FSA money covers medical expenses your health insurance does not pay for

A Flexible Spending Account (FSA) holds pre-tax dollars you set aside for out-of-pocket medical costs. You can spend FSA money on items and services that treat, diagnose, or prevent a medical condition — but not on general health or wellness products. The IRS maintains a list of what counts as a medical expense, and it is narrower than most people expect.

The key rule: the expense must be for medical care, not for general health maintenance. Vitamins are not covered. A prescription medication is. A gym membership is not covered. Physical therapy ordered by a doctor is. This distinction matters because using FSA funds on ineligible items means you owe taxes on that money plus a penalty.

Key Takeaways

  • FSA funds cover prescription medications, medical devices, and treatments prescribed or ordered by a doctor, but not over-the-counter vitamins or general wellness products.
  • Dental and vision care — including cleanings, fillings, glasses, and contact lenses — are FSA-may be able to access if you have a separate dental or vision FSA or if your medical FSA plan covers them.
  • Copays, coinsurance, and deductibles count as FSA expenses, but health insurance premiums and cosmetic procedures do not.
  • Most over-the-counter items now require a doctor's prescription or letter to be FSA-may be able to access, even if they treat a medical condition.
  • Your FSA plan document and your employer's benefits summary show which specific items your plan covers, because rules vary by employer.

Prescription medications and medical devices

Prescription drugs are FSA-may be able to access without question. This includes medications for chronic conditions, antibiotics, pain relievers prescribed by a doctor, and psychiatric medications. Insulin and other diabetes supplies — test strips, lancets, syringes — are also covered.

Medical devices ordered or prescribed by a doctor are covered: crutches, wheelchairs, hearing aids, continuous positive airway pressure (CPAP) machines, blood pressure monitors, and glucose meters. Replacement parts and supplies for these devices count too. A knee brace prescribed by a doctor is covered; a knee brace you buy for general support is not.

Over-the-counter medications now require a doctor's prescription to be FSA-may be able to access. Aspirin, antacids, allergy medicine, and cold medicine all fall into this category. Your doctor can write a prescription for an over-the-counter item, which then makes it may be able to access. Some FSA plans allow you to submit a doctor's letter instead of a full prescription.

Dental and vision expenses

Dental work is FSA-may be able to access: cleanings, fillings, root canals, crowns, extractions, and orthodontia. You can use FSA funds for braces, retainers, and the dentist's portion of implants. Dental X-rays and exams count. Cosmetic dental work — teeth whitening or veneers done purely for appearance — does not.

Vision care is also covered: eye exams, glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK) is FSA-may be able to access. Sunglasses are not, even if they have a prescription, because they are considered general eyewear rather than medical treatment.

Some employers offer a separate Dependent Care FSA for childcare expenses, which is different from a medical FSA. Dental and vision coverage depends on your specific plan. Check your plan document or call your FSA administrator to confirm whether dental and vision are included in your medical FSA or whether you have a separate account for them.

Copays, deductibles, and coinsurance

Money you pay out of pocket to your health insurance counts as an FSA expense. Copays for doctor visits, urgent care, and emergency room trips are covered. Coinsurance — the percentage of a medical bill you pay after meeting your deductible — is covered. Deductibles themselves are covered once you pay them.

Health insurance premiums are not FSA-may be able to access. You cannot use FSA funds to pay your monthly or annual insurance bill. Premiums for supplemental insurance (like accident or critical illness coverage) are also not covered.

Mental health and therapy services

Therapy and counseling ordered by a doctor or mental health professional are FSA-may be able to access. This includes sessions with a psychiatrist, psychologist, licensed clinical social worker, or counselor. Inpatient mental health treatment and rehabilitation programs are covered. Prescription psychiatric medications are covered.

Meditation apps, online wellness programs, and self-help books are not FSA-may be able to access, even if they address mental health. The expense must involve a licensed provider or a prescribed treatment.

What is not covered by FSA

General health and wellness products are not FSA-may be able to access: vitamins, supplements, protein powders, and herbal remedies. Gym memberships and fitness classes are not covered. Cosmetic procedures — Botox, dermal fillers, hair removal, or cosmetic surgery — are not covered unless they are reconstructive (for example, surgery after an injury or to correct a birth defect).

Toiletries and personal care items are not covered: toothpaste, deodorant, shampoo, and soap. Sunscreen is not covered. Over-the-counter pain relievers, allergy medicine, and cold medicine are not covered unless you have a doctor's prescription. Maternity clothes, even if purchased during pregnancy, are not FSA-may be able to access.

Cosmetic dentistry — whitening, veneers, or purely cosmetic orthodontia — is not covered. Eyeglasses or contact lenses purchased for cosmetic reasons rather than vision correction are not covered. Hearing aids for mild hearing loss may not be covered depending on your plan; check your plan document.

How to know what your specific plan covers

FSA rules are set by the IRS, but your employer's plan can be more restrictive. Your employer may exclude certain items that the IRS allows, or may require additional documentation. The plan document your employer gave you when you enrolled lists what is and is not covered under your specific account.

Your FSA administrator — the company that manages the account for your employer — also publishes a list of covered items. Most administrators have a searchable database on their website or a customer service line you can call with questions about a specific purchase. Before you spend FSA money on something you are unsure about, ask your administrator or check your plan document.

If you buy something and later find out it was not covered, you will owe income tax on that amount plus a 20 percent penalty. Keeping receipts and asking before you buy protects you from this outcome.

Frequently Asked Questions

Can I use my FSA to buy vitamins or supplements?

No. Vitamins and supplements are not FSA-may be able to access because they are considered general health maintenance rather than treatment for a specific medical condition. This is true even if a doctor recommends them. A prescription vitamin ordered by a doctor may be covered under some plans, but standard over-the-counter vitamins are not.

Do I need a prescription for over-the-counter pain relievers to use my FSA?

Yes, as of 2020. Over-the-counter medications including aspirin, ibuprofen, acetaminophen, and allergy medicine require a doctor's prescription or a doctor's letter to be FSA-may be able to access. Your doctor can write a prescription for these items, which then makes them may be able to access for FSA purchase.

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

No. Gym memberships and fitness classes are not FSA-may be able to access because they are general wellness activities, not treatment for a medical condition. However, physical therapy prescribed by a doctor is FSA-may be able to access, even if it takes place at a gym or fitness facility.

Are glasses and contact lenses covered by FSA?

Yes. Eyeglasses, contact lenses, and contact lens solution are FSA-may be able to access. Eye exams are also covered. However, sunglasses are not covered, even prescription sunglasses, because they are considered general eyewear rather than medical treatment for a vision condition.

What happens if I spend FSA money on something that is not covered?

You will owe income tax on that amount plus a 20 percent penalty. For example, if you spend $100 of FSA funds on a non-covered item and your tax bracket is 22 percent, you will owe $22 in taxes plus $20 in penalties, totaling $42. This is why checking before you buy is important.