FSA-may be able to access Items: The Core List

Your FSA covers most things a doctor would prescribe or recommend for a medical condition, plus some over-the-counter items the IRS allows. The broadest categories are prescription medications, medical equipment (like crutches or blood pressure monitors), and certain over-the-counter drugs and supplies. Dental work, vision care, and mental health treatment are covered. What matters is whether the item treats, prevents, or diagnoses a medical condition — not whether you need a prescription for it.

The IRS publishes a list, but it is long and specific. A few examples: insulin and other diabetes supplies are in; vitamins are out unless prescribed for a diagnosed deficiency. Sunscreen is out; medicated sunscreen prescribed by a dermatologist is in. Pregnancy tests are in; general wellness items are out. The rule is consistent but the line between "medical" and "wellness" shifts depending on the item and your situation.

Key Takeaways

  • Prescription medications, medical equipment, dental work, and vision care are always FSA-may be able to access, with or without a doctor's note.
  • Many over-the-counter items like pain relievers, allergy medicine, and first-aid supplies are FSA-may be able to access, but you may need to keep a receipt showing the item treats a specific condition.
  • Cosmetic procedures, general wellness items (vitamins, gym memberships, sunscreen), and items used for comfort rather than treatment are not FSA-may be able to access.
  • Your FSA plan document or your plan administrator's website lists what is covered under your specific plan, since some employers add or remove items.
  • Keeping receipts and documentation is essential because the IRS can audit FSA spending, and you may need to prove an item was medically necessary.

Prescription Medications and Medical Devices

Any medication prescribed by a licensed provider is FSA-may be able to access, whether it is for a chronic condition or a one-time illness. This includes inhalers, antibiotics, blood pressure pills, and psychiatric medications. The prescription itself is your proof of medical necessity.

Medical devices and equipment are also covered: glucose monitors, blood pressure cuffs, thermometers, heating pads, ice packs, crutches, wheelchairs, and CPAP machines. Bandages, gauze, and medical tape count. Orthopedic shoes prescribed by a doctor are in; regular shoes are out. The device must be used to treat or manage a medical condition, not for general comfort or prevention of injury in a healthy person.

Over-the-Counter Drugs and Supplies You Can Use FSA Money For

Since 2020, you can buy many over-the-counter medications and supplies with your FSA without a prescription. This includes pain relievers (ibuprofen, acetaminophen), allergy medicine, cold medicine, antacids, anti-diarrheal medication, and topical creams for rashes or itching. First-aid supplies like bandages, antibiotic ointment, and elastic bandages are covered. Feminine hygiene products became FSA-may be able to access in 2021.

The catch: you still need to show the item treats a diagnosed or obvious medical condition. If you buy ibuprofen for a headache, you should keep the receipt. If you buy it for general wellness, it may not hold up in an audit. Your FSA plan administrator can tell you whether they require a receipt or a doctor's note for specific items — some do, some do not.

Dental and Vision Care

Dental work is broadly FSA-may be able to access: cleanings, fillings, root canals, crowns, extractions, orthodontics, and dentures. You can use FSA funds to pay your dentist directly or to reimburse yourself for out-of-pocket costs. Dental insurance copays and deductibles are also covered.

Vision care includes eye exams, glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK) is covered. Sunglasses are not, even if you have a light sensitivity condition — the IRS distinguishes between corrective lenses and protective eyewear. If your eye doctor prescribes special lenses for a medical reason, ask your FSA plan administrator whether they will cover it.

Mental Health and Therapy Services

Therapy, counseling, and psychiatric care are FSA-may be able to access. This includes sessions with a therapist, psychologist, or psychiatrist, whether in person or telehealth. Copays and deductibles for mental health visits are covered. Medications prescribed by a psychiatrist are covered under the prescription medication rule.

Some employers' FSA plans also cover wellness programs like stress-reduction classes or meditation apps if they are prescribed by a healthcare provider for a diagnosed condition. Check your plan document or ask your plan administrator whether your specific wellness service is covered.

What Is Not FSA-may be able to access

Cosmetic procedures are never covered, even if they improve your appearance in a way that affects your confidence. Botox, hair removal, teeth whitening, and cosmetic surgery are out. If a procedure is medically necessary — like reconstructive surgery after an injury — it may be covered, but cosmetic intent disqualifies it.

General wellness items are not covered: vitamins and supplements (unless prescribed for a specific deficiency), gym memberships, fitness equipment, weight-loss programs, and general nutritional counseling. Sunscreen, insect repellent, and other preventive products are out. Maternity clothes, diapers, and baby formula are not FSA-may be able to access. Over-the-counter items used for comfort rather than treatment — like heating pads for general back pain without a diagnosis — fall into a gray area and may not be covered depending on your plan.

How to Know What Your Specific Plan Covers

Your employer's FSA plan document is the final word on what is covered. Some employers add items beyond the IRS minimum or exclude items the IRS allows. Your plan administrator (usually a third-party company that manages the account) maintains a list of covered items and can answer questions before you spend money.

Most FSA administrators have a website or phone line where you can search for a specific item. If you are unsure, ask before you buy. Spending FSA money on ineligible items means you pay for it with pre-tax dollars but cannot get reimbursed — you lose the money. Keeping receipts and documentation protects you if your spending is audited.

Frequently Asked Questions

Can I use my FSA to buy vitamins?

Only if a doctor prescribes them for a diagnosed deficiency. A general multivitamin for wellness is not FSA-may be able to access. If your doctor writes a prescription or a letter stating you need a specific vitamin for a medical condition, keep that documentation with your receipt.

Are over-the-counter pain relievers FSA-may be able to access without a prescription?

Yes. Since 2020, you can buy ibuprofen, acetaminophen, and other over-the-counter pain relievers with your FSA without a prescription. Keep your receipt in case your plan administrator or the IRS asks for proof that the item was medically necessary.

Can I use FSA money for my gym membership or fitness classes?

Not unless a doctor prescribes it as treatment for a specific medical condition and documents it in writing. A general gym membership for wellness is not covered. Some plans may cover a fitness class prescribed by a doctor for weight loss or cardiac rehabilitation — ask your plan administrator.

Is teeth whitening FSA-may be able to access?

No. Teeth whitening is considered cosmetic and is not covered by FSA, even if it is done by a dentist. Medically necessary dental work like fillings, crowns, and extractions is covered.

What happens if I buy something with my FSA card and it turns out to be ineligible?

You will owe the money back to your FSA account. Your plan administrator may ask you to reimburse the account or may deduct the amount from future FSA contributions. Keep receipts so you can dispute a denial if you believe an item should be covered.