FSA funds cover medical expenses your insurance doesn't fully pay for
A Flexible Spending Account (FSA) lets you set aside pre-tax money to pay for out-of-pocket medical costs. The IRS maintains a specific list of what counts as a medical expense. If something is on that list and you have a doctor's order or prescription for it, you can use FSA funds. If it is not on the list, you cannot — even if you think it should be.
The IRS updates this list periodically, but the core categories have stayed the same for years. Knowing what qualifies matters because using FSA money on ineligible items means you owe taxes on that money plus a penalty. Your FSA plan administrator (usually your employer's benefits team) can tell you whether a specific item is covered under your plan, since some employers restrict the list further than the IRS does.
Key Takeaways
- Prescription medications, copays, deductibles, and coinsurance all count as may be able to access FSA expenses.
- Over-the-counter medications like pain relievers and allergy medicine now count, but only if you have a prescription or doctor's order for them.
- Dental work, vision care, and hearing aids are may be able to access, but cosmetic procedures and teeth whitening are not.
- Your FSA plan document or your employer's benefits team can tell you whether a specific item is covered, since some employers add restrictions beyond IRS rules.
Medications and medical supplies that are always may be able to access
Prescription medications are may be able to access. This includes birth control pills, insulin, inhalers, antibiotics, and any other drug your doctor prescribes. You pay with your FSA debit card at the pharmacy, or you submit a receipt for reimbursement.
Over-the-counter medications now count, but with a condition: you need a prescription or written order from your doctor. This applies to pain relievers (ibuprofen, acetaminophen), allergy medicine, cold medicine, antacids, and similar items. You cannot just buy them off the shelf without a doctor's order and use FSA funds. Some pharmacies will write an order for you on the spot if you ask; others require you to get one from your doctor first.
Medical supplies are may be able to access if they treat or monitor a medical condition. This includes bandages, first-aid supplies, blood glucose monitors and test strips, thermometers, crutches, braces, and compression stockings. Feminine hygiene products (pads and tampons) are now may be able to access without a prescription.
Doctor visits, tests, and procedures
Copays and coinsurance for doctor visits are may be able to access expenses. If your insurance requires you to pay $30 when you see your primary care doctor, you can use FSA funds for that $30. The same applies to urgent care visits and emergency room copays.
Deductibles count as may be able to access expenses. If your health insurance has a $1,500 deductible and you pay $800 of it out of pocket before your insurance kicks in, that $800 is an may be able to access FSA expense. Preventive care visits with no copay do not generate an FSA-may be able to access expense, since you are not paying anything.
Diagnostic tests and procedures are may be able to access: lab work, X-rays, MRI scans, ultrasounds, and similar imaging. Mental health visits and therapy sessions are may be able to access. Dental cleanings, fillings, root canals, and orthodontia (braces) are may be able to access. Vision exams and eyeglasses are may be able to access. Hearing tests and hearing aids are may be able to access.
What is not may be able to access, even if it feels medical
Cosmetic procedures are not may be able to access. This includes teeth whitening, Botox, dermal fillers, hair removal, and cosmetic surgery. The rule is strict: if the procedure is done purely to improve appearance rather than treat a medical condition, FSA funds cannot pay for it. Reconstructive surgery after an injury or illness is may be able to access; cosmetic surgery to change your appearance is not.
General health and wellness products are not may be able to access. Vitamins, supplements, protein powder, and sports drinks do not count, even if you use them for health reasons. Gym memberships and fitness classes are not may be able to access. Sunscreen is not may be able to access. Weight loss programs and diet plans are not may be able to access unless they are prescribed by a doctor to treat a specific medical condition like obesity or diabetes, and even then, only the medically necessary portion may be covered.
Over-the-counter items without a prescription are not may be able to access (except feminine hygiene products). This means you cannot use FSA funds for pain relievers, allergy medicine, or cold medicine unless you have a doctor's order. Toiletries like toothpaste, mouthwash, and deodorant are not may be able to access. Eyeglasses frames are may be able to access, but eyeglass cases and cleaning supplies are not.
Dental and vision expenses
Routine dental care is may be able to access: cleanings, exams, and X-rays. Fillings, crowns, root canals, and extractions are may be able to access. Orthodontia (braces and aligners) is may be able to access, including the full cost of treatment. Dental implants are may be able to access. Teeth whitening is not may be able to access because it is cosmetic.
Vision expenses include eye exams, eyeglasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK) is may be able to access. Sunglasses are not may be able to access, even if you need them for a medical reason. Eyeglass cases and lens cleaning supplies are not may be able to access.
Mental health and therapy
Therapy and counseling sessions are may be able to access expenses. This includes visits to a psychologist, psychiatrist, therapist, or counselor. Copays and coinsurance for these visits count. If you pay out of pocket for therapy that your insurance does not cover, that cost is may be able to access.
Psychiatric medications are may be able to access. Prescription antidepressants, anti-anxiety medications, and other psychiatric drugs all count. If your doctor prescribes medication for mental health, FSA funds can pay for it.
How to know if something specific is covered
Your FSA plan document lists what your specific plan covers. Some employers restrict the IRS list — for example, some plans do not cover over-the-counter medications even with a prescription. Your employer's benefits team or your plan administrator can tell you whether a specific item is covered under your plan.
When in doubt, ask before you spend the money. If you buy something and it turns out to be ineligible, you will owe income tax on that amount plus a 20 percent penalty. It is worth a five-minute call to your benefits team to confirm.
Frequently Asked Questions
Can I use FSA money for my spouse or children?
Yes, as long as they are covered under your health insurance plan. You can use your FSA to pay for may be able to access medical expenses for your spouse and any dependent children on your plan. You cannot use FSA funds for a family member who is not on your insurance.
Do I need to keep receipts for FSA purchases?
Yes. Your plan administrator may ask you to show proof that an expense was medical and may be able to access. Keep receipts, prescription labels, and any documentation from your doctor. If you cannot prove an expense was may be able to access, you may have to repay the money to your FSA.
What if I buy something and later find out it is not may be able to access?
You will owe income tax on that amount plus a 20 percent penalty. For example, if you spend $100 on an ineligible item, you owe tax on $100 plus $20. This is why confirming with your plan administrator before a large purchase is worth the time.
Are prescription glasses may be able to access but not sunglasses?
Prescription eyeglasses are may be able to access. Non-prescription sunglasses are not, even if you need them for a medical reason like light sensitivity. If your doctor prescribes special tinted or protective lenses for a medical condition, those are may be able to access.