What You Can Actually Buy With FSA Money

FSA money covers medical expenses your insurance doesn't, but the list is narrower than most people think

A Flexible Spending Account (FSA) lets you set aside pre-tax money for out-of-pocket health costs. The catch: you can only spend it on things the IRS classifies as medical expenses. That means copays, deductibles, and prescription drugs, yes — but not toothpaste, vitamins, or gym memberships, even if they're health-related.

The IRS publishes a list of what counts. It's longer than most people realize, but it has hard edges. Spend on something not on the list, and you'll owe taxes on that money plus a 20 percent penalty. The best approach is to check the specific item before you buy, not after.

Key Takeaways

• FSA money covers copays, coinsurance, deductibles, and prescription drugs, as well as medical equipment like crutches, wheelchairs, and hearing aids.
• Over-the-counter medications like pain relievers and allergy medicine are covered only if you have a prescription or a doctor's written order.
• Dental and vision care — including exams, cleanings, glasses, and contact lenses — are covered FSA expenses.
• Health-related purchases that aren't medical treatment, like vitamins, gym memberships, and cosmetic procedures, are not covered and will trigger taxes and penalties if paid with FSA funds.
• Your FSA plan document lists covered items specific to your employer's plan, so check there before spending on anything unclear.

Prescription drugs and over-the-counter medications with a prescription

Prescription medications are always covered. This includes birth control pills, inhalers, antibiotics, and any other drug your doctor prescribes. You pay with your FSA debit card at the pharmacy, and the cost comes straight from your account.

Over-the-counter medications are covered only if you have a prescription or a written order from your doctor. Ibuprofen, acetaminophen, antihistamines, and decongestants all count — but only with a prescription. A doctor can write one for OTC drugs just as easily as for prescription ones; many will do it on request. Without the prescription, the IRS does not consider the purchase a medical expense, even if you're treating a medical condition.

Medical equipment and supplies you use at home

FSA money covers durable medical equipment: crutches, wheelchairs, walkers, canes, braces, and orthopedic shoes. It also covers supplies like bandages, gauze, elastic wraps, heating pads, and ice packs. Blood pressure monitors, glucose meters, and test strips for diabetes management are covered. Hearing aids and batteries for hearing aids are covered expenses.

The equipment must be prescribed or recommended by a doctor for treatment of a specific condition. A general wellness item — like a generic back support you buy at a drugstore without a doctor's order — may not be covered. Check your plan document or call your FSA administrator if you're unsure whether a particular item qualifies.

Dental and vision care

Dental exams, cleanings, fillings, root canals, crowns, and extractions are all covered. Orthodontia — braces and retainers — is covered. Dental X-rays and fluoride treatments are covered. If your dental insurance has a deductible or copay, you can use FSA funds to pay it.

Vision care includes eye exams, glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK) is a covered expense. Sunglasses are not covered, even if you need them for a medical reason like light sensitivity. If your vision insurance has a copay or deductible, FSA money can pay that too.

Mental health and therapy services

Copays and coinsurance for therapy, counseling, and psychiatry are covered FSA expenses. This includes sessions with a licensed therapist, psychologist, or psychiatrist. Medications prescribed for mental health conditions are covered. If your insurance requires a deductible before mental health coverage kicks in, FSA funds can pay that deductible.

Some employers' FSA plans also cover certain wellness programs or stress-reduction classes if they're prescribed by a doctor as treatment for a diagnosed condition. Check your plan document, because coverage varies by employer.

What is not covered, even though it sounds medical

Vitamins and supplements are not covered unless prescribed by a doctor for a specific deficiency or condition. A multivitamin you take for general health does not count. Gym memberships and fitness classes are not covered, even if your doctor recommends exercise. Cosmetic procedures — including teeth whitening, Botox, and hair removal — are not covered.

Sunscreen is not a covered expense. Neither is toothpaste, mouthwash, or deodorant, even medicated versions. Weight-loss programs and diet plans are not covered. Travel to a medical appointment is not covered, though the medical appointment itself is. Maternity clothes are not covered, but the hospital bill for delivery is.

How to know before you spend

Your FSA plan document lists what your specific employer's plan covers. Some employers add or remove items, so the IRS list is a floor, not a ceiling. Before you spend on anything you're unsure about, take three steps: first, check your plan document or your FSA administrator's website; second, ask your doctor if they can write a prescription or order for the item if it's borderline; third, contact your FSA administrator directly if you're still uncertain.

Keep your receipts. If the IRS audits your FSA spending, you'll need to show what you bought and prove it was a covered expense. A receipt alone isn't always enough — you may also need a doctor's note or prescription. Your FSA administrator can tell you what documentation to keep for the items you buy.

Frequently Asked Questions

Can I use FSA money to pay my insurance premium?

No. You cannot use FSA funds to pay health insurance premiums, including those for your employer's plan, Medicare, or a marketplace plan. You can use FSA money to pay the out-of-pocket costs that insurance doesn't cover — copays, deductibles, and coinsurance — but not the premium itself.

Is a doctor's visit covered?

Yes. Copays and coinsurance for doctor visits are covered FSA expenses. If you have a high-deductible plan and haven't met your deductible yet, you can use FSA funds to pay the full cost of the visit. The visit itself is a covered medical expense.

What happens if I spend FSA money on something that's not covered?

You'll owe income tax on that amount, plus a 20 percent penalty. If you spent $100 on a non-covered item and you're in the 22 percent tax bracket, you'd owe $42 in taxes and penalties combined. Keep receipts so you can prove what you bought if questions come up later.

Can I use FSA money for my pet's medical care?

No. Veterinary expenses are not covered by FSA funds. The IRS considers FSA accounts for human medical expenses only. Pet health insurance and veterinary bills must be paid with after-tax dollars.

Are prescription glasses and contacts covered if I don't have vision insurance?

Yes. Glasses, contacts, and contact lens solution are covered FSA expenses regardless of whether you have separate vision insurance. You can use FSA funds to pay the full cost if you don't have vision coverage, or to pay any copay or deductible if you do.