What FSA and HSA accounts actually cover
FSA and HSA accounts let you pay for certain medical expenses with pre-tax money, which means you spend less overall. But not every health-related purchase qualifies. The IRS maintains a specific list of may have access to medical expenses, and both account types follow it closely — though HSAs have slightly wider rules than FSAs in a few areas.
The core rule is straightforward: the expense must be for diagnosis, treatment, or prevention of a disease or condition, and it cannot be something that merely promotes general health or wellness. A gym membership does not may have access to. A prescription for blood pressure medication does. The difference matters because using FSA or HSA money on ineligible items can trigger taxes and penalties.
Key Takeaways
- Prescription medications, doctor visits, dental work, and vision care are covered by both FSA and HSA accounts.
- Over-the-counter medicines now require a prescription to be FSA or HSA may be able to access, with rare exceptions like insulin.
- HSAs cover some expenses FSAs do not, including long-term care insurance premiums and certain medical equipment purchases.
- Cosmetic procedures, gym memberships, and general wellness products are never may be able to access, even if they have a health benefit.
- Keeping receipts and documentation is essential because the IRS can audit FSA and HSA spending years after purchase.
Medical care and prescriptions that may have access to
Doctor visits, hospital stays, surgery, and mental health counseling are all may be able to access. This includes copays, coinsurance, and deductibles you pay out of pocket. Prescription medications prescribed by a doctor are covered. Over-the-counter medicines — including pain relievers, cold medicine, and allergy tablets — now require a prescription to be may be able to access, a rule that changed in 2020. The one major exception is insulin, which remains may be able to access without a prescription.
Dental and vision care are covered: cleanings, fillings, root canals, crowns, eyeglasses, contact lenses, and eye exams all count. Orthodontia (braces) is may be able to access. Hearing aids and related services may have access to. Physical therapy, chiropractic care, and acupuncture are covered if a doctor orders them for treatment of a specific condition.
Medical equipment and supplies you can purchase
Crutches, wheelchairs, walkers, and other mobility aids are may be able to access. Blood glucose monitors and testing strips for diabetes are covered. Bandages, gauze, and other wound care supplies count. Elastic bandages and braces for joint support are may be able to access if they treat a diagnosed condition. Pregnancy tests and ovulation kits are covered. Thermometers, blood pressure monitors, and similar diagnostic devices may have access to.
Prosthetics and orthotics — artificial limbs, corrective shoes, and similar devices — are may be able to access. Wigs used to treat hair loss from medical treatment (such as chemotherapy) are covered. Canes, guide dogs for the blind, and service animals are may be able to access. However, general fitness equipment like treadmills or stationary bikes does not may have access to, even if a doctor recommends exercise.
Where FSA and HSA rules differ
HSAs have broader coverage than FSAs in several categories. HSAs cover long-term care insurance premiums (with limits), while FSAs do not. HSAs can pay for certain medical equipment and supplies that FSAs exclude, including some home medical devices. HSAs can cover certain types of medical alert systems and monitoring equipment. If you have an HSA, check the specific rules with your plan administrator before purchasing equipment, as coverage can vary by plan.
Both accounts exclude cosmetic procedures — teeth whitening, Botox, hair removal, and similar treatments — unless they are medically necessary to treat a disease or injury. Cosmetic dentistry (like veneers for appearance only) is not covered, but dental work to repair damage from injury or disease is. Both accounts also exclude gym memberships, weight loss programs, and general wellness supplements, even if marketed as health products.
Expenses that are never may be able to access
Vitamins and nutritional supplements are not covered unless prescribed by a doctor to treat a specific deficiency or condition. Sunscreen is not may be able to access. Toothpaste, mouthwash, and other personal hygiene products do not may have access to. Cosmetics and skincare products are excluded. Maternity clothes are not covered, though certain maternity support garments prescribed for a medical condition may be. Childcare and babysitting are never may be able to access, even if needed to attend a medical appointment.
Travel to receive medical care is not covered — you cannot use FSA or HSA money for plane tickets or hotel stays, even if the trip is for surgery or treatment. However, transportation directly related to medical care (like an ambulance) is may be able to access. Cosmetic surgery is not covered unless it is reconstructive surgery following an accident or disease. Fertility treatments and related procedures are covered, but adoption expenses are not.
How to know if something is may be able to access before you buy
Your FSA or HSA plan administrator can answer may be able to access questions before you spend the money. Many plans have online portals or customer service lines where you can ask about specific items. The IRS publishes a list of may have access to medical expenses on its website, though it is written in technical language. Your plan's summary of benefits should also outline what is and is not covered.
When in doubt, keep the receipt and any documentation showing what the expense was for. If you are later unsure whether something was may be able to access, you can ask your plan administrator to review it. Do not assume that because something is sold in a pharmacy or health store that it qualifies — many items sold in those locations (vitamins, general wellness products, cosmetics) are not may be able to access.
What happens if you use FSA or HSA money on ineligible expenses
If you withdraw money from an FSA or HSA for an ineligible expense, you must pay income tax on that amount, plus a 20 percent penalty. The penalty applies to HSAs; FSA penalties vary by plan but are typically similar. If the IRS audits your account, they can go back several years and assess penalties on multiple ineligible purchases.
Some people accidentally use FSA or HSA debit cards on ineligible items because the card does not always block purchases. If this happens, you can sometimes correct it by repaying the account out of pocket. Contact your plan administrator immediately if you realize a purchase was ineligible — the sooner you address it, the better your options for fixing the mistake.
Frequently Asked Questions
Can I use my FSA or HSA card to buy over-the-counter pain relievers?
Not without a prescription. As of 2020, over-the-counter medicines require a doctor's prescription to be may be able to access, even common items like ibuprofen or allergy medicine. Insulin is the main exception — it remains may be able to access without a prescription. If your doctor prescribes an over-the-counter medication, you can use your account to pay for it.
Are vitamins and supplements covered?
General vitamins and supplements are not covered. However, if a doctor prescribes a specific supplement to treat a diagnosed deficiency or condition — such as vitamin D for low levels or iron for anemia — it becomes may be able to access. The key is that it must be prescribed, not just recommended, and it must treat a specific medical condition.
Can I use my HSA to pay for a gym membership if my doctor recommends exercise?
No. Gym memberships and general fitness programs are never may be able to access, even with a doctor's recommendation. However, if you need physical therapy following an injury or surgery, and a doctor orders it, that is covered. The difference is treatment of a specific condition versus general wellness.
What if I buy something I think is may be able to access and later find out it is not?
Contact your plan administrator right away. Depending on your plan, you may be able to repay the ineligible amount out of pocket to avoid taxes and penalties. The sooner you address it, the more options you have. Keep all receipts so you can document what you purchased and when.
Does my HSA cover the same things as my FSA?
Mostly, but HSAs are slightly broader. HSAs cover long-term care insurance premiums and some medical equipment that FSAs exclude. Both follow the IRS list of may have access to medical expenses, but your specific HSA plan may have additional restrictions. Check your plan documents or contact your administrator to confirm what your account covers.