What an FSA Covers

A Flexible Spending Account (FSA) covers medical, dental, and vision expenses that you pay out of your own pocket. The IRS maintains a specific list of what counts as a may have access to medical expense. If your doctor prescribes it, or if it treats or prevents a medical condition, it usually qualifies. Over-the-counter items like pain relievers, allergy medicine, and antacids are covered only if you have a prescription from your doctor.

Your FSA does not cover health insurance premiums, cosmetic procedures, or general wellness items like vitamins or gym memberships. It also does not cover long-term care insurance or services that are purely cosmetic — even if they're performed by a doctor. The key test is whether the expense is medically necessary to diagnose, treat, or prevent a disease or condition.

Key Takeaways

  • FSAs cover doctor visits, prescription medications, dental work, vision care, and medical equipment like crutches or hearing aids.
  • Over-the-counter medications and supplies require a prescription from your doctor to be FSA-may be able to access, even common items like ibuprofen or allergy pills.
  • Cosmetic procedures, gym memberships, vitamins without a medical reason, and health insurance premiums are never covered by an FSA.
  • You must spend your FSA money within the plan year or lose it — there is no rollover to the next year, though your employer may offer a grace period of up to 2.5 months.

Medical, Dental, and Vision Expenses That may have access to

Medical expenses covered by an FSA include doctor office visits, urgent care visits, emergency room care, and hospital stays. Prescription medications are covered. Mental health counseling and therapy sessions are covered if provided by a licensed professional. Medical equipment like wheelchairs, crutches, hearing aids, and blood glucose monitors all count. Laboratory tests and imaging like X-rays and MRIs are covered.

Dental work covered includes cleanings, fillings, root canals, extractions, and orthodontia like braces. Dental implants and crowns are covered. Vision care includes eye exams, glasses, contact lenses, and laser eye surgery like LASIK. Hearing aids and the cost of fitting them are covered. Fertility treatments, including in vitro fertilization (IVF), are covered under most FSA plans.

Over-the-Counter Items: When They Count and When They Don't

The rule changed in 2020: over-the-counter medications and medical supplies now require a prescription to be FSA-may be able to access. This means you can use your FSA card to buy ibuprofen, acetaminophen, allergy medicine, antacids, or cold medicine — but only if your doctor wrote a prescription for it. A prescription does not have to be filled at a pharmacy; your doctor can write one specifically so you can purchase the item with FSA funds.

Over-the-counter medical supplies like bandages, gauze, thermometers, and first-aid kits do not require a prescription and are covered. Sunscreen is not covered because it is considered cosmetic. Toothpaste and toothbrushes are not covered. Feminine hygiene products are now covered as of January 2024, without requiring a prescription.

What Is Never Covered

Health insurance premiums — whether for individual, family, or employer plans — cannot be paid with FSA funds. Cosmetic procedures like Botox, teeth whitening for appearance only, or hair removal are not covered, even if performed by a doctor. Gym memberships, fitness classes, and general wellness programs are not covered. Vitamins and nutritional supplements are not covered unless prescribed by a doctor for a specific medical condition.

Long-term care insurance premiums are not covered. Maternity clothes are not covered. Childcare and dependent care are handled through a separate account (a Dependent Care FSA), not a medical FSA. Prescription eyeglasses are covered, but non-prescription sunglasses are not. Travel for medical treatment is not covered, though the medical treatment itself is.

How to Know If Something Qualifies

The IRS publishes a list of may have access to medical expenses in Publication 502. You can also check with your FSA plan administrator — they have the final say on what your specific plan covers, because employers can sometimes restrict coverage beyond what the IRS allows. Before you spend money on something you are unsure about, contact your plan administrator or check your plan documents.

If you buy something and later find out it was not covered, you cannot get reimbursed. Keep receipts for everything you purchase with your FSA card or FSA funds. If you use your FSA debit card and the merchant codes the purchase incorrectly, your plan may ask you to provide a receipt and a letter from your doctor stating the item was medically necessary.

The Use-It-or-Lose-It Rule and Planning Your Spending

Money in your FSA does not roll over to the next year. If you do not spend it by the end of the plan year, you lose it. This is called the use-it-or-lose-it rule. However, your employer may offer a grace period of up to 2.5 months into the next calendar year, during which you can still spend the previous year's FSA funds. Some employers instead offer a carryover of up to $610 (this amount changes yearly) into the next plan year.

Because of this rule, estimate your out-of-pocket medical expenses for the year before you decide how much to contribute. Include prescription medications you take regularly, dental work you know is coming, and vision care. If you have a family, add up expenses for all household members. It is better to contribute less and have money left over in your regular budget than to contribute too much and forfeit funds.

Frequently Asked Questions

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

Yes. Your FSA covers medical expenses for you, your spouse, and any dependent children, regardless of whether they are covered under your health insurance plan. You do not have to be the one receiving the care — you just have to be the one paying for it with FSA funds.

Do I need a receipt to use my FSA card at the pharmacy or doctor's office?

Usually not at the point of purchase. However, keep all receipts and explanation of benefits statements. Your plan administrator may ask for documentation later to verify that the expense was medically necessary and FSA-may be able to access. If you cannot provide proof, you may have to repay the amount.

What happens if I use my FSA card for something that is not covered?

If the merchant codes it as a medical expense, the transaction may go through. You would then owe the money back to your FSA plan. If your plan catches the error, they will ask you to repay it. Keep documentation of what you bought so you can dispute it if needed.

Can I use my FSA for prescription glasses but not sunglasses?

Yes. Prescription eyeglasses and contact lenses are covered because they correct vision. Non-prescription sunglasses are not covered because they are considered cosmetic. Prescription sunglasses are covered because the prescription is the may have access to factor.

Are mental health services and therapy covered by an FSA?

Yes. Therapy sessions, counseling, and psychiatric care provided by a licensed mental health professional are covered. This includes psychologists, psychiatrists, licensed clinical social workers, and licensed professional counselors. Copays and coinsurance for these services are also covered.