FSA may be able to access means the expense is on the IRS list of medical costs you can pay with pre-tax money from your Flexible Spending Account
When an expense is FSA may be able to access, it qualifies under IRS rules as a medical, dental, or vision cost you can reimburse yourself for using money you set aside before taxes are taken from your paycheck. The IRS publishes a specific list of what counts. If something is on that list, you can use FSA funds to pay for it without owing income tax on that money. If it is not on the list, you cannot use FSA funds, even if you think it should be medical.
The key difference between may be able to access and ineligible is whether the IRS considers it a treatment, diagnosis, or prevention of disease or injury. Vitamins and supplements are mostly ineligible. Cosmetic procedures are ineligible. Over-the-counter medicines are ineligible unless you have a doctor's prescription. The line is often stricter than what your health insurance will cover.
Key Takeaways
- FSA may be able to access expenses must be on the IRS list and used to treat, diagnose, or prevent disease or injury — not for general wellness or appearance.
- Common may be able to access expenses include copays, deductibles, prescription medications, dental work, glasses, and hearing aids, but the rules vary by category.
- Over-the-counter medicines and supplements are ineligible unless you have a written prescription from a doctor.
- If you use FSA funds on an ineligible expense, you owe income tax on that amount plus a 20 percent penalty.
Common may be able to access expenses you can pay with FSA funds
Copays, coinsurance, and deductibles for any health service count as may be able to access. Prescription medications are may be able to access. Dental work — fillings, crowns, root canals, orthodontia — is may be able to access. Vision care including eye exams, glasses, contact lenses, and lens solution is may be able to access. Hearing aids and hearing aid batteries are may be able to access. Crutches, wheelchairs, and other durable medical equipment are may be able to access if prescribed by a doctor.
Mental health treatment, physical therapy, and chiropractic care are may be able to access if a doctor orders them. Pregnancy tests, contraception, and fertility treatments are may be able to access. Insulin and diabetes supplies are may be able to access. Allergy shots and allergy testing are may be able to access. If you pay out of pocket for any of these, you can submit a receipt to your FSA plan and get reimbursed with pre-tax money.
Expenses that are not FSA may be able to access
Over-the-counter pain relievers, cold medicine, allergy medicine, and antacids are ineligible unless a doctor writes a prescription for them. Vitamins, minerals, and herbal supplements are ineligible even if recommended by a doctor, unless the doctor prescribes them to treat a specific disease. Cosmetic procedures — teeth whitening, Botox, hair removal — are ineligible. Gym memberships and fitness equipment are ineligible. Sunscreen and skincare products are ineligible.
Toothpaste, mouthwash, and dental floss are ineligible. Eyeglasses frames that are purely cosmetic (not medically necessary) may be ineligible depending on your plan. Maternity clothes are ineligible. Wigs are ineligible unless medically necessary due to hair loss from disease or treatment. Weight loss programs and diet foods are ineligible unless prescribed by a doctor to treat obesity as a disease.
How to know if something is may be able to access before you spend
Your FSA plan administrator — the company your employer hired to manage the account — publishes a list of may be able to access and ineligible expenses. Ask your HR department for that list or the plan's website. The IRS also maintains a searchable database called Publication 502, which lists medical expenses. You can search by category or keyword to see whether the specific item or service you are considering is on the approved list.
When in doubt, ask your FSA plan administrator in writing before you spend the money. If they confirm it is may be able to access and you follow their instructions, you are protected even if the IRS later disagrees. If you spend first and ask later, you bear the risk. Keep receipts for everything you buy with FSA funds, because your plan may ask for proof that the expense was may be able to access.
What happens if you use FSA funds on an ineligible expense
If you submit a receipt for an ineligible expense and your plan catches it, they will deny the reimbursement and you will have to pay out of pocket. If you already took the reimbursement and later the IRS audits your return, you will owe income tax on that amount plus a 20 percent penalty. The tax is calculated at your marginal rate, so the total cost can be significant.
For example, if you are in the 22 percent tax bracket and you improperly reimbursed yourself $500 for an ineligible expense, you would owe $110 in tax plus $100 in penalty, for a total of $210. That erases most of the tax savings you got from setting aside the money in the first place. The safest approach is to check the list before you spend.
Prescriptions change the rules for some items
A doctor's prescription can make an otherwise ineligible item may be able to access. Over-the-counter allergy medicine becomes may be able to access if a doctor prescribes it by name. A multivitamin becomes may be able to access if a doctor prescribes it to treat a specific deficiency. Sunscreen becomes may be able to access if prescribed to treat a skin condition. The prescription must be written on a prescription pad or in a format your FSA plan recognizes — a verbal recommendation or a note in an email does not count.
Get the prescription in writing and keep it with your receipt. When you submit for reimbursement, include both documents. Your plan may ask to see the prescription before they approve the reimbursement, so having it ready speeds up the process.
FSA may be able to access versus insurance coverage
An expense can be covered by your health insurance but not FSA may be able to access, or vice versa. Your insurance company and the IRS use different rules. For example, your insurance might cover certain vitamins or supplements, but the IRS does not allow FSA reimbursement for them. Conversely, your insurance might not cover a particular dental procedure, but you can still use FSA funds to pay for it if the IRS considers it may be able to access.
Do not assume that because your insurance covers something, your FSA will reimburse it. Check the FSA list separately. If you are unsure, contact your FSA plan administrator and ask specifically whether the expense is on their may be able to access list.
Frequently Asked Questions
Can I use FSA funds to pay my health insurance premium?
No, you cannot use FSA funds to pay your regular health insurance premium. You can use FSA funds to pay for COBRA continuation coverage or long-term care insurance premiums, but not your employer's group health plan premium. Copays and deductibles under that plan are may be able to access, but the premium itself is not.
Are over-the-counter pain relievers may be able to access without a prescription?
No. As of 2020, over-the-counter pain relievers, cold medicine, allergy medicine, and antacids are ineligible unless a doctor writes a prescription for them. A prescription makes them may be able to access even though they are sold without one at the pharmacy. The prescription must be on paper or in a format your plan recognizes.
Can I use FSA funds 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 may be able to access medical expenses for yourself, your spouse, and any dependent children or relatives, as long as they are claimed as dependents on your federal tax return. Keep receipts showing the dependent's name.
What if my plan says something is may be able to access but the IRS disagrees?
If your FSA plan administrator confirms in writing that an expense is may be able to access and you follow their instructions, you are generally protected from penalty if the IRS later disagrees. Get the confirmation in writing and keep it with your receipt. This protects you in an audit.
Are dental cleanings and checkups FSA may be able to access?
Yes. Preventive dental care including cleanings, exams, and X-rays is may be able to access. Fillings, crowns, root canals, and orthodontia are also may be able to access. Cosmetic dental work like teeth whitening is ineligible unless it is medically necessary to treat a disease or injury.