FSA money covers medical expenses you pay out of your own pocket, not insurance premiums or general living costs
A Flexible Spending Account (FSA) holds pre-tax dollars your employer sets aside for you to spend on may have access to medical expenses. The IRS publishes a list of what counts. If you buy something on that list and pay for it yourself — not through insurance — you can reimburse yourself from your FSA. If you buy something not on the list, you cannot use FSA funds, even if it relates to health.
The key word is "may have access to." Your FSA cannot pay for vitamins, gym memberships, cosmetic procedures, or most over-the-counter items, even though they touch on wellness. It also cannot pay your insurance premiums, copays on insurance claims, or anything your insurance already covers. It pays only for costs that come out of your pocket for specific medical services and supplies.
Key Takeaways
- FSA funds cover doctor visits, dental work, vision care, prescription medications, and medical equipment you purchase yourself, not through insurance.
- Over-the-counter medications like pain relievers and cold medicine now may have access to, but only if you have a prescription from your doctor.
- Cosmetic procedures, gym memberships, vitamins, and general wellness products do not may have access to, even if they improve your health.
- You must spend FSA money on the expense in the same calendar year it was set aside, or you lose it — there is no rollover.
- Keep receipts and documentation for every purchase, because your plan administrator may ask you to prove the expense was may have access to.
Medical services and procedures your FSA covers
Your FSA pays for visits to doctors, dentists, optometrists, and mental health providers when you pay out of pocket. This includes office visit copays if your plan structure requires you to pay them upfront before insurance kicks in, though many plans bill insurance first. It also covers the full cost of services your insurance does not cover or that you receive from an out-of-network provider you pay directly.
Surgical procedures, diagnostic tests, and physical therapy sessions all may have access to. So do X-rays, lab work, and imaging like MRI or ultrasound scans. If you need a procedure and you are paying for it yourself — whether because you have not met your deductible, your insurance denied it, or you chose an out-of-network provider — FSA funds can cover that cost.
Mental health and substance abuse treatment also qualifies. Therapy sessions, counseling, and inpatient or outpatient rehabilitation programs are all covered expenses. Prescription medications for any condition are covered too.
Medications and medical supplies you can purchase with FSA funds
Prescription medications of any kind may have access to. Over-the-counter medications now may have access to as well, but only if you have a written prescription from your doctor — you cannot straightforward buy them off the shelf. This includes pain relievers, allergy medications, cold medicines, and heartburn treatments, as long as your doctor has prescribed them by name.
Medical supplies and equipment cover a wide range of items. Bandages, gauze, first aid supplies, blood pressure monitors, glucose meters and test strips, thermometers, and crutches all may have access to. Hearing aids and batteries for hearing aids may have access to. Orthopedic braces, compression stockings, and other medical devices prescribed by a doctor may have access to. Incontinence supplies, including adult diapers and protective undergarments, are covered.
Insulin and other diabetes management supplies are covered. Inhalers and nebulizers for asthma or respiratory conditions are covered. Contact lenses and eyeglass frames are covered if prescribed by an eye care professional. Dental supplies like replacement toothbrushes are not covered, but dental work itself is.
Dental and vision care expenses
Dental work qualifies in full: cleanings, fillings, root canals, crowns, extractions, orthodontia, and implants. You can use FSA funds whether you are paying your dentist directly or reimbursing yourself after your dental insurance has paid its share. Dental insurance premiums themselves do not may have access to, but the out-of-pocket costs for the actual work do.
Vision care includes eye exams, glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK or PRK) qualifies. Sunglasses do not may have access to, even if they are prescription, because they are considered cosmetic. Frames and lenses may have access to; the cosmetic aspect does not.
What does not may have access to, even if it relates to health
Vitamins and nutritional supplements do not may have access to, even if recommended by your doctor, because the IRS classifies them as general health products rather than treatment for a specific condition. Gym memberships and fitness classes do not may have access to, even if prescribed as part of physical therapy — only the physical therapy session itself qualifies. Weight loss programs and diet plans do not may have access to.
Cosmetic procedures do not may have access to: teeth whitening, Botox, dermal fillers, hair removal, and cosmetic surgery are not covered. Sunscreen does not may have access to. Toiletries and hygiene products do not may have access to, even if medically necessary for a skin condition — the condition itself may be treatable with a prescribed medication that does may have access to.
Insurance premiums — health, dental, or vision — do not may have access to. Copays and coinsurance that your insurance charges do not may have access to as FSA expenses; those are insurance costs, not medical expenses. Childcare, even if needed because you work, does not may have access to for an FSA (though it may may have access to for a Dependent Care FSA, which is a separate account type).
How to document and submit FSA reimbursements
Keep the receipt or invoice from every purchase. Your plan administrator may ask you to submit proof that an expense was may have access to before they reimburse you. The receipt should show the date, the provider or vendor name, what was purchased, and the amount paid. For prescription medications, the receipt should show the medication name and that it was prescribed.
Some FSA plans issue a debit card you can use at pharmacies, doctors' offices, and medical suppliers. The card is pre-loaded with your FSA balance and works like a regular debit card. Other plans require you to pay out of pocket and then submit a claim form with your receipt to get reimbursed. A few plans use both methods.
If your plan uses a debit card, you may still need to provide documentation later if the vendor does not automatically report the expense type to the plan. Keep receipts for at least three years in case your plan audits your spending. If you cannot document that an expense was may have access to, you may have to repay the reimbursement.
The use-it-or-lose-it rule and timing
FSA funds must be spent in the same calendar year they were set aside. If you do not spend your full balance by December 31, the money is forfeited — you cannot roll it over to the next year. Some plans offer a short grace period (usually through March 15 of the following year) to submit claims for expenses incurred in the prior year, but the expense itself must have happened in the year the money was set aside.
This means you should estimate carefully how much you will spend on may have access to expenses in the coming year when you enroll. If you overestimate and do not spend it all, you lose the difference. If you underestimate, you cannot add more money mid-year unless you have a may have access to life event, such as a change in family status or a significant change in your health care costs.
Frequently Asked Questions
Can I use my FSA to buy over-the-counter pain relievers without a prescription?
No. Over-the-counter medications now may have access to for FSA reimbursement, but only if your doctor has written a prescription for them by name. You cannot straightforward buy ibuprofen or acetaminophen off the shelf and use FSA funds. Your doctor must prescribe it, and you must have that prescription on file.
Does my FSA cover my health insurance premium?
No. FSA funds cannot pay for any insurance premium — health, dental, or vision. They cover only the out-of-pocket medical expenses you incur after insurance has paid its share, or expenses your insurance does not cover at all.
What happens if I do not spend all my FSA money by the end of the year?
The unused balance is forfeited. FSA funds do not roll over to the next year. Some plans offer a grace period to submit claims for prior-year expenses, but the expense must have occurred in the year the money was set aside. Plan carefully when you enroll to avoid losing money.
Can I use my FSA for my spouse's or child's medical expenses?
Yes. FSA funds can cover may have access to medical expenses for you, your spouse, and any dependent claimed on your tax return, regardless of whose name is on the receipt or bill. The expense must still be may have access to; the person receiving the care does not have to be you.
Are vitamins and supplements covered by my FSA?
No. Vitamins and nutritional supplements do not may have access to for FSA reimbursement, even if your doctor recommends them. The IRS treats them as general health products rather than treatment for a specific medical condition. Prescription medications for a diagnosed condition do may have access to.