FSA funds cover medical expenses your insurance doesn't pay for, plus some items insurance won't cover at all

A Flexible Spending Account (FSA) lets you pay for certain health costs with pre-tax money you set aside during open enrollment. The IRS publishes a list of what counts as a may have access to medical expense. If an expense is on that list, you can use FSA funds to pay for it — whether your insurance covers it or not. If it's not on the list, you cannot use FSA money, even if you think it should be medical.

The key is that FSA money must go toward something the IRS classifies as medical care. That includes doctor visits, prescriptions, and dental work, but also items like bandages, crutches, and reading glasses. It does not include cosmetic procedures, gym memberships, or most over-the-counter vitamins, even if they help your health.

Key Takeaways

  • FSA funds pay for doctor visits, hospital care, prescription medications, dental work, and vision care — whether your insurance covers them or not.
  • You can use FSA money for medical equipment and supplies like crutches, wheelchairs, hearing aids, and blood pressure monitors without a prescription.
  • Over-the-counter medicines and medical supplies now require a prescription from your doctor to be FSA-may be able to access, even aspirin and antacids.
  • Cosmetic procedures, gym memberships, vitamins (unless prescribed), and weight-loss programs do not count as FSA-may be able to access expenses.
  • The IRS maintains the official list of may have access to expenses, and your FSA plan documents show which items your specific plan covers.

Medical care and treatment that FSA covers

FSA funds pay for visits to doctors, dentists, optometrists, and mental health providers. This includes the copay you owe at the visit, the coinsurance (your percentage of the bill after insurance pays its share), and the full cost if you see an out-of-network provider and pay out of pocket. Hospital stays, surgery, and emergency room visits all count.

Prescription medications are FSA-may be able to access. Over-the-counter drugs — including pain relievers, cold medicine, antacids, and allergy tablets — are also may be able to access, but only if you have a prescription from your doctor. A prescription for an OTC drug is a separate document your doctor writes; it is not the same as buying the item without a prescription. Some FSA plans may not cover OTC drugs even with a prescription, so check your plan documents.

Mental health treatment, including therapy and psychiatric care, is FSA-may be able to access. Substance abuse treatment programs also count. Dental work — fillings, crowns, root canals, cleanings, and orthodontia — is FSA-may be able to access, as is vision care like eye exams and glasses.

Medical equipment and supplies you can buy with FSA funds

FSA money covers durable medical equipment: wheelchairs, crutches, walkers, canes, and hospital beds. Hearing aids and batteries for hearing aids are FSA-may be able to access. Blood pressure monitors, glucose meters, and thermometers count. Braces for joints, back supports, and compression stockings are may be able to access.

Supplies for managing a medical condition are covered: bandages, gauze, tape, syringes, lancets for blood testing, and test strips for glucose monitors. Incontinence supplies, ostomy supplies, and catheter supplies are FSA-may be able to access. Sunscreen is not may be able to access, but medicated sunscreen prescribed by a dermatologist for a skin condition may be.

Eyeglasses and contact lenses are FSA-may be able to access, as are the solutions and cases you need to use them. Dental supplies like floss and toothpaste are not may be able to access on their own, but if your dentist prescribes a medicated toothpaste or mouthwash for a gum condition, that prescription version is may be able to access.

What FSA does not cover

Cosmetic procedures — including teeth whitening, Botox, hair removal, and plastic surgery — are not FSA-may be able to access unless they are medically necessary. For example, surgery to repair a broken nose is may be able to access, but surgery to reshape a nose for appearance alone is not. Your doctor's documentation of medical necessity matters here.

Gym memberships, fitness classes, and exercise equipment are not FSA-may be able to access, even if your doctor recommends exercise. Weight-loss programs and diet plans do not count. Vitamins and supplements are not may be able to access unless your doctor prescribes them for a specific deficiency or condition.

Over-the-counter items that are not drugs or medical supplies do not count: toothpaste, mouthwash, shampoo, soap, deodorant, and feminine hygiene products are not FSA-may be able to access. Maternity clothes are not may be able to access. Childcare is not may be able to access, even though it may be covered by a Dependent Care FSA (a different account type).

How to know if something is FSA-may be able to access before you buy it

The IRS publishes Publication 502, which lists may have access to medical expenses. Your FSA plan administrator — the company that runs your account — also publishes a list of what your specific plan covers. These lists sometimes differ because plans can be more restrictive than the IRS rules, but they cannot be more generous.

If you are unsure about a specific item, contact your FSA plan administrator before you buy it. They can tell you whether that exact product or service is may be able to access under your plan. Buying something and then finding out it is not may be able to access means you cannot use FSA funds to pay for it, and you may have to repay the account if you already did.

When you buy something at a pharmacy or medical supply store, the register system sometimes flags items as FSA-may be able to access or not. This is helpful but not always accurate — the system depends on how the item is coded in the store's database. If you are paying with an FSA debit card and the transaction is declined, ask the cashier to ring it up differently or contact your FSA administrator.

Using your FSA debit card versus paying out of pocket and getting reimbursed

Many FSA plans issue a debit card that you can use at pharmacies, doctor offices, and medical supply stores. When you swipe the card, the transaction is usually approved if the merchant's system recognizes the item as medical. This is fast, but it is not foolproof — some may be able to access items may be declined if the store codes them incorrectly.

You can also pay out of pocket with your own money and then submit a claim for reimbursement. You will need to keep your receipt and submit it to your FSA plan administrator along with a claim form. This method takes longer but gives you time to confirm the expense is may be able to access before you submit it. Reimbursement typically takes one to two weeks after you submit a complete claim.

Some FSA plans require you to submit a receipt even when you use the debit card, especially for large purchases or items the plan wants to verify. Check your plan documents to see what documentation your plan requires.

The use-it-or-lose-it rule and what happens to unused FSA money

FSA money does not roll over to the next year. If you do not spend what you contributed by the end of the plan year, you lose it. This is called the use-it-or-lose-it rule. Most plans have a grace period of two and a half months after the plan year ends — so money contributed in 2024 can usually be spent through mid-March 2025 — but check your plan documents for your exact important date.

Some plans offer a carryover option that lets you carry over up to $640 (this amount changes yearly) to the next plan year. Not all plans offer this, and it is the plan's choice, not yours. If your plan offers it, the carryover is automatic — you do not have to do anything.

Because of the use-it-or-lose-it rule, many people choose a lower FSA contribution amount than they think they might spend, or they front-load spending on known expenses like annual dental cleanings or prescription refills early in the year.

Frequently Asked Questions

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

Yes. FSA money 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. The expense just has to be FSA-may be able to access and you have to have a receipt.

Is a prescription required for all FSA purchases?

No. Medical equipment like crutches, wheelchairs, and hearing aids do not require a prescription. Over-the-counter drugs and some supplies do require a prescription to be FSA-may be able to access. Medical supplies like bandages and gauze do not. Check your plan documents or ask your FSA administrator about the specific item you want to buy.

What happens if I use my FSA debit card for something that is not FSA-may be able to access?

If the transaction goes through, your FSA plan may ask you to repay the account within a set time period, usually 60 days. If you do not repay it, the plan may report it as taxable income to you. Keep receipts so you can prove what you bought if the plan questions a transaction.

Can I use FSA money for telehealth visits?

Yes. Telehealth visits with doctors, therapists, and other licensed providers are FSA-may be able to access the same way in-person visits are. You pay the copay or full cost with FSA funds. Some telehealth platforms let you pay directly with an FSA debit card; others require you to pay out of pocket and submit a receipt for reimbursement.

Are dental implants and orthodontia covered by FSA?

Yes. Dental work including implants, crowns, root canals, and braces is FSA-may be able to access. Cosmetic dental work like teeth whitening is not may be able to access unless your dentist documents that it is medically necessary — for example, if discoloration is from a medical condition or medication.