Your FSA card covers medical and dental expenses, but not everything that sounds health-related
Your FSA card pays for may have access to medical expenses — a specific list set by the IRS, not by your employer or your plan. The card works at pharmacies, doctor's offices, and medical supply stores, but the same item can be allowed or blocked depending on what it is and why you're buying it. Vitamins are blocked. Prescription vitamins are allowed. Sunscreen is blocked. Sunscreen prescribed by a dermatologist for a skin condition is allowed. The difference matters because using your FSA card on an ineligible expense can trigger an audit and a bill for taxes plus penalties.
The IRS publishes the official list of may be able to access expenses in Publication 502. Your FSA plan administrator follows this list, though some plans are stricter. Before you swipe your card on anything beyond basic prescriptions and copays, you can check with your plan administrator or ask for documentation requirements — some items need a doctor's letter stating medical necessity before you buy.
Key Takeaways
- Prescription medications, copays, deductibles, and dental work are covered; over-the-counter drugs, cosmetics, and general wellness items are not.
- The IRS publishes a list of may be able to access expenses, but borderline items like certain medical devices or treatments require documentation to prove medical necessity.
- Using your card on an ineligible expense means you pay tax plus a 20 percent penalty, so keeping receipts and asking before you buy protects you.
- Some items require a letter from your doctor stating medical necessity; your FSA plan administrator can tell you which ones before you purchase.
Prescription medications and pharmacy purchases
Prescription drugs are always covered, including insulin, inhalers, and birth control. Over-the-counter medications are covered only if you have a prescription for them — so ibuprofen you buy off the shelf is not covered, but ibuprofen your doctor prescribes is. This applies to allergy medicine, cold medicine, and antacids too.
Pharmacy purchases beyond medication are usually not covered: toothpaste, mouthwash, shampoo, and deodorant are personal care items, not medical expenses. Diabetic supplies like test strips and lancets are covered. Bandages, gauze, and medical tape are covered. Crutches, braces, and compression sleeves are covered if they treat a specific condition.
Doctor visits, dental work, and mental health care
Copays and coinsurance for doctor visits are covered. Deductibles are covered. Lab work and imaging ordered by a doctor are covered. Mental health counseling and therapy sessions are covered, including copays to a therapist or psychiatrist.
Dental work is covered: cleanings, fillings, root canals, extractions, and orthodontia all count. Dental copays and deductibles are covered. Dental X-rays are covered. Teeth whitening is not covered unless it is medically necessary, which is rare and requires documentation from your dentist.
Medical equipment and supplies you might not expect
Eyeglasses and contact lenses are covered, including the exam and the frames. Hearing aids and batteries are covered. Crutches, walkers, and wheelchairs are covered. Heating pads and ice packs are covered. Blood pressure monitors and glucose meters are covered. Pregnancy tests are covered. Certain medical devices like CPAP machines and nebulizers are covered.
Some items sit in a gray zone and require a letter from your doctor stating medical necessity. These include: certain types of mattresses (if prescribed for a back condition), air purifiers (if prescribed for asthma or allergies), humidifiers (if prescribed for a respiratory condition), and home modifications like grab bars or ramps. Ask your FSA plan administrator whether the item you want to buy is on their list of things that need a doctor's letter before you purchase it.
What is blocked and why
Vitamins and supplements are not covered, even if they support your health. Protein powder and meal replacement shakes are not covered. Fitness equipment like dumbbells or yoga mats is not covered. Gym memberships are not covered. Cosmetics are not covered, even if they are labeled "medical-grade."
Sunscreen is not covered as a general purchase. Insect repellent is not covered. Toiletries like soap, shampoo, and deodorant are not covered. Over-the-counter pain relievers, cold medicine, and allergy medicine are not covered unless you have a prescription. Condoms and other contraceptives are not covered (though prescription birth control is). Food and beverages are not covered, even if labeled as healthy or organic.
How to know before you swipe
Your FSA plan administrator publishes a list of may be able to access expenses — ask for it or check your plan documents. The IRS also publishes Publication 502, which lists what counts as a medical expense for tax purposes; your FSA follows this list closely. Many plan administrators have online tools or customer service lines where you can search for a specific item.
When in doubt, contact your plan administrator before you buy. They can tell you whether a specific item is covered and whether you need a doctor's letter. If you buy something and it is denied, you will receive a notice explaining why and a bill for the amount plus taxes and a 20 percent penalty. Keeping receipts and asking first prevents this.
What happens if you use your card on something ineligible
If you swipe your FSA card on an ineligible expense, your plan administrator may catch it immediately and deny the charge. If they don't catch it at the point of sale, they will find it during their annual audit of your account. When they do, you receive a bill for the amount you spent plus income tax on that amount plus a 20 percent penalty.
For example, if you buy $100 of vitamins with your FSA card and your tax bracket is 24 percent, you owe $100 plus $24 in taxes plus $20 in penalties — a total of $144. This is why documentation and asking before you purchase matters. Keep receipts for at least three to five years in case your plan administrator audits your account.
Frequently Asked Questions
Can I use my FSA card at the grocery store for healthy food?
No. Food is not a medical expense, even if it is organic or labeled as healthy. The only exception is medical foods — specialized formulas prescribed by a doctor for a specific condition, like a formula for a newborn with a milk allergy. These require a prescription and a letter from your doctor.
Are over-the-counter pain relievers covered if I have chronic pain?
Not without a prescription. Over-the-counter ibuprofen, acetaminophen, and aspirin are not covered even if you use them regularly for a diagnosed condition. If your doctor prescribes one of these medications, it becomes covered. Ask your doctor to write a prescription if you use it regularly.
What if my FSA card is declined at the pharmacy?
The pharmacy may have flagged the item as ineligible, or your FSA account may be out of funds. Call your plan administrator to find out which. If it is an may be able to access issue, ask whether the item needs a prescription or a doctor's letter. If it is a funding issue, you can pay out of pocket and request reimbursement later if you have funds remaining.
Do I need to keep receipts for FSA purchases?
Yes. Your plan administrator can audit your account at any time and ask for proof that expenses were medical and that you paid what you claimed. Keep receipts for at least three to five years. If you cannot produce a receipt, you may be asked to repay the amount.
Can I use my FSA card for my pet's medical care?
No. Veterinary expenses are not covered, even if the pet is a service animal. Service animals themselves may be covered as a medical expense under certain circumstances, but their ongoing care and veterinary bills are not.