FSA funds cover medical and dental costs you pay out of pocket, but not everything health-related

A Flexible Spending Account (FSA) lets you set aside pre-tax money to pay for may have access to medical expenses. The IRS maintains a specific list of what counts. Common covered items include copays, deductibles, prescription medications, and dental work. Items that seem medical but aren't on the list — like cosmetic procedures, over-the-counter vitamins without a prescription, or gym memberships — cannot be paid for with FSA funds, even if you think they help your health.

The key rule: the expense must be for diagnosis, treatment, or prevention of a disease or condition, and it must be medically necessary. Your employer's FSA plan document may be more restrictive than the IRS rules, so what one plan covers might not be covered by another. Before you spend from your FSA, check your plan's summary of benefits or call your plan administrator to confirm.

Key Takeaways

  • Copays, coinsurance, deductibles, and prescription medications are always FSA-may be able to access, as long as they treat a diagnosed condition.
  • Dental and vision care — including cleanings, fillings, glasses, and contact lenses — are covered if your plan includes them.
  • Over-the-counter items like pain relievers, allergy medicine, and cold remedies require a prescription from your doctor to be FSA-may be able to access.
  • Cosmetic procedures, gym memberships, and general wellness products are not FSA-may be able to access, even if they improve your health.
  • Your specific plan may cover fewer items than the IRS allows, so you must check your plan documents before spending.

Medical expenses that FSA funds can cover

Copays and coinsurance for doctor visits, urgent care, and emergency room visits are FSA-may be able to access. So are deductibles you pay before your insurance kicks in. If you have a $1,500 deductible and you pay $400 of it out of pocket, that $400 can come from your FSA.

Prescription medications are covered. Over-the-counter medications — like ibuprofen, antihistamines, or cough syrup — are also covered, but only if your doctor writes a prescription for them. A prescription for an OTC item changes its tax status. Some plans allow you to buy OTC items without a prescription if you have a letter of medical necessity from your doctor, but this varies by plan.

Mental health and substance abuse treatment, including therapy and counseling sessions, are FSA-may be able to access. So are costs for medical equipment prescribed by a doctor: crutches, wheelchairs, blood pressure monitors, glucose meters, and hearing aids all may have access to. Insulin and other injectable medications are covered.

Dental and vision care covered by FSA

Routine dental care — cleanings, exams, and X-rays — is FSA-may be able to access. So are fillings, root canals, crowns, and extractions. Orthodontia, including braces and retainers, is covered. Dental implants and bridges are may be able to access if they replace missing teeth for functional reasons, not purely cosmetic ones.

Vision expenses include eye exams, glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK) is FSA-may be able to access. Frames and lens coatings are covered as part of the cost of glasses.

What is not covered, even though it seems medical

Cosmetic procedures are not FSA-may be able to access. This includes teeth whitening, hair removal, wrinkle treatments, and cosmetic surgery. The exception: if a procedure is medically necessary — for example, reconstructive surgery after an accident or burn — it may be covered. Purely elective cosmetic work is not.

Gym memberships and fitness classes are not covered, even if your doctor recommends exercise. General wellness products — vitamins, supplements, and herbal remedies — are not may be able to access unless they treat a specific diagnosed condition and your doctor prescribes them. Sunscreen, toothpaste, and shampoo are not covered. Maternity clothes are not covered, though prenatal vitamins prescribed by your doctor are.

Weight loss programs and diet plans are not FSA-may be able to access unless they treat a diagnosed medical condition like obesity or diabetes, and your doctor refers you to the specific program. Even then, some plans do not cover them. Fertility treatments, including IVF and medications, are FSA-may be able to access in most plans, but some employer plans exclude them, so check yours.

How to know what your specific plan covers

Your employer's FSA plan document is the final word on what you can spend money on. The IRS sets a floor — certain things are always may be able to access — but your employer can choose to cover fewer items. Some plans exclude fertility treatments, for example, or limit dental coverage to preventive care only.

Your plan administrator (usually a benefits company hired by your employer) can tell you whether a specific expense is covered. Call the number on your FSA card or in your plan materials and ask. Many plans also have online portals where you can search for may be able to access expenses or submit a question. If you buy something and later find out it was not covered, you may have to pay back the FSA from your own money, so it is worth checking first.

Over-the-counter items: the prescription rule

As of 2020, you can use FSA funds for over-the-counter medications and medical supplies without a prescription — but only if your plan allows it. Many plans do allow it now, but not all. Check your plan documents or call your administrator.

If your plan requires a prescription for OTC items, your doctor can write one. A prescription for ibuprofen or allergy medicine is legal and common; your doctor simply writes it as they would for any other medication. You fill it at the pharmacy and pay with your FSA card. Some people get a letter of medical necessity from their doctor instead, which they keep on file in case the FSA administrator asks for proof later.

Frequently Asked Questions

Can I use my FSA for my spouse's or child's medical expenses?

Yes, if they are your tax dependents. You can use your FSA to pay for medical expenses for your spouse and any children you claim on your tax return. The expense must still be FSA-may be able to access; the dependent status just determines who can be covered.

What if I buy something and later find out it is not FSA-may be able to access?

You will have to repay the FSA from your own money. The FSA administrator may ask you to return the funds, or you may have to report it when you file taxes. It is worth confirming before you spend, especially for larger expenses.

Can I use FSA funds for pet medical care?

No. Veterinary expenses are not FSA-may be able to access because the IRS considers them personal expenses, not medical care for you or your dependents. This applies even if your pet is a service animal; the exception is for guide dogs and other animals trained to perform a specific medical function, which some plans cover under different rules.

Are prescription glasses and contacts always covered?

Yes, as long as your plan includes vision coverage. Glasses, contacts, contact solution, and eye exams are standard FSA-may be able to access expenses. Some plans may have limits on how often you can replace them or how much they will reimburse, so check your plan details.

Can I use FSA money for a doctor-recommended weight loss program?

Only if your doctor refers you to a specific program to treat a diagnosed condition like obesity or diabetes, and your plan covers weight loss programs. General weight loss programs and gym memberships are not covered. Ask your plan administrator whether your specific program qualifies before you enroll.