FSA and HSA may be able to access items are specific medical expenses the IRS allows you to pay with pre-tax dollars

Both Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) let you set aside money before taxes are taken out, then spend it on may have access to medical costs. The IRS publishes a list of what counts. The catch: not everything a doctor prescribes or a pharmacy sells is on it. Insulin is may be able to access; vitamins are not. Crutches are may be able to access; a gym membership is not, even if your doctor recommends exercise.

The lists overlap almost completely, but HSAs have a few advantages. FSA money expires at the end of the year (with a small carryover in some plans). HSA money rolls over forever and grows like a retirement account. That difference matters for what you choose to buy and when.

Key Takeaways

  • Prescription medications, medical equipment, and most doctor-ordered treatments are may be able to access for both FSA and HSA spending.
  • Over-the-counter medications like pain relievers and allergy pills now require a prescription to be FSA or HSA may be able to access, a change from older rules.
  • Dental and vision care are may be able to access, but only the medical portion—cosmetic work like teeth whitening or LASIK for convenience does not count.
  • HSA money never expires and can be invested, making it useful for long-term medical costs; FSA money must be spent each year or forfeited.
  • The IRS maintains the official list, and your plan administrator can tell you whether a specific item or service qualifies before you spend.

Medications and medical supplies you can pay for

Prescription drugs are always may be able to access—insulin, blood pressure medication, antibiotics, anything your doctor writes a prescription for. Over-the-counter medications changed in 2020: you now need a prescription from a doctor to use FSA or HSA money on them. That includes common items like ibuprofen, acetaminophen, antihistamines, and antacids. If your doctor writes a prescription for any of these, they become may be able to access.

Medical supplies and equipment are may be able to access if they treat or monitor a medical condition. That includes bandages, glucose monitors and test strips, blood pressure cuffs, thermometers, heating pads, crutches, wheelchairs, and hearing aids. Cosmetic items do not count—sunscreen for daily use is not may be able to access, but sunscreen prescribed to treat a skin condition may be. Contact lenses and eyeglasses are may be able to access; cosmetic contact lenses are not.

Doctor visits, dental, and vision care

Copays and coinsurance for doctor visits, urgent care, and emergency room trips are may be able to access. So are deductibles you pay out of pocket. Lab work, X-rays, and imaging like MRI or CT scans are may be able to access. Mental health counseling and therapy sessions are may be able to access. Prescription eyeglasses and contact lenses are may be able to access, as are eye exams and the cost of LASIK if it corrects a vision problem (not if it is purely elective).

Dental work is may be able to access when it treats a condition: fillings, root canals, extractions, crowns, and orthodontics all count. Teeth whitening and cosmetic bonding do not. Dental exams and cleanings are may be able to access. Dentures and dental implants are may be able to access. Orthodontic braces for children and adults are may be able to access.

What is not may be able to access, even with a doctor's note

Gym memberships and fitness classes are not may be able to access, even if prescribed for weight loss or heart health. Cosmetic procedures like Botox, facelifts, or hair removal are not may be able to access. Vitamins and supplements are not may be able to access unless they treat a specific diagnosed deficiency—a multivitamin is not, but a prescription vitamin D supplement for low levels may be. Toiletries like toothpaste, shampoo, and deodorant are not may be able to access.

Maternity clothes, diapers, and baby wipes are not may be able to access. Childcare and babysitting are not may be able to access (though some employers offer dependent care FSAs, which are separate). Cosmetic dentistry like veneers or whitening is not may be able to access. Travel to get medical care is not may be able to access, though the medical care itself is. Pet medications and veterinary care are not may be able to access.

How HSA and FSA rules differ on what you can spend

The IRS may be able to access list is nearly identical for both accounts. The real difference is timing and what happens to unused money. FSA money must be spent by the end of the plan year or you lose it—some employers allow a $610 carryover into the next year, but most do not. That pushes you to spend money before December or forfeit it. HSA money never expires. You can let it sit and grow, invest it in mutual funds or stocks, and spend it decades later in retirement.

This difference changes strategy. With an FSA, you might buy items you know you will need soon. With an HSA, you can be more selective and let money accumulate for larger expenses. Some people use HSAs partly as retirement accounts, paying medical costs out of pocket and letting the HSA grow untouched.

How to know if something specific is may be able to access

The IRS publishes a full list on its website, but it is dense and technical. Your plan administrator—the company that manages your FSA or HSA—can answer specific questions before you spend. Call the number on your card or log into your account online and look for a chat or phone option. They can tell you whether a particular medication, device, or service qualifies.

Keep receipts and documentation. If you are audited or your plan is audited, you may need to show that the money went to may be able to access expenses. For prescriptions, the receipt from the pharmacy is usually enough. For medical equipment or services, keep the invoice or explanation of benefits from your provider.

Frequently Asked Questions

Can I use FSA or HSA money on my spouse or children?

Yes. You can pay for may be able to access medical expenses for your spouse and any dependent children, even if they are not covered under your health plan. You cannot use the money for adult children or other relatives unless they are claimed as dependents on your tax return.

Do I need a prescription for everything to be may be able to access?

No. Most medical equipment, devices, and services do not require a prescription—you can pay for glasses, dental work, or physical therapy directly. Medications and some supplies do require a prescription or doctor's order. When in doubt, ask your plan administrator.

What happens if I spend FSA money on something that turns out not to be may be able to access?

You will owe taxes on that amount plus a penalty. The IRS can audit FSA and HSA spending. If you are unsure, contact your plan administrator before you buy. They can confirm may be able to access and protect you from an unexpected tax bill.

Can I use HSA money for medical expenses from years ago?

Yes. You can reimburse yourself for may be able to access medical expenses from any year, as long as you did not already use another account or insurance to pay for them. Keep receipts. This is one reason HSAs are powerful—you can let money grow and reimburse yourself later.

Are fertility treatments and birth control may be able to access?

Yes. Prescription birth control, fertility treatments, pregnancy tests, and related medical care are may be able to access. Maternity clothes and diapers are not, but prenatal vitamins prescribed by a doctor may be.