FSA funds cover specific medical and dental costs that you pay out of pocket, but not everything a doctor recommends
A Flexible Spending Account (FSA) lets you set aside pre-tax money to pay for may be able to access medical, dental, and vision expenses. The IRS publishes a list of what qualifies, and it is narrower than you might expect. You can use FSA money for copays, deductibles, prescription medications, and certain medical equipment — but not for insurance premiums, over-the-counter drugs without a prescription, or cosmetic procedures.
The key rule: the expense must be medically necessary, not just health-related. A massage might feel therapeutic, but it is not FSA-may be able to access unless a doctor prescribes it to treat a specific condition. Vitamins and supplements are generally not covered unless your doctor writes a prescription for them as treatment.
FSA money is yours to spend during the plan year, but you lose what you do not use — there is no rollover to the next year (with rare exceptions). That makes it important to estimate your actual out-of-pocket costs before you contribute.
Key Takeaways
- FSA money covers copays, coinsurance, deductibles, and prescription medications, but not insurance premiums or over-the-counter drugs bought without a prescription.
- Dental and vision expenses like cleanings, exams, glasses, and contact lenses are FSA-may be able to access if your plan includes a dental or vision benefit.
- Medical equipment such as crutches, wheelchairs, hearing aids, and glucose monitors qualifies, but only if prescribed by a doctor.
- You forfeit any FSA money you do not spend by the end of the plan year, so contribute only what you realistically expect to use.
- Cosmetic procedures, gym memberships, and most over-the-counter items do not may have access to, even if they relate to your health.
Prescription medications and medical supplies you can pay for
Prescription drugs are FSA-may be able to access across the board — insulin, antibiotics, blood pressure medication, birth control, and anything else your doctor prescribes. You can use FSA money at the pharmacy counter or pay out of pocket and submit a receipt for reimbursement later.
Medical supplies prescribed by a doctor also may have access to: glucose monitors and test strips, EpiPens, inhalers, bandages for wound care, and compression stockings. The difference between may be able to access and ineligible often comes down to whether a doctor ordered it as treatment. A thermometer is FSA-may be able to access; a fitness tracker is not, even if you use it to monitor your heart rate.
Over-the-counter medications are trickier. Aspirin, cold medicine, antacids, and allergy pills do not may have access to unless your doctor writes a prescription for them specifically. If your doctor prescribes ibuprofen by name as treatment for arthritis, that prescription version is FSA-may be able to access — but the same drug bought off the shelf at the drugstore is not.
Dental and vision care expenses
Dental work covered by FSA includes cleanings, exams, fillings, root canals, crowns, and orthodontia. If your employer's FSA plan includes a dental benefit (not all do), you can use FSA money to pay your dentist's bill or your coinsurance after insurance pays its share. Cosmetic dental work like teeth whitening is not covered unless it is part of reconstructive surgery after an injury.
Vision expenses include eye exams, glasses, contact lenses, and contact lens solution. You can use FSA funds to buy frames and lenses at an optical shop, or pay for LASIK or other corrective surgery if your plan covers it. Sunglasses, even if they have a prescription, are not FSA-may be able to access because they are considered cosmetic.
Not all employer FSA plans include dental and vision benefits — some cover only medical expenses. Check your plan documents or call your benefits administrator to confirm what your specific FSA covers before you set aside money for these services.
Medical equipment and devices prescribed by a doctor
If a doctor prescribes medical equipment to treat a condition, FSA money covers it. That includes wheelchairs, crutches, walkers, canes, and braces. Hearing aids and batteries are FSA-may be able to access. Blood pressure monitors, pulse oximeters, and peak flow meters may have access to. Continuous positive airway pressure (CPAP) machines and supplies are covered.
The prescription requirement matters. A back brace you buy at a pharmacy without a doctor's order is not FSA-may be able to access; the same brace ordered by your doctor is. Orthopedic shoes are FSA-may be able to access only if a podiatrist or orthopedist prescribes them as treatment, not if you buy them for comfort.
Mobility aids, oxygen equipment, and ostomy supplies all may have access to when prescribed. If you are unsure whether a specific device is may be able to access, ask your doctor to write a prescription for it and keep that documentation with your receipt. Your FSA plan administrator can also tell you whether a particular item is on the IRS-approved list.
Copays, coinsurance, and deductibles
FSA money covers the out-of-pocket costs your insurance does not pay. That includes copays at the doctor's office, coinsurance (the percentage you pay after insurance pays its share), and deductibles (the amount you pay before insurance kicks in). You can use FSA funds to meet your deductible, then use insurance for the rest of the year.
This is often where FSA money gets used fastest. If your plan has a $1,500 deductible and you have surgery early in the year, you might use most of your FSA balance in one visit. That is why estimating your likely out-of-pocket costs matters — you do not want to contribute more than you will actually spend.
What FSA money cannot cover
Insurance premiums themselves are not FSA-may be able to access, whether they are for health, dental, or vision coverage. You cannot use FSA money to pay your monthly premium or your employer's portion of your insurance cost.
Cosmetic procedures are off-limits: teeth whitening, Botox, hair removal, and elective plastic surgery do not may have access to. Gym memberships, fitness classes, and diet programs are not covered, even if your doctor recommends exercise. Weight loss programs and meal delivery services are not FSA-may be able to access.
Most over-the-counter items fall outside FSA coverage: pain relievers, cold medicine, allergy pills, antacids, and sleep aids bought without a prescription. Sunscreen, sunglasses, and personal hygiene items like toothpaste and deodorant do not may have access to. Vitamins and herbal supplements are generally not covered unless a doctor prescribes them as medical treatment for a specific condition.
Certain medical services are also excluded: routine physical exams for employment or insurance purposes, cosmetic dentistry, and fertility treatments in some states. Check your plan's specific rules, because some employers offer more generous coverage than the IRS minimum.
How to know if something is FSA-may be able to access
The IRS maintains a list of may be able to access medical expenses in Publication 502, which your FSA plan administrator should have on file. When you are unsure about a specific purchase, ask your benefits administrator or your FSA plan's customer service line before you spend the money — they can tell you whether an item qualifies.
Keep receipts for everything you buy with FSA money. If you pay out of pocket and want to be reimbursed later, you will need documentation showing what you bought, when, and how much you paid. Some FSA plans use a debit card that works like a credit card at pharmacies and doctors' offices; others require you to submit receipts for reimbursement.
If you use your FSA debit card at a pharmacy or medical office, the system usually blocks ineligible items automatically. If you are unsure whether something will go through, ask the cashier or call your FSA administrator before checkout.
The use-it-or-lose-it rule and how to plan your contribution
FSA money does not roll over to the next year. Whatever you do not spend by the end of your plan year is forfeited — you cannot get it back or carry it forward. This is the biggest risk of an FSA: if you overestimate your medical expenses, you lose money.
Some employers offer a grace period (usually two and a half months into the next plan year) to spend remaining FSA funds, or a limited carryover of up to $610 (the amount changes yearly). Check your plan documents to see if yours includes either option.
To avoid forfeiting money, estimate your actual out-of-pocket costs for the coming year: copays you know you will have, prescriptions you refill regularly, and any planned dental or vision work. Be conservative — it is better to contribute less and have money left in your regular account than to lose FSA funds you did not use.
Frequently Asked Questions
Can I use FSA money for my spouse's or child's medical expenses?
Yes, if they are covered under your health insurance plan. FSA money can pay for may be able to access expenses for you, your spouse, and any dependents on your insurance, regardless of whose name is on the receipt. You cannot use FSA funds for a family member who is not on your plan.
Are prescription glasses and contacts FSA-may be able to access?
Yes, if your FSA plan includes a vision benefit. Glasses, contact lenses, contact lens solution, and eye exams are all covered. Sunglasses are not may be able to access, even if they have a prescription lens. Check your plan documents to confirm your FSA covers vision expenses.
Can I use FSA money for mental health or therapy?
Yes. Copays and coinsurance for therapy, counseling, and psychiatric care are FSA-may be able to access. Medications prescribed for mental health conditions are also covered. The expense must be for treatment of a diagnosed condition, not general wellness.
What happens to my FSA money if I leave my job?
You forfeit any unused FSA balance when you leave your employer. You cannot take the money with you or roll it into another account. If you have unused funds, try to spend them before your last day of employment, or check whether your employer offers a grace period to use remaining money after you leave.
Is acupuncture or chiropractic care FSA-may be able to access?
Yes, if a doctor refers you or prescribes it as treatment for a specific condition. Copays and coinsurance for acupuncture and chiropractic care are FSA-may be able to access. The key is that it must be medically necessary treatment, not general wellness or preventive care without a diagnosis.