Medical and dental expenses you can pay from your FSA
A Flexible Spending Account lets you set aside pre-tax money for out-of-pocket health costs. You can use FSA funds to pay for doctor visits, prescription medications, dental work, vision care, and medical equipment — but only for expenses your health insurance does not cover or only partially covers.
The IRS maintains a detailed list of what counts as a medical expense. The basic rule: if it treats, prevents, or diagnoses a medical condition, and a doctor would reasonably prescribe it, you can pay for it with FSA money. This includes copays, deductibles, and coinsurance amounts you owe after insurance pays its share.
Common FSA-may be able to access expenses include eyeglasses, contact lenses, hearing aids, crutches, wheelchairs, and insulin. You can also use FSA funds for mental health counseling, physical therapy, and chiropractic care if your insurance covers those services. Dental cleanings, fillings, root canals, and orthodontic work all count.
Key Takeaways
- You can use FSA money for copays, deductibles, prescription drugs, dental work, vision care, and medical equipment that your insurance does not fully cover.
- Over-the-counter medications like pain relievers and allergy medicine require a prescription from your doctor to be FSA-may be able to access, even if you buy them without a prescription at the pharmacy.
- Cosmetic procedures, gym memberships, and general wellness products do not count as FSA expenses unless they treat a diagnosed medical condition.
- You must have a receipt or explanation of benefits showing the expense is medical in nature — your FSA administrator may ask for proof before reimbursing you.
- FSA funds do not roll over to the next year, so you lose any money you do not use by the end of the plan year.
Over-the-counter medications and supplies
Over-the-counter medications are FSA-may be able to access, but with one important catch: you need a prescription from your doctor. This applies to pain relievers, allergy medicine, cold medicine, antacids, and any other OTC drug you want to pay for with FSA funds. The prescription does not mean you have to fill it at a pharmacy — you can still buy the item at a drugstore without a prescription, as long as you have a written or electronic prescription on file.
Medical supplies that do not require a prescription are usually FSA-may be able to access without a doctor's order. Bandages, first-aid supplies, thermometers, blood pressure monitors, and glucose test strips all count. Sunscreen does not count unless your dermatologist prescribes it to treat a skin condition.
Feminine hygiene products became FSA-may be able to access in 2020. You can use FSA funds for tampons, pads, and menstrual cups without a prescription or doctor's order.
What does not count as an FSA expense
Cosmetic procedures and products are not FSA-may be able to access, even if a doctor performs them. Botox, teeth whitening, hair removal, and cosmetic surgery do not may have access to. The exception: if a procedure treats a medical condition rather than appearance, it may count. For example, a nose surgery to fix a deviated septum that causes breathing problems is FSA-may be able to access, but the same surgery done purely for appearance is not.
General wellness and prevention products do not count unless they treat a diagnosed condition. Vitamins and supplements are not FSA-may be able to access. Gym memberships and fitness classes are not covered. Toothpaste, mouthwash, and shampoo are not FSA expenses. Weight-loss programs and diet foods do not count unless your doctor prescribes them as treatment for obesity or a related medical condition.
Childcare, long-term care insurance, and health insurance premiums are not FSA expenses. Neither are travel costs to reach a medical appointment, parking fees at a hospital, or meals while you are receiving treatment.
How to prove an expense is FSA-may be able to access
When you submit a claim to your FSA administrator, you may need to provide a receipt or explanation of benefits showing what the expense was for. Keep receipts from pharmacies, doctor offices, and medical suppliers. If you use your FSA debit card at a pharmacy, the transaction may be flagged for review — the pharmacy code does not always tell the FSA administrator whether you bought a medical supply or a non-may be able to access item like shampoo.
Your FSA administrator can ask you to submit a receipt within a set time frame, usually 30 to 60 days. If you do not provide proof, the claim may be denied and you will owe the money back. Some FSA debit cards use "store-level detail" technology that automatically knows whether a pharmacy transaction was for an may be able to access item, which reduces the need for manual review.
Keep receipts for at least three years in case your employer or the IRS audits your FSA account. A receipt should show the date, the merchant name, what you bought, and the amount paid.
Dependent care and transit benefits are separate
Some employers offer a separate Dependent Care FSA alongside the medical FSA. This account is for childcare, adult daycare, and after-school programs — not medical expenses. The rules and contribution limits are different. If your employer offers both accounts, you choose how much to put in each one.
A few employers also offer a Transit FSA for commuting costs like bus passes, train tickets, and parking. This is a third separate account with its own rules and limits. Medical FSA funds cannot be moved to either of these accounts.
What happens to unused FSA money
FSA funds do not roll over to the next year. Any money you do not use by the end of your plan year is forfeited — you lose it. This is called the "use-it-or-lose-it" rule. Some employers offer a grace period of up to 2.5 months into the next year to spend the previous year's funds, but this is optional and not all employers provide it.
Because of this rule, you need to estimate carefully how much medical expense you will have in the coming year. If you overestimate and do not spend all the money, you forfeit the balance. If you underestimate, you pay out of pocket for expenses above your FSA balance.
A few employers allow a small carryover of up to $610 (this amount changes yearly) to the next plan year instead of a grace period, but this is rare. Check your plan documents or ask your benefits administrator what your employer offers.
How to use your FSA for reimbursement
Most employers give you an FSA debit card that works like a regular debit card at pharmacies, doctor offices, and medical suppliers. You swipe it at checkout and the cost comes out of your FSA balance. Some merchants will ask you to verify that the purchase is for an may be able to access expense.
If you do not have a debit card, or if a provider does not accept it, you can pay out of pocket and then submit a claim for reimbursement. You fill out a claim form, attach your receipt, and send it to your FSA administrator. Reimbursement usually takes one to two weeks.
You cannot use FSA funds to pay someone else's medical expenses, even a family member, unless that person is your dependent for tax purposes. Spouses are not dependents, so you cannot use your FSA to pay for your spouse's medical costs.
Frequently Asked Questions
Can I use my FSA to pay for my spouse's medical expenses?
No. FSA funds can only pay for medical expenses of you and your tax dependents — usually your children. Your spouse is not a dependent, so their medical costs are not FSA-may be able to access, even if you are married and file taxes jointly.
Do I need a prescription for over-the-counter pain relievers to use my FSA?
Yes. Any over-the-counter medication requires a written or electronic prescription from your doctor to be FSA-may be able to access. You can still buy the medication without a prescription at the pharmacy, but you must have the prescription on file. Vitamins and supplements do not count even with a prescription.
What happens if I do not use all my FSA money by the end of the year?
You forfeit the unused balance — you lose it. Some employers offer a grace period of up to 2.5 months into the next year to spend the previous year's funds, but this is optional. Check your plan documents to see if your employer provides a grace period or carryover.
Can I use my FSA for dental work and vision care?
Yes. Dental cleanings, fillings, orthodontics, and root canals are FSA-may be able to access. Vision expenses like eyeglasses, contact lenses, and eye exams also count. These expenses must be for treatment or correction of a medical condition, not cosmetic purposes.
Are vitamins and supplements FSA-may be able to access?
No. Vitamins, minerals, and dietary supplements are not FSA-may be able to access, even if your doctor recommends them. The only exception is if your doctor prescribes a supplement as a drug to treat a specific medical condition, which is rare and requires documentation.