What FSA money actually covers
An FSA (Flexible Spending Account) covers medical expenses that you pay out of your own pocket — not things your insurance already pays for. The IRS maintains a specific list of what counts. Common items include copays, deductibles, prescription drugs, and over-the-counter medications with a doctor's note. Dental work, vision care, and mental health treatment all count. The key rule: the expense must be for diagnosis, treatment, or prevention of a medical condition, and it cannot be something your health plan already covers.
What does not count is just as important. Cosmetic procedures, gym memberships, vitamins without a medical reason, and most over-the-counter items without a prescription do not may have access to. Health insurance premiums themselves do not count, nor do long-term care insurance premiums. If you are unsure whether something qualifies, your FSA plan administrator can tell you — they have the final say, not your employer or the store where you buy it.
Key Takeaways
- FSA money covers copays, deductibles, prescription drugs, dental work, vision care, and mental health treatment when you pay out of pocket.
- Over-the-counter medications and medical supplies count only if a doctor writes a prescription or letter stating medical necessity.
- Cosmetic procedures, gym memberships, and health insurance premiums do not count, even if they relate to health.
- Your FSA plan administrator, not the store or your employer, makes the final decision on whether an expense qualifies.
- Keeping receipts and documentation is required — the IRS can audit FSA spending, and your plan may ask for proof that an expense was medical.
Medical supplies and equipment that may have access to
Medical equipment and supplies have specific rules. Items like bandages, crutches, wheelchairs, hearing aids, and diabetic testing supplies all count. Prescription glasses and contact lenses may have access to. Dental supplies such as toothbrushes and floss do not, but dental work itself does. Pregnancy tests, feminine hygiene products, and incontinence supplies count as medical expenses.
The line between medical and personal care is where confusion often starts. Sunscreen does not count unless a dermatologist prescribes it for a specific skin condition. Toothpaste does not count. But if a doctor prescribes a special medicated cream or ointment, that does. The rule is: if it is something a healthy person would buy anyway, it probably does not count. If it treats or prevents a diagnosed medical problem, it probably does.
Prescription and over-the-counter medications
Prescription medications always count, regardless of what they treat. Over-the-counter medications (OTC) are trickier. As of 2020, you can use FSA money for OTC drugs and medications only if you have a prescription from a doctor. This includes common items like ibuprofen, allergy medicine, antacids, and cold medicine. Without a prescription, they do not count, even if they are medically necessary.
The prescription does not have to be filled at a pharmacy. A doctor can write a prescription for an OTC item, and you can then buy it at any store — grocery, pharmacy, or online — and use FSA funds. Some people ask their doctor for a standing prescription for items they use regularly (like allergy medicine) so they can use FSA money throughout the year. Keep the prescription with your receipt; your plan administrator may ask for it.
Dental and vision care expenses
Dental work counts in full: cleanings, fillings, root canals, crowns, orthodontia, and extractions. Dental insurance copays and deductibles count. Teeth whitening does not count because it is cosmetic, but if a dentist prescribes whitening for medical reasons (such as discoloration from medication), it may count — ask your plan first.
Vision care includes eye exams, prescription glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK) counts. Sunglasses do not, even if they have a prescription, because they are considered cosmetic. If you wear prescription sunglasses for a medical condition (such as light sensitivity from an eye disease), documentation from your eye doctor may make them count — but this varies by plan, so check first.
Mental health and therapy services
Therapy, counseling, and psychiatric care all count. This includes sessions with a therapist, psychologist, psychiatrist, or counselor, whether in person or by video. Copays and deductibles for mental health visits count. Prescription psychiatric medications count like any other prescription drug.
Support groups and wellness programs do not count unless they are prescribed by a doctor for treatment of a diagnosed condition. A general meditation app does not count, but if a therapist prescribes a specific app as part of treatment for anxiety, it may. The distinction is treatment versus general wellness. Ask your plan administrator if you are unsure whether a specific service or app qualifies.
What does not count and why
Cosmetic procedures never count, even if they improve how you feel. This includes teeth whitening, hair removal, wrinkle treatments, and plastic surgery. Health insurance premiums (including your employer's share) do not count. Gym memberships and fitness classes do not count, even if your doctor recommends exercise. Vitamins and supplements do not count unless a doctor prescribes them for a specific deficiency or condition.
Childcare, maternity clothes, and general wellness items do not count. Travel to receive medical care does not count — you cannot use FSA money for gas, flights, or hotels, even if you are traveling for surgery. Marijuana, even in states where it is legal, does not count under federal FSA rules. If an expense seems like it should count but you are not certain, your plan administrator can give you a definitive answer in writing.
How to document what you spend
Keep every receipt for every FSA purchase. Your plan administrator may ask for proof that an expense was medical, especially for items that could be personal (like a thermometer or pain reliever). A receipt alone is sometimes not enough — you may need a doctor's note, prescription, or explanation of medical necessity. The IRS can audit FSA accounts, and if you cannot document that money was spent on may have access to expenses, you may have to repay it.
Some FSA debit cards come with a feature that automatically flags non-may have access to purchases and asks for documentation. Others require you to submit receipts after you spend. Check your plan's rules. If you are reimbursing yourself from your own money, you will need receipts plus a claim form. Keep records for at least three years — that is how far back the IRS can audit.
Frequently Asked Questions
Can I use FSA money for my spouse's or child's medical expenses?
Yes. FSA money can cover medical expenses for you, your spouse, and any dependent you claim on your tax return. The person receiving the care does not have to be on your FSA account — only that you are paying for their medical expense out of pocket.
Do I need a prescription for every over-the-counter item?
Yes, as of 2020. Ibuprofen, allergy medicine, antacids, and other OTC drugs require a doctor's prescription to be FSA-may be able to access. A doctor can write a prescription for OTC items, and you can buy them anywhere and use FSA funds. Vitamins and supplements still do not count even with a prescription, unless prescribed for a specific deficiency.
What happens if I spend FSA money on something that does not count?
If your plan administrator discovers a non-may have access to purchase, you will be asked to repay that amount from your personal funds. The money comes out of your FSA account and is no longer available to you. The IRS can also audit your account, so keeping good documentation protects you.
Can I use FSA money for pet medical care?
No. FSA money covers medical expenses for humans only. Veterinary care and pet medications do not count, even if the pet is a service animal. Service animal training and equipment also do not count under FSA rules.
Does FSA cover the cost of a medical device I buy online?
Yes, if the device qualifies. A blood pressure monitor, glucose meter, or heating pad counts. You will need a receipt showing what you bought and proof that it is a medical device. Some online retailers do not clearly label items as medical, so keep documentation of what you purchased and why it is medically necessary.