allow claims for 60 to 90 days after the end of the plan year.