FSA-may be able to access items are medical expenses the IRS allows you to pay for with pre-tax dollars from your Flexible Spending Account
The IRS publishes a list of what counts as a medical expense under tax law. If something is on that list, you can use FSA money to pay for it. If it is not, you cannot — even if your doctor recommends it or your insurance covers it. The rule is strict: the expense must be for diagnosis, cure, mitigation, treatment, or prevention of disease, or for affecting any structure or function of the body.
What qualifies varies by item. Some things — like prescription medications, insulin, and doctor visits — are always may be able to access. Others — like vitamins, cosmetic procedures, and gym memberships — are never may be able to access. A third group sits in the middle: items like sunscreen, toothpaste, and certain medical equipment are may be able to access only if they treat or prevent a specific medical condition, not just general health.
Key Takeaways
- Prescription medications, copays, deductibles, and medical equipment prescribed by a doctor are always FSA-may be able to access.
- Over-the-counter medicines became FSA-may be able to access again in 2020, but only if you have a prescription or a doctor's note stating medical necessity.
- Items marketed for general wellness — vitamins, gym memberships, cosmetic procedures — are not may be able to access, even if they improve your health.
- Some items like sunscreen and toothpaste are may be able to access only when used to treat a diagnosed condition, not for routine care.
- Your FSA plan administrator can tell you whether a specific item is may be able to access before you buy it.
Prescription and Over-the-Counter Medications
Prescription medications are always FSA-may be able to access. This includes birth control, blood pressure medication, antibiotics, inhalers, and any other drug your doctor prescribes. You can use your FSA debit card at the pharmacy to pay for them directly.
Over-the-counter medicines became FSA-may be able to access again in 2020, but with a condition: you need either a prescription from your doctor or a written statement from your doctor saying the medicine is medically necessary for a diagnosed condition. Ibuprofen, acetaminophen, allergy medicine, and antacids all fall into this category. Without the prescription or note, they are not may be able to access. Your pharmacist can often provide the note on the spot if you ask.
Medical Visits, Tests, and Procedures
Copays and coinsurance for doctor visits, specialist appointments, and urgent care are FSA-may be able to access. So are deductibles you pay toward your health insurance. Lab work, imaging (X-rays, MRIs, ultrasounds), and diagnostic tests ordered by a doctor all count.
Procedures performed by a licensed medical provider to treat or diagnose a condition are may be able to access. This includes surgery, dental work, vision correction, physical therapy, and mental health counseling. The key is that a medical professional must order or perform the service for a medical reason — not for cosmetic improvement or general wellness.
Medical Equipment and Supplies
Durable medical equipment prescribed by a doctor is FSA-may be able to access. This includes wheelchairs, crutches, hearing aids, blood pressure monitors, glucose meters, and continuous positive airway pressure (CPAP) machines. The equipment must be prescribed or recommended in writing by a healthcare provider for a diagnosed condition.
Supplies used with medical equipment are also may be able to access: test strips for glucose monitors, lancets, syringes, bandages for wound care, and replacement parts. Routine supplies like general first-aid bandages or over-the-counter pain relief patches are not may be able to access unless your doctor prescribes them for a specific condition.
Dental and Vision Care
Dental exams, cleanings, fillings, root canals, crowns, and orthodontia are all FSA-may be able to access. Teeth whitening and cosmetic dental work are not. If your dentist charges for a procedure that serves both a medical and cosmetic purpose — like bonding to repair a broken tooth — only the medical portion is may be able to access.
Vision care includes eye exams, glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK) is may be able to access. Cosmetic procedures like eyelid surgery purely for appearance are not. If the procedure corrects a vision problem or treats a medical condition of the eye, it is may be able to access.
Items That Require a Doctor's Note
Some items sit in a gray zone: they are may be able to access only when a doctor confirms they treat or prevent a specific medical condition. Sunscreen is may be able to access if your doctor prescribes it for a skin condition like lupus or photosensitivity, but not for routine sun protection. Toothpaste is may be able to access if prescribed for a diagnosed gum disease, but not for general oral health. Vitamins and supplements are may be able to access only with a doctor's note stating they treat a deficiency or medical condition.
Orthopedic shoes, compression stockings, and back braces are may be able to access when prescribed for a diagnosed condition. A general wellness item — even one that helps your health — is not may be able to access without that medical link. Before you buy, ask your doctor for a written statement if you are unsure.
What Is Not FSA-may be able to access
Cosmetic procedures and products are never may be able to access, even if they improve your appearance and confidence. This includes cosmetic surgery, teeth whitening for appearance only, anti-wrinkle creams, and hair loss treatments not prescribed for a medical condition.
General wellness items are not may be able to access: gym memberships, fitness classes, diet programs, and nutritional supplements taken for general health. Toiletries like shampoo, soap, and deodorant are not may be able to access. Maternity clothes, childcare, and over-the-counter pain relievers without a prescription are not may be able to access. Travel to receive medical care, even if the care itself is may be able to access, is not covered.
How to Confirm an Item Is may be able to access
Before you spend FSA money on something you are unsure about, contact your FSA plan administrator. They can tell you whether a specific item or service is may be able to access under your plan. Many plans have online tools or a phone line where you can ask about a product by name.
Keep your receipts and any documentation your doctor provides. If you use your FSA debit card and the transaction is later questioned, you may need to show proof that the expense was medical in nature. Some plan administrators ask for receipts randomly; others only when a purchase looks unusual. Having the paperwork ready protects you from having to repay the amount out of pocket.
Frequently Asked Questions
Can I use my FSA for my family members' medical expenses?
Yes. You can use FSA money to pay for the medical expenses of your spouse and any dependent children, even if they are not covered under your health insurance plan. The expense must still be FSA-may be able to access — the person receiving care does not have to be on your plan.
Is a prescription required for all over-the-counter medicines?
As of 2020, yes — you need either a prescription or a written statement from your doctor saying the medicine is medically necessary. A simple note from your doctor saying "Patient needs ibuprofen for arthritis" is enough. Many pharmacists can provide this note if you ask.
What happens if I buy something that turns out to be ineligible?
If you use your FSA debit card for an ineligible expense, you may have to repay that amount to your FSA from your own pocket. Some plan administrators catch ineligible purchases and ask for documentation; others do not. Keeping receipts and asking before you buy protects you from this risk.
Are mental health services and therapy FSA-may be able to access?
Yes. Copays for therapy, counseling, and psychiatric visits are may be able to access. Medications prescribed by a psychiatrist or other doctor are may be able to access. Mental health treatment is treated the same as any other medical care under FSA rules.
Can I use FSA money for preventive care like vaccines?
Yes. Vaccines, flu shots, and other preventive services ordered by a doctor are FSA-may be able to access. Preventive care that is medically necessary counts as treatment or prevention of disease under IRS rules.