What an FSA covers
An FSA (Flexible Spending Account) pays for may have access to medical expenses — things your health insurance doesn't cover or that you pay out of pocket. The IRS maintains a specific list of what counts. If you buy something on that list with FSA money, you don't pay income tax on it. If you buy something off the list, you'll owe taxes plus a 20% penalty.
The key word is "medical." An FSA doesn't pay for vitamins you take to feel better, gym memberships, or cosmetic procedures. It pays for things prescribed by a doctor, things that treat a diagnosed condition, or things the IRS explicitly allows because they're medically necessary.
You control the money in your FSA account — your employer doesn't decide what you spend it on. But you have to keep receipts and be ready to prove to your FSA administrator that each purchase was allowed. Some FSA cards come with a "store list" built in, so the card straightforward declines if you try to buy something that doesn't count.
Key Takeaways
- FSA money covers doctor visits, prescriptions, dental work, vision care, and medical equipment — anything on the IRS may have access to medical expense list.
- Over-the-counter medicines and supplies (like pain relievers, allergy medicine, and bandages) count only if you have a prescription or a letter from your doctor saying they're medically necessary.
- You cannot use FSA money for cosmetic procedures, gym memberships, vitamins, or general wellness products unless a doctor prescribes them to treat a specific condition.
- Keep all receipts and documentation — your FSA administrator can ask you to prove a purchase was allowed, and using FSA money on ineligible items triggers taxes and penalties.
- Some FSA debit cards block ineligible purchases automatically, while others let you buy anything and require you to submit receipts later for reimbursement.
Doctor visits, prescriptions, and medical equipment
FSA money covers the copay or full cost of a visit to your primary care doctor, a specialist, or an urgent care clinic. It also covers the cost of prescription medications your doctor writes for you, whether you pick them up at a pharmacy or have them delivered.
Medical equipment and supplies count if they treat a diagnosed condition or disability. That includes blood glucose monitors and test strips for diabetes, inhalers for asthma, crutches, wheelchairs, hearing aids, and continuous positive airway pressure (CPAP) machines. It also covers the cost of replacing or repairing these items.
Mental health and therapy services are covered — both visits to a therapist or psychiatrist and prescription psychiatric medications. Physical therapy, occupational therapy, and speech therapy all count as long as a doctor refers you or prescribes the treatment.
Dental and vision care
FSA money covers dental work: cleanings, fillings, root canals, crowns, extractions, and orthodontia (braces). It covers the cost of a dental exam and X-rays. It also covers dentures and dental implants if you need them to replace missing teeth.
Vision care includes eye exams, glasses, contact lenses, and contact lens solution. It covers the cost of laser eye surgery (LASIK or PRK) if you choose to have it. It does not cover cosmetic procedures like eyelid surgery done purely for appearance.
Both dental and vision expenses count whether you see an in-network provider or an out-of-network one. You pay the full bill and then submit the receipt to your FSA administrator for reimbursement, or you use your FSA debit card at the provider's office.
Over-the-counter medicines and first aid
Over-the-counter pain relievers, allergy medicines, cold medicines, and antacids do not count as FSA expenses unless you have a prescription. This rule changed in 2020. Before that, you could buy ibuprofen or antihistamines with FSA money without a prescription — now you cannot.
If your doctor writes a prescription for ibuprofen, naproxen, or any OTC medicine, then you can use FSA money to buy it. Some doctors will write a prescription for a common OTC item if you ask, knowing it will let you use your FSA. You pay the pharmacy, keep the receipt, and submit it to your FSA administrator along with the prescription.
First aid supplies like bandages, gauze, and medical tape do not count. Sunscreen does not count. Thermometers, blood pressure cuffs, and pulse oximeters do not count unless a doctor prescribes them as part of treatment for a specific condition.
What does not count
Cosmetic procedures — including Botox, dermal fillers, teeth whitening for appearance, and elective plastic surgery — are not covered. Cosmetic dentistry (like veneers chosen purely for looks) does not count, though a crown that replaces a damaged tooth does.
Gym memberships, fitness classes, and general wellness products do not count, even if they improve your health. Vitamins and supplements do not count unless a doctor prescribes them to treat a diagnosed deficiency or condition. Maternity clothes, diapers, and baby formula do not count.
Hair loss treatments, anti-wrinkle creams, and other anti-aging products do not count. Toothpaste, mouthwash, and floss do not count. Massage therapy does not count unless a doctor prescribes it as physical therapy for an injury or condition.
How to know if something counts
The IRS publishes a full list of may have access to medical expenses on its website (Publication 502). You can search it by item name. If you're unsure whether something counts, ask your FSA administrator before you buy it — they can tell you whether a specific product or service is allowed.
Some items are gray areas. For example, a humidifier might count if a doctor prescribes it to treat asthma or allergies, but not if you buy it for general comfort. A seat cushion might count if a doctor says you need it for a back condition, but not if you buy it for comfort at your desk. The difference is whether a doctor has prescribed or recommended it as treatment for a diagnosed condition.
If you're not sure, keep the receipt and the prescription or doctor's note. When you submit it for reimbursement, your FSA administrator will tell you whether it's allowed. If it's not, you'll have to pay it back out of pocket and may owe taxes and a penalty.
Submitting receipts and getting reimbursed
If your FSA comes with a debit card, you can swipe it at the doctor's office, pharmacy, or medical supply store. The card draws from your FSA balance. Some FSA cards are set up to block purchases that don't count, so the card will decline if you try to buy something ineligible.
If your card doesn't block ineligible purchases, or if you pay out of pocket and want to be reimbursed, you'll need to submit a claim. Your FSA administrator will give you a form or an online portal where you upload the receipt and a description of what you bought. Keep receipts for at least three years in case your FSA administrator asks you to prove the purchase was allowed.
Reimbursement usually takes one to two weeks after you submit the claim. Some FSA administrators reimburse the same day. Check your FSA plan documents or call your administrator to find out how long it takes.
Frequently Asked Questions
Can I use my FSA to pay my health insurance premium?
No. You cannot use FSA money to pay your health insurance premium, your copay for insurance, or your deductible. However, you can use FSA money to pay for the actual medical services once you've met your deductible — the doctor visit itself, the prescription, the lab test.
Does my FSA cover my spouse's or child's medical expenses?
Yes. FSA money can be used for any family member — your spouse, children, parents, or anyone else you claim as a dependent on your taxes. The expense has to be may have access to, but it doesn't matter whose name is on the receipt.
Can I use FSA money for my pet's veterinary bills?
No. Veterinary expenses do not count as may have access to medical expenses under IRS rules, even if the pet is a service animal. Service animals themselves (the cost of training or purchasing one) also do not count.
What happens if I use my FSA money on something that doesn't count?
If your FSA administrator discovers you bought something ineligible, you'll have to repay the money to your FSA account. You'll also owe income tax on that amount plus a 20% penalty. This is why keeping receipts and asking before you buy is important.
Can I use my FSA for telehealth visits?
Yes. Telehealth visits with a doctor count as may have access to medical expenses, just like in-person visits. You can use your FSA debit card or pay out of pocket and submit the receipt for reimbursement.