FSA funds cover medical and dental costs your insurance doesn't pay for

A Flexible Spending Account (FSA) lets you set aside pre-tax money from your paycheck to pay for out-of-pocket health expenses. The IRS maintains a specific list of what counts as a may have access to medical expense — and the list is longer than most people think, but also narrower in some surprising ways.

The core rule is straightforward: you can use FSA money for any medical, dental, or vision expense that your health insurance doesn't cover, plus some things it does cover (like copays and deductibles). But "medical expense" has a technical meaning. Over-the-counter pain relievers count. Vitamins do not. A gym membership does not, even if your doctor recommends exercise.

The IRS publishes a detailed list, and your plan administrator (usually your employer's benefits office) can tell you whether a specific item qualifies. When in doubt, ask before you spend — you cannot get reimbursed for something that turns out to be ineligible, and you cannot roll the money back into your paycheck.

Key Takeaways

  • FSA money covers copays, coinsurance, deductibles, and out-of-pocket costs for doctor visits, prescriptions, dental work, and vision care.
  • Over-the-counter medications like pain relievers and allergy medicine count, but only if you have a prescription or a doctor's note saying you need them.
  • Preventive care that your insurance covers at no cost (like annual checkups) cannot be paid with FSA funds.
  • Expenses that improve health but are not medical treatment — gym memberships, vitamins, weight-loss programs — do not may have access to unless a doctor prescribes them for a specific condition.
  • You must spend FSA money by the end of the plan year or lose it; there is no way to carry the balance forward to next year.

Prescription medications and over-the-counter drugs

Prescription medications are always FSA-may be able to access. This includes birth control, insulin, inhalers, antibiotics, and any other drug your doctor prescribes. You pay with your FSA debit card at the pharmacy, or you submit a receipt for reimbursement.

Over-the-counter drugs are trickier. As of 2020, you can use FSA funds for over-the-counter medications — but only if you have a prescription or a doctor's written order saying you need them. This applies to pain relievers (ibuprofen, acetaminophen), allergy medicine, cold medicine, antacids, and anti-diarrheal medication. A doctor's note takes just a few minutes to request; many practices will email one to you or give you one at your next visit.

Vitamins, supplements, and herbal products do not may have access to, even if they are sold in the pharmacy section. The exception: if a doctor prescribes a specific vitamin or supplement for a diagnosed deficiency or condition, it becomes may be able to access. Prenatal vitamins prescribed during pregnancy count. A general multivitamin does not.

Doctor visits, lab work, and mental health care

Copays and coinsurance for doctor visits are FSA-may be able to access. So are deductibles you have not met yet. If your plan charges a $30 copay per visit, you can use FSA funds to cover it. If you have a $1,500 deductible and you pay $400 out of pocket before insurance kicks in, that $400 is FSA-may be able to access.

Lab work, X-rays, and diagnostic tests are covered. Blood tests, imaging, pathology reports — anything your doctor orders to diagnose or monitor a condition qualifies. Preventive screenings that your insurance covers at no cost (like a colonoscopy or mammogram under the Affordable Care Act) cannot be paid with FSA funds, because you have no out-of-pocket cost to reimburse.

Mental health care and therapy are FSA-may be able to access. Copays for psychiatry, psychology, or counseling sessions count. So do deductibles and coinsurance for mental health treatment. If your plan covers therapy but charges a copay, FSA funds cover that copay.

Dental and vision expenses

Dental work is one of the biggest FSA uses because dental insurance often covers less than medical insurance does. Fillings, root canals, crowns, extractions, and oral surgery are all may be able to access. So are cleanings, X-rays, and exams — even preventive ones that your dental insurance covers at no cost, because the IRS treats dental differently than medical preventive care.

Orthodontia (braces) is may be able to access, including the full cost of treatment. Teeth whitening is not may be able to access unless it is medically necessary (for example, to correct discoloration from a medical condition or medication). Cosmetic dentistry — veneers, bonding for appearance only — does not may have access to.

Vision expenses include eye exams, glasses, contact lenses, and contact lens solution. Copays for eye doctor visits are covered. The cost of frames and lenses is covered. Laser eye surgery (LASIK) is may be able to access. Sunglasses are not, even if they are prescription, because they are considered cosmetic.

Medical equipment and supplies

Durable medical equipment — items your doctor prescribes that you keep and use over time — is FSA-may be able to access. This includes blood glucose monitors, blood pressure cuffs, nebulizers, heating pads, crutches, wheelchairs, and oxygen equipment. You need a prescription or a doctor's letter stating medical necessity.

Medical supplies are covered: bandages, gauze, tape, syringes, lancets, test strips, and other consumables you use to manage a health condition. Incontinence products are may be able to access. Elastic bandages and braces are may be able to access. First-aid kits are not (they are general household items), but individual medical supplies are.

Hearing aids and batteries are FSA-may be able to access. So are cochlear implants and related devices. Prescription medical alert devices count. A smartwatch or fitness tracker does not, even if it monitors your heart rate, because it is not prescribed medical equipment.

Fertility, pregnancy, and women's health

Fertility treatment is FSA-may be able to access. This includes in vitro fertilization (IVF), intrauterine insemination (IUI), and related procedures. Medications used in fertility treatment are covered. Copays and deductibles for fertility clinic visits are covered. Surrogacy costs are not may be able to access.

Pregnancy-related expenses are covered: prenatal visits, ultrasounds, lab work, and delivery. Copays for obstetric care are FSA-may be able to access. Maternity clothes are not. Childbirth classes may be may be able to access if they are medically necessary (for example, if recommended by your doctor for a high-risk pregnancy), but general parenting classes are not.

Birth control is FSA-may be able to access: pills, patches, IUDs, implants, and other contraceptive methods. Copays and the full cost of methods your insurance does not cover are may be able to access. Condoms are not may be able to access because they are available without a prescription and are considered preventive rather than treatment.

What does not may have access to

Expenses that improve health but are not medical treatment do not may have access to. Gym memberships and fitness classes are not may be able to access, even if your doctor recommends exercise. Weight-loss programs and diet plans are not may be able to access unless a doctor prescribes them for a specific medical condition (obesity, diabetes, heart disease) and you have documentation of that prescription.

Cosmetic procedures are not may be able to access unless they are medically necessary. Botox for wrinkles does not may have access to. Botox for chronic migraines does may have access to if a doctor prescribes it. Hairpieces and wigs are not may be able to access unless they are needed because of hair loss caused by a medical condition (chemotherapy, alopecia) and a doctor provides a letter of medical necessity.

General wellness items do not may have access to: toothbrushes, toothpaste, soap, shampoo, deodorant, and other hygiene products. Sunscreen is not may be able to access. Insect repellent is not may be able to access. Over-the-counter pain relievers without a prescription do not may have access to (though they do if you have a doctor's note). Pet medications and veterinary care are not may be able to access, even if the pet is a service animal — only human medical expenses count.

How to know if something qualifies

The IRS publishes a full list of may have access to medical expenses on its website (Publication 502). Your plan administrator should also have a list or a way to check specific items. Many FSA debit cards come with a customer service number you can call to ask about a specific expense before you buy it.

When you are unsure, ask your doctor or the provider. A straightforward email to your doctor's office asking for a prescription or letter of medical necessity takes minutes and protects you from spending FSA money on something that turns out to be ineligible. Keep receipts and documentation — if the IRS ever audits your FSA use, you will need to show what you spent money on and why it may have access to.

Remember that FSA money is use-it-or-lose-it. You cannot carry unused funds into the next year (with rare exceptions for dependent care FSAs). Plan your spending carefully, and do not set aside more than you are confident you will spend in the plan year.

Frequently Asked Questions

Can I use FSA money for my spouse's or child's medical expenses?

Yes. FSA funds can pay for medical expenses of you, your spouse, and your dependents — anyone you claim on your tax return. You do not have to be on the same health insurance plan. If your spouse has their own FSA through their employer, they can use their own FSA for their expenses, or you can use yours.

Do I need a receipt to use my FSA debit card?

At a pharmacy or doctor's office, usually not — the transaction is coded as medical. For other purchases (medical equipment, supplies), you may need to provide a receipt or prescription to the FSA administrator to prove the expense was medical. Keep receipts for at least three years in case of an audit.

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

You cannot get the money back. The expense is not reimbursed, and you cannot roll it back into your paycheck. This is why it is worth asking your plan administrator or doctor before you spend, especially on items that are borderline (like certain supplements or fitness programs).

Can I use FSA money for medical expenses I had last year?

No. FSA funds must be used for expenses incurred during the plan year they are set aside for. If you had a medical bill in December of last year, you cannot reimburse it with this year's FSA money. You can only reimburse expenses from the current plan year.

Are prescription glasses and contacts covered if my insurance does not cover them?

Yes. Even if your health insurance does not include vision coverage, FSA funds cover the full cost of glasses, contacts, contact lens solution, and eye exams. This is one reason FSAs are valuable for people whose insurance has no vision benefit.