FSA funds cover medical and dental expenses your insurance doesn't fully pay for, plus some over-the-counter items

A Flexible Spending Account (FSA) lets you set aside pre-tax money for healthcare costs. What you can spend it on depends on whether it's a medical FSA, a dependent care FSA, or a limited-purpose FSA — and the IRS rules that govern each one are specific about what counts.

Medical FSAs cover the broadest range: prescription medications, copays, deductibles, dental work, vision care, and many over-the-counter items. Dependent care FSAs pay only for childcare or adult daycare expenses while you work. Limited-purpose FSAs (often paired with HSAs) cover dental and vision only. The key is that FSA money must be spent on may have access to medical expenses — if you use it for something that doesn't may have access to, you owe taxes on that amount plus a penalty.

Key Takeaways

  • Medical FSAs cover copays, deductibles, prescriptions, dental, vision, and some over-the-counter items like bandages and pain relievers.
  • Over-the-counter medications now require a prescription from your doctor to be FSA-may be able to access, even if they're sold without one at the pharmacy.
  • Dependent care FSAs pay only for childcare or adult daycare costs while you're working, not for school tuition or summer camps.
  • Limited-purpose FSAs cover dental and vision expenses only and are designed to pair with Health Savings Accounts.
  • You cannot use FSA money for health insurance premiums, cosmetic procedures, or general wellness items like vitamins or gym memberships.

What a Medical FSA Covers

Medical FSAs pay for most healthcare services and supplies your doctor orders or prescribes. This includes copays and coinsurance when you see a doctor, dentist, or eye doctor; deductibles you owe before insurance kicks in; prescription medications; and medical equipment like crutches, wheelchairs, or blood pressure monitors.

Over-the-counter medications and supplies are FSA-may be able to access if they treat a specific medical condition and you have a prescription. Aspirin for a headache, antihistamines for allergies, or antacids for heartburn all may have access to — but only if your doctor writes a prescription for them. Bandages, gauze, first-aid tape, and medical supplies like glucose test strips or lancets are FSA-may be able to access without a prescription. Sunscreen, toothpaste, and deodorant are not, even if they're in the pharmacy section.

Dental work covered by FSA includes fillings, root canals, crowns, orthodontia, and cleanings. Vision expenses include eye exams, glasses, contact lenses, and contact lens solution. Mental health and therapy services, hearing aids and batteries, and medical transportation are also covered.

Over-the-Counter Items and the Prescription Rule

Before 2020, you could buy many over-the-counter medications with FSA money without a prescription. That changed: now your doctor must write a prescription for any over-the-counter drug or medicine, even though you can still buy it at the pharmacy without showing the prescription.

This applies to common items like ibuprofen, acetaminophen, allergy pills, cold medicine, and heartburn relief. You don't need to fill the prescription at a pharmacy — you can buy the item at any store — but you do need the prescription on file to prove it was medically necessary. Keep the prescription and your receipt together in case your FSA administrator asks for proof.

Medical supplies that are not drugs — bandages, thermometers, heating pads, ice packs, and compression wraps — do not need a prescription. Neither do items like crutches, braces, or elastic bandages.

Dependent Care FSA: What It Covers and What It Doesn't

A dependent care FSA is separate from a medical FSA and covers only childcare or adult daycare expenses while you work. This includes daycare centers, in-home daycare providers, after-school programs, and adult day programs for aging parents or disabled family members.

Dependent care FSA does not cover school tuition, summer camps, overnight camps, or babysitting for social events. It does not pay for preschool if it's primarily educational rather than care-based, though many programs blur that line — check with your FSA administrator. It also does not cover transportation to daycare or school, even if the provider arranges it.

The person providing care must have a tax ID or Social Security number, and you must report their information to your FSA plan. If you pay a nanny or in-home provider, you may also have payroll tax obligations separate from your FSA.

Limited-Purpose FSA and Dental and Vision Coverage

A limited-purpose FSA (also called a dental and vision FSA) covers only dental and vision expenses. It's designed to work alongside an HSA, letting you use the HSA for general medical costs and the limited-purpose FSA for dental and vision. If you have an HSA, your employer may offer a limited-purpose FSA as an option.

Dental coverage includes preventive care (cleanings, exams, X-rays), basic care (fillings, extractions), and major care (crowns, root canals, bridges). Orthodontia is usually covered but may have a lifetime limit. Vision coverage includes eye exams, glasses, contact lenses, and contact lens solution. Hearing aids and hearing services are not covered under a limited-purpose FSA — they would need a medical FSA.

What FSA Cannot Pay For

FSA money cannot be used for health insurance premiums, including Medicare, Medicaid, or employer health plan premiums. It cannot pay for cosmetic procedures like teeth whitening, Botox, or elective surgery unless the procedure is medically necessary (for example, reconstructive surgery after an injury). General wellness items like vitamins, supplements, gym memberships, and weight loss programs are not FSA-may be able to access unless prescribed by a doctor for a specific medical condition.

Toiletries and personal care items — toothpaste, deodorant, shampoo, soap — are not covered. Eyeglasses or contacts for cosmetic reasons (like colored contacts) are not covered, but prescription glasses and contacts are. Pet medications and veterinary care are not FSA-may be able to access, even if the pet is a service animal (service animal care may be deductible on your taxes, but not through FSA).

How to Know if Something Qualifies

The IRS publishes a list of may have access to medical expenses, but the safest approach is to ask your FSA administrator before you spend the money. Most FSA plans have a website or customer service line where you can check whether a specific item or service is covered. Some FSA debit cards will decline a purchase if it's not may have access to, but others won't — and you're responsible for knowing the rules.

Keep receipts for everything you buy with FSA money. If the IRS or your plan audits your account, you'll need to show proof that the expense was may have access to. If you can't provide documentation, you'll owe taxes on that amount plus a 20 percent penalty.

When in doubt, ask for a prescription from your doctor. A prescription doesn't may provide FSA coverage, but it creates a paper trail showing the expense was medically necessary, which protects you if questions come up later.

Frequently Asked Questions

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

Yes, if your spouse is a dependent on your tax return. You can use your FSA to pay for their copays, prescriptions, dental work, and other may have access to medical expenses. The money doesn't have to be spent on you alone — it covers any dependent family member.

Do I need a receipt to use my FSA debit card?

You should keep receipts even if your FSA debit card doesn't ask for them. If your plan audits your account or the IRS questions a purchase, you'll need proof that the expense was may have access to. Receipts are your only defense.

What happens to FSA money I don't spend by the end of the year?

Most FSAs have a "use it or lose it" rule — unspent money goes back to your employer at the end of the plan year. Some plans offer a grace period (usually 2.5 months) to spend remaining funds, or a carryover of up to $610 (the amount changes yearly). Check your plan documents to see which rule applies to you.

Can I use FSA money for my child's braces?

Yes, if orthodontia is covered under your plan. Braces are a may have access to dental expense. Check your plan documents or call your FSA administrator to confirm the coverage and whether there's a lifetime limit on orthodontia benefits.

Is acupuncture or chiropractic care FSA-may be able to access?

Yes, if your doctor refers you or prescribes it. Acupuncture and chiropractic care are may have access to medical expenses when ordered by a healthcare provider for a specific condition. Without a referral or prescription, coverage depends on your plan — ask your administrator.