FSA money covers specific medical and dental costs, not everyday purchases
A Flexible Spending Account (FSA) lets you set aside pre-tax money for healthcare costs your insurance doesn't fully cover. You can use it for doctor visits, prescriptions, dental work, vision care, and medical equipment — but not for groceries, gym memberships, or cosmetic procedures. The IRS maintains a detailed list of what counts, and your plan administrator can tell you whether a specific item is allowed before you spend the money.
The key difference between an FSA and regular insurance is that FSA money is yours to spend on things insurance won't pay for at all, or won't pay for until you've met a deductible. If your insurance covers 80 percent of a dental crown and you owe 20 percent out of pocket, that 20 percent is an FSA-may be able to access expense.
Key Takeaways
- FSA funds cover copays, coinsurance, deductibles, and costs for services your insurance doesn't cover at all.
- Prescription medications, over-the-counter drugs (with a prescription), dental work, vision care, and hearing aids are all FSA-may be able to access.
- You cannot use FSA money for health insurance premiums, cosmetic procedures, or items like vitamins and toiletries unless they treat a specific medical condition.
- Your plan administrator or the IRS Publication 502 can confirm whether a specific medical expense is allowed before you pay.
Medical expenses you can pay with FSA funds
FSA money covers the out-of-pocket costs you owe after insurance pays its share. This includes copays (the flat fee you pay at a doctor visit), coinsurance (your percentage of the bill), and deductibles (the amount you pay before insurance kicks in). If you have a $1,500 deductible and you've paid $800 so far this year, you can use FSA funds for the remaining $700.
Prescription medications are FSA-may be able to access, and so are many over-the-counter drugs — but only if you have a prescription from a doctor. Aspirin, allergy medicine, and cold medicine bought without a prescription are not allowed. If your doctor writes a prescription for over-the-counter ibuprofen to treat arthritis, that prescription makes it FSA-may be able to access.
Mental health and therapy services, including copays and coinsurance for psychiatrist or counselor visits, are covered. So are lab tests, X-rays, and diagnostic imaging that your doctor orders. If you need physical therapy after an injury, the copays and any portion you owe after insurance are FSA-may be able to access.
Dental and vision care covered by FSA
Dental work is one of the most common FSA uses. Cleanings, fillings, root canals, crowns, extractions, and orthodontia (braces) are all may be able to access. If your dental insurance has a waiting period before it covers major work, or if you have no dental insurance at all, FSA funds can cover the full cost. The same applies to dentures and dental implants.
Vision care includes eye exams, glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK) is FSA-may be able to access. If you need a new prescription and new frames, both are covered. Sunglasses are not may be able to access unless they are prescribed as medical treatment for a light-sensitive condition.
Medical equipment and supplies you can purchase
FSA funds cover durable medical equipment — items your doctor prescribes that you'll use for more than one year. Hearing aids, wheelchairs, crutches, blood pressure monitors, glucose meters, and continuous positive airway pressure (CPAP) machines are all may be able to access. Eyeglasses and contact lenses count as medical equipment.
Supplies for managing a diagnosed condition are covered: insulin, test strips for diabetes, bandages, compression stockings, and orthopedic braces. Pregnancy tests and ovulation kits are FSA-may be able to access. If your doctor prescribes a special mattress or cushion for a medical condition, that qualifies. Canes, walkers, and grab bars installed in your home for safety are may be able to access.
Over-the-counter medical supplies like pain relievers, antacids, and allergy medicine are not may be able to access unless you have a prescription. However, items like first-aid kits, thermometers, and heating pads purchased without a prescription are not allowed.
What is not covered by FSA funds
Health insurance premiums — whether for individual coverage, family coverage, or COBRA — cannot be paid with FSA money. The same applies to long-term care insurance premiums. Cosmetic procedures like teeth whitening, Botox, or hair removal are not covered, even if a doctor performs them. Cosmetic dentistry (veneers, bonding for appearance only) is not may be able to access, though cosmetic work done to repair damage from injury or disease may be.
Vitamins, supplements, and herbal products are not FSA-may be able to access unless a doctor prescribes them to treat a specific medical condition. Toiletries like toothpaste, shampoo, and soap are not covered. Gym memberships and fitness equipment are not may be able to access, even if your doctor recommends exercise. Weight-loss programs and diet foods are not covered unless prescribed by a doctor as treatment for obesity or a related condition.
Cosmetic surgery, including nose jobs, facelifts, and breast augmentation, is not covered. Fertility treatments and surrogacy are not FSA-may be able to access in most plans, though some employers include them — check your plan documents. Adoption expenses are not covered.
How to confirm whether something is FSA-may be able to access
The IRS publishes Publication 502, which lists hundreds of may be able to access and ineligible expenses. You can download it free from IRS.gov. If you're unsure about a specific item, call your plan administrator before you buy it. They can tell you in minutes whether it qualifies, and they can often provide written confirmation so you have proof if you're audited.
Some items fall into a gray area. For example, certain vitamins are may be able to access only if prescribed by a doctor for a diagnosed deficiency. Certain medical alert systems are may be able to access only if prescribed. Your plan administrator knows how your specific plan interprets these borderline cases, so ask them rather than guessing.
Keep receipts and documentation for everything you buy with FSA funds. If you're audited, you'll need to show that the expense was medical in nature and that you paid it out of pocket (not through insurance). A receipt alone may not be enough — you may also need a doctor's note or prescription.
Frequently Asked Questions
Can I use FSA money for my spouse's medical expenses?
Yes, if your spouse is a dependent on your tax return. You can use your FSA to pay for your spouse's copays, prescriptions, dental work, and other may be able to access medical costs. The same rule applies to dependent children and other tax dependents.
Is a prescription required for all over-the-counter medications?
Yes. Over-the-counter drugs like pain relievers, allergy medicine, and cold medicine are FSA-may be able to access only if a doctor writes a prescription for them. Without a prescription, they are not allowed, even if you would normally buy them at a pharmacy.
Can I use FSA funds to pay for my pet's medical care?
No. FSA funds are for human medical expenses only. Veterinary care and pet medications are not may be able to access, even if a veterinarian prescribes them.
What happens if I buy something with FSA money and later find out it's not may be able to access?
You may owe taxes on that amount. If you discover the error, contact your plan administrator immediately. Some plans allow you to request a refund or correction. If you cannot correct it, you may need to report the ineligible expense as taxable income when you file your tax return.
Are fertility treatments and pregnancy-related expenses covered?
Pregnancy tests, prenatal vitamins (if prescribed), and copays for prenatal care are may be able to access. However, fertility treatments like in vitro fertilization (IVF) and surrogacy are not covered in most plans. Check your plan documents or ask your administrator, because some employers include fertility coverage.