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

A Flexible Spending Account (FSA) lets you set aside pre-tax money to pay for healthcare expenses. The IRS maintains a specific list of what counts as an may be able to access expense — it's not everything health-related, and the rules differ from HSA rules in important ways. You can use FSA money for copays, deductibles, prescription medications, dental work, vision care, and certain over-the-counter products, but not for insurance premiums, cosmetic procedures, or general wellness items like vitamins.

The key difference from an HSA: FSA money must be spent in the same calendar year you set it aside, or you lose it. That "use it or lose it" rule shapes how much you should contribute and what you buy with it. You also cannot carry over more than $640 into the next year (as of 2024, though this amount changes annually).

Key Takeaways

  • FSA money covers copays, coinsurance, deductibles, and prescription drugs, whether or not your insurance covers them.
  • Many over-the-counter items like pain relievers, allergy medicine, and first-aid supplies are FSA-may be able to access, but you need a prescription or doctor's note for some of them.
  • Dental and vision expenses — including exams, cleanings, glasses, and contact lenses — are covered by FSA funds.
  • You cannot use FSA money for health insurance premiums, cosmetic procedures, gym memberships, or most vitamins and supplements.
  • Any FSA money you don't spend by December 31 is forfeited, so plan your contributions carefully.

Medical expenses FSA money covers

FSA funds pay for any out-of-pocket medical cost your insurance requires you to pay: copays when you visit a doctor, coinsurance (your percentage of the bill after insurance pays its share), and deductibles (the amount you pay before insurance kicks in). This includes urgent care visits, emergency room copays, and specialist referral fees.

Prescription medications are FSA-may be able to access, whether your insurance covers them or not. If your insurance denies a drug or charges you a high copay, you can use FSA money to fill the prescription. Over-the-counter medications are trickier: as of 2020, you can buy pain relievers (ibuprofen, acetaminophen), allergy medicine, cold medicine, and antacids with FSA funds, but only if you have a prescription or a doctor's note saying you need them. Without that documentation, the pharmacy may reject the FSA card at checkout.

Medical equipment and supplies are covered: blood pressure monitors, glucose meters and test strips, thermometers, bandages, elastic bandages, crutches, and heating pads all may have access to. Diagnostic tests like blood work ordered by your doctor are FSA-may be able to access. Mental health copays and therapy sessions are covered the same way as any other medical visit.

Dental and vision expenses you can pay with FSA

Dental work is fully FSA-may be able to access: cleanings, exams, fillings, root canals, crowns, extractions, and orthodontia (braces). If your dental insurance has a waiting period or annual maximum, FSA money fills the gap. Dental X-rays, fluoride treatments, and periodontal work all count. You do not need a separate prescription or note — the dentist's invoice is sufficient proof.

Vision expenses include eye exams, glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK and PRK) is FSA-may be able to access. If you buy frames and lenses separately, both are covered. Sunglasses are not covered unless they are prescription sunglasses.

Over-the-counter items with FSA restrictions

The rules for over-the-counter (OTC) items changed in 2020, and many people still get them wrong. You can use FSA money for OTC medications — pain relievers, allergy pills, cold medicine, antacids, anti-diarrheal medication — but only if you have a prescription or written order from a doctor. A text message or email from your doctor counts; you do not need a paper prescription. Without that documentation, the purchase will be rejected if you try to use your FSA card.

OTC medical supplies do not require a prescription: bandages, gauze, elastic wraps, heating pads, ice packs, and first-aid kits are FSA-may be able to access. Cough drops are covered as a medical supply, not a candy. Sunscreen is not FSA-may be able to access. Feminine hygiene products became FSA-may be able to access in 2021 and do not require a prescription.

Vitamins and supplements are generally not FSA-may be able to access unless a doctor prescribes them to treat a specific medical condition. A multivitamin for general health does not may have access to. If your doctor writes an order saying you need vitamin D for a deficiency or calcium for osteoporosis, those become FSA-may be able to access.

What FSA money cannot cover

Health insurance premiums — whether for medical, dental, or vision coverage — cannot be paid with FSA funds. This includes premiums for your employer plan, a spouse's plan, or a plan you buy on your own. The same rule applies to HSA contributions: you cannot use FSA money to fund an HSA.

Cosmetic procedures are not covered: teeth whitening, Botox, hair removal, and elective plastic surgery do not may have access to, even if a doctor performs them. If a procedure is medically necessary (reconstructive surgery after an accident, for example), it may be covered, but purely cosmetic work is not.

Gym memberships, fitness classes, and general wellness programs are not FSA-may be able to access, even if your employer markets them as health benefits. Weight loss programs are not covered unless a doctor refers you for a specific medical condition like diabetes or hypertension. Massage therapy is not covered unless a doctor orders it as treatment for a diagnosed condition like chronic pain or injury.

Toiletries and personal care items — toothpaste, soap, shampoo, deodorant — are not FSA-may be able to access. Maternity clothes and diapers are not covered. Pet medications and veterinary care do not may have access to.

How to know if something is FSA-may be able to access before you buy

Your FSA plan administrator (usually your employer's benefits department or a third-party company managing the account) publishes an may be able to access expenses list. Ask for it by name or request it through your benefits portal. The IRS also maintains a searchable database of may be able to access and ineligible items on its website, though it is not always current.

When in doubt, ask your pharmacist or the retailer before checkout. Many drugstores and online retailers that accept FSA cards have their own lists of may be able to access items. If you buy something and it is rejected, you can usually return it and buy something else instead.

Keep receipts for everything you buy with FSA money. Your plan administrator may ask for proof that an expense was medical in nature, especially for items like bandages or pain relievers that could be personal care. The receipt should show what you bought and the date.

Planning your FSA contribution to avoid losing money

Because FSA money expires at the end of the calendar year, contribute only what you know you will spend. If you overestimate, the unused balance is forfeited — your employer cannot refund it to you, and you cannot roll it into next year's FSA (with a small exception: up to $640 can carry over, but only if your plan allows it, and most do not).

Track your healthcare spending from the previous year: how much you spent on copays, prescriptions, dental work, and vision care. Add a buffer for unexpected costs like urgent care or a new prescription. If you have a planned procedure coming up — dental work, surgery, or a course of physical therapy — factor that into your contribution.

If you realize mid-year that you will not spend all your FSA money, you can request a refund of contributions for the remainder of the year if your plan allows it, though this is rare. Some employers offer a grace period (usually two and a half months into the next year) to spend the previous year's balance, but this is optional and not all plans include it. Check your plan documents to see what applies to you.

Frequently Asked Questions

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

Yes. FSA money can pay for medical expenses for you, your spouse, and any dependent you claim on your tax return. You do not need to be on the same insurance plan. The expense just has to be incurred during the year you set the money aside.

Do I need a receipt to use my FSA card at the pharmacy?

Not at checkout, but you should keep receipts for your records. Your FSA plan administrator can audit expenses and ask for proof that something was medical. A pharmacy receipt showing the medication name, date, and amount is sufficient proof.

What happens if I leave my job mid-year?

You lose access to your FSA when you leave your employer, even if you have money left in the account. You may be able to continue coverage through COBRA, but that requires paying the full premium yourself. Any unused FSA balance is forfeited. Plan your final contribution carefully if you know you are leaving.

Can I use FSA money for telehealth visits?

Yes. Copays for telehealth appointments are FSA-may be able to access the same way as in-person visits. If the telehealth provider charges a flat fee instead of a copay, that fee is also covered.

Are prescription glasses and contacts both FSA-may be able to access?

Yes, both are covered. Frames, lenses, contact lenses, and contact lens solution are all FSA-may be able to access. Non-prescription sunglasses are not, but prescription sunglasses are.