What an FSA covers
A Flexible Spending Account (FSA) lets you set aside pre-tax money from your paycheck to pay for specific medical and dependent care costs. You can use FSA funds for any expense that the IRS classifies as a may have access to medical expense — which is narrower than "anything health-related" but broader than most people think.
The key rule: the expense must be for diagnosis, cure, mitigation, treatment, or prevention of disease, or for affecting any body structure or function. That covers doctor visits, prescriptions, and dental work. It also covers items like crutches, hearing aids, and glucose monitors. What it does not cover: cosmetic procedures, vitamins (unless prescribed for a specific condition), or most over-the-counter items — though that last category has exceptions.
FSA funds come from your employer's plan, so the exact list of covered expenses depends on your plan document. Your employer's benefits administrator or HR department can tell you whether a specific item is covered under your plan. If you are unsure, ask before you spend the money — once you use FSA funds, you cannot get them back if the IRS later rules the expense was not may have access to.
Key Takeaways
- FSA money covers doctor visits, prescription medications, dental and vision care, and medical equipment like crutches or hearing aids.
- Over-the-counter medications like pain relievers and allergy medicine are not covered unless your doctor writes a prescription for them.
- Cosmetic procedures, gym memberships, and most vitamins are not covered, even if they relate to your health.
- Your specific plan document determines the final list of covered expenses, so check with your HR department if you are unsure about a purchase.
- Dependent care FSAs (a separate account type) cover daycare and after-school programs, not medical expenses.
Medical expenses FSAs definitely cover
These items are covered under virtually all FSA plans: doctor and dentist visits (including copays and deductibles), prescription medications, eyeglasses and contact lenses, dental work (fillings, crowns, braces, root canals), hearing aids and batteries, and mental health counseling or therapy sessions.
Also covered: medical equipment and supplies like blood pressure monitors, glucose meters and test strips, crutches, wheelchairs, orthopedic braces, and CPAP machines. Pregnancy-related expenses count too — prenatal visits, delivery, and maternity care all may have access to. Physical therapy, chiropractic care, and acupuncture are covered if a doctor orders them. Prescription eyeglasses and contact lenses are covered; non-prescription sunglasses are not.
Over-the-counter items with FSA restrictions
The rules for over-the-counter (OTC) items changed in 2020 and created confusion that still exists. The short version: OTC medications are not covered unless a doctor writes a prescription for them, even if you buy them at a pharmacy. OTC medical supplies — like bandages, heating pads, or ace wraps — are covered without a prescription.
This means you cannot use FSA funds to buy ibuprofen, acetaminophen, antihistamines, or cold medicine off the shelf. You can use FSA funds to buy the same medications if your doctor writes a prescription and you fill it at a pharmacy. You can also use FSA funds for OTC items like first-aid kits, thermometers, and pain relief patches. The distinction is medication versus supply: if it is a drug meant to treat a symptom, you need a prescription. If it is a device or supply that helps with medical care, you do not.
What FSA cannot cover
Cosmetic procedures are never covered, even if they are performed by a doctor. That includes teeth whitening, Botox, hair removal, and cosmetic surgery. The exception: if a procedure is reconstructive (repairing damage from injury or disease), it may be covered — ask your plan administrator.
General wellness expenses are not covered: gym memberships, fitness classes, weight loss programs, and nutritional supplements do not may have access to. Vitamins and minerals are not covered unless a doctor prescribes them to treat a specific diagnosed deficiency. Over-the-counter sunscreen is not covered. Toothpaste and toothbrushes are not covered. Maternity clothes are not covered (though maternity care is).
Travel for medical treatment, lodging during treatment, and meals are generally not covered, though there are narrow exceptions for specific situations — ask your plan if you are traveling for a procedure. Childcare that is not specifically for dependent care (see below) is not covered under a medical FSA.
Dependent care FSAs are separate and different
Some employers offer a second type of FSA called a Dependent Care FSA (or Dependent Care Flexible Spending Account). This is a completely separate account from a medical FSA, and it covers different things entirely.
A Dependent Care FSA covers the cost of childcare and adult dependent care that allows you to work. This includes daycare centers, in-home daycare, after-school programs, summer camps (if they are primarily childcare), and care for an elderly parent or disabled adult. The care must be for someone you claim as a dependent on your taxes, and it must free up time for you to work or look for work.
A Dependent Care FSA does not cover education costs (even if the program includes care), overnight camps, or care during times you are not working. The annual limit for Dependent Care FSAs is lower than for medical FSAs and varies by year — check your plan documents for the current limit.
How to know if something is covered before you spend
Your employer provides a plan document (sometimes called a Summary Plan Description) that lists covered expenses. This is the official source, and it is more detailed than any general list. Ask your HR department or benefits administrator for a copy, or check your employee benefits portal.
If you are still unsure after reading the plan document, contact your FSA administrator (the company that manages the account — often a third-party vendor, not your employer). They can tell you whether a specific item or service is covered. Some administrators have online tools or phone lines for this exact question.
Keep receipts and documentation for everything you buy with FSA funds. If the IRS audits your account, you will need to show that the expense was may have access to. The documentation does not have to be fancy — a receipt showing what you bought is usually enough.
What happens if you spend FSA money on something not covered
If you use FSA funds for an expense that is not covered, you have spent pre-tax money on a non-may have access to purchase. You cannot deduct that expense on your taxes, and you cannot get the money back into your FSA. The money is gone.
If you are audited and the IRS finds that you used FSA funds for non-may have access to expenses, you may owe taxes on that money plus penalties. This is rare for small mistakes, but it is a reason to be careful. When in doubt, ask your plan administrator before you spend.
Frequently Asked Questions
Can I use my FSA to buy over-the-counter pain relievers?
Not without a prescription. Ibuprofen, acetaminophen, and other OTC medications are not covered by FSA unless a doctor writes a prescription for them. However, you can use FSA funds for OTC medical supplies like bandages, heating pads, and ice packs.
Does my FSA cover dental work?
Yes. Dental visits, cleanings, fillings, crowns, root canals, braces, and other dental procedures are covered by FSA. Cosmetic dental work like teeth whitening is not covered unless it is part of reconstructive treatment.
Can I use FSA money for my child's daycare?
Only if your employer offers a Dependent Care FSA, which is a separate account from a medical FSA. A medical FSA does not cover childcare. If you have a Dependent Care FSA, daycare and after-school programs are covered expenses.
What if I buy something with my FSA card and later find out it is not covered?
You cannot reverse the transaction or get the money back. The funds are spent. To avoid this, check your plan document or contact your FSA administrator before you make the purchase, not after.
Are vitamins covered by FSA?
Vitamins and nutritional supplements are not covered unless a doctor prescribes them to treat a specific medical condition. A general multivitamin for wellness is not covered.