FSA funds cover medical expenses your insurance doesn't pay for

A Flexible Spending Account (FSA) holds pre-tax money you set aside to pay for out-of-pocket medical costs. You can use FSA money for expenses that your health insurance plan doesn't cover, or for the portions you have to pay yourself — like copays, coinsurance, and deductibles. The IRS maintains a specific list of what counts as a medical expense, and only items on that list can be purchased with FSA funds.

The key rule: the expense must be for diagnosis, treatment, or prevention of a medical condition, and it must not be something you'd buy anyway if you didn't have a medical reason. Vitamins you take for general wellness don't count, but prescription vitamins for a specific deficiency do. Toothpaste doesn't count, but prescription toothpaste for a gum disease does.

Key Takeaways

  • FSA money covers copays, coinsurance, deductibles, and other out-of-pocket medical costs that your insurance doesn't pay.
  • Over-the-counter medications like pain relievers and allergy medicine count only if you have a prescription from your doctor.
  • Dental and vision expenses — including exams, glasses, contacts, and cleanings — are covered by FSA funds.
  • Items like gym memberships, cosmetic procedures, and general wellness products do not count, even if they benefit your health.
  • You must keep receipts and documentation to prove expenses are medical in nature if your FSA plan or the IRS ever asks.

Prescription medications and over-the-counter drugs

Prescription medications are always FSA-may be able to access. This includes birth control pills, inhalers, antibiotics, blood pressure medication, and any other drug your doctor prescribes. You can use your FSA card at the pharmacy just like a regular insurance card, or pay out of pocket and submit a receipt for reimbursement.

Over-the-counter medications are trickier. As of 2020, you can use FSA funds for over-the-counter drugs only if you have a prescription from your doctor — even for common items like ibuprofen, allergy medicine, or cold medicine. A prescription doesn't mean the medication has to be prescription-strength; your doctor can write a prescription for over-the-counter products. Some people get a standing prescription from their doctor for items they use regularly, like pain relievers or antihistamines, so they can pay with FSA funds.

Dental and vision care

Dental expenses covered by FSA include routine cleanings, exams, fillings, root canals, crowns, braces, and extractions. You can use FSA funds for preventive care (cleanings and exams), basic procedures (fillings), and major work (crowns and implants). Cosmetic dental work like teeth whitening is not covered unless your dentist documents that it's medically necessary.

Vision expenses include eye exams, glasses, contact lenses, and contact lens solution. You can use FSA money at an optometrist or ophthalmologist, and at retailers like Warby Parker or LensCrafters if they perform exams. Laser eye surgery (LASIK) is also FSA-may be able to access. Sunglasses are not covered, even if they're prescription, because they're considered general eyewear rather than medical treatment.

Medical equipment and supplies

FSA covers durable medical equipment prescribed by a doctor: crutches, wheelchairs, walkers, blood pressure monitors, glucose meters, and hearing aids all count. You can also use FSA funds for medical supplies like bandages, elastic wraps, heating pads, and ice packs — but only if they're used to treat a specific condition, not for general first aid.

Diabetic supplies are fully FSA-may be able to access: test strips, lancets, syringes, and insulin pumps. Incontinence products are covered. Pregnancy tests and ovulation kits count. Sunscreen does not count as a medical expense, even though it prevents skin cancer, because it's considered a general wellness product.

Mental health and therapy services

Therapy and counseling sessions with a licensed mental health professional — psychologist, psychiatrist, social worker, or counselor — are FSA-may be able to access. You can use FSA funds to pay for the session itself, whether you pay the therapist directly or through your insurance. Psychiatric medications are also covered.

Some employers' FSA plans cover meditation apps or online therapy platforms if they're prescribed or recommended by your doctor as part of treatment for a diagnosed condition. Check your plan documents or call your FSA administrator to confirm whether specific mental health apps or services are covered under your plan.

Fertility and family planning

Fertility treatments, including in vitro fertilization (IVF), are FSA-may be able to access. You can use FSA funds for fertility drugs, egg retrieval procedures, embryo transfer, and related lab work. Prenatal vitamins are covered. Contraception — birth control pills, patches, IUDs, and barrier methods — is also FSA-may be able to access.

Pregnancy tests and ovulation predictor kits count. Maternity support garments prescribed by a doctor are covered. Adoption-related medical exams required by adoption agencies may be covered depending on your plan; check with your FSA administrator.

What doesn't count as an FSA expense

General wellness products and services are not FSA-may be able to access, even if they improve your health. Gym memberships, fitness classes, and sports equipment don't count. Vitamins and supplements for general health don't count, though prescription vitamins for a diagnosed deficiency do. Weight loss programs and diet plans are not covered unless they're prescribed by a doctor to treat obesity or a related medical condition.

Cosmetic procedures — including Botox, facelifts, and teeth whitening — are not covered. Hairpieces and wigs are not covered. Travel to receive medical treatment is not covered (though the medical treatment itself is). Over-the-counter pain relievers, allergy medicine, and cold medicine are not covered without a prescription. Toothpaste, mouthwash, and floss are not covered, even though they're dental products.

How to pay with your FSA and keep records

Most FSAs issue a debit card that works like a credit card at pharmacies, doctors' offices, and medical retailers. You can also pay out of pocket and submit a receipt to your FSA plan for reimbursement. Keep all receipts and documentation — your FSA plan may ask you to verify that an expense is medical in nature, and the IRS can audit FSA accounts.

When you submit a receipt, include the date, the provider's name, what was purchased or treated, and the amount. If you're reimbursed for an expense that turns out not to be FSA-may be able to access, you may have to pay the money back. Some FSA plans use a "store and forward" system where the pharmacy or doctor's office automatically confirms the expense is may be able to access before you pay; others require you to submit documentation later.

Frequently Asked Questions

Can I use my FSA for over-the-counter pain relievers without a prescription?

No. As of 2020, over-the-counter medications — including pain relievers, allergy medicine, and cold medicine — require a prescription from your doctor to be FSA-may be able to access. You can ask your doctor to write a prescription for over-the-counter products you use regularly, and then use your FSA to pay for them.

Are vitamins and supplements covered by FSA?

Vitamins for general health are not covered. However, if your doctor prescribes a specific vitamin or supplement to treat a diagnosed deficiency or medical condition, it becomes FSA-may be able to access. For example, prenatal vitamins are covered, and prescription vitamin D for a deficiency is covered.

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

No. Gym memberships and fitness classes are considered general wellness and are not FSA-may be able to access. However, if your doctor prescribes physical therapy for an injury or condition, that therapy is covered by FSA.

What happens if I use my FSA card for something that isn't may be able to access?

Your FSA plan may flag the transaction and ask you to provide documentation that the expense is medical. If you can't prove it's may be able to access, you may be required to reimburse the FSA. Some plans use real-time verification at the point of sale to prevent ineligible purchases.

Are dental cleanings and exams covered by FSA?

Yes. Routine dental care — cleanings, exams, X-rays, and fillings — is FSA-may be able to access. Major dental work like crowns, root canals, and implants is also covered. Cosmetic dental work like teeth whitening is not covered unless your dentist documents it as medically necessary.