Your FSA covers medical costs your insurance doesn't, but the list is narrower than you think
A Flexible Spending Account (FSA) is a tax-advantaged account your employer offers that lets you set aside pre-tax money for healthcare expenses. The money you put in reduces your taxable income, which means you pay less in federal income tax. But you can't spend it on anything medical—only on specific items the IRS allows, and the rules are strict enough that many common healthcare purchases don't may have access to.
The core principle: FSA money covers costs your health insurance doesn't pay for, or costs that fall under your deductible. That includes copays, coinsurance, deductibles themselves, and certain medical supplies. It does not cover insurance premiums, over-the-counter medications (with a narrow exception), cosmetic procedures, or general wellness products, even if they're sold in a pharmacy.
Key Takeaways
- FSA funds cover copays, coinsurance, deductibles, and prescription medications, but not insurance premiums or most over-the-counter drugs without a prescription.
- Medical equipment like crutches, wheelchairs, and blood glucose monitors qualifies, but fitness equipment and general wellness items do not.
- Dental and vision care—including exams, cleanings, glasses, and contact lenses—are FSA-may be able to access even if your insurance doesn't cover them.
- You must spend FSA money by December 31 of the plan year or lose it; there is no rollover to the next year (with rare exceptions for dependent care accounts).
- Receipts and proof of medical necessity are required; your FSA administrator can deny reimbursement if documentation is missing.
What FSA money covers: the actual list
The IRS publishes a detailed list of FSA-may be able to access expenses. The broadest categories are copays and coinsurance (the percentage of a bill you pay after insurance), deductibles, and prescription medications. If your insurance plan requires you to pay $50 to see a doctor, that $50 comes from your FSA. If your deductible is $1,500 and you've met it, you can use FSA funds for the remaining balance of a medical bill.
Prescription drugs are always may be able to access. Over-the-counter medications are may be able to access only if you have a prescription from a doctor—a note saying "take ibuprofen for headaches" counts, but buying ibuprofen off the shelf without a prescription does not. Insulin is the one exception: you can buy insulin over the counter without a prescription and still use FSA funds.
Medical equipment and supplies that treat or monitor a condition are may be able to access: blood glucose monitors and test strips, crutches, wheelchairs, hearing aids, prescription eyeglasses and contact lenses, and orthopedic braces. Dental work—fillings, cleanings, root canals, orthodontia—is may be able to access. Vision care, including eye exams and glasses, is may be able to access. Mental health treatment, including therapy and psychiatric medications, is may be able to access.
Certain medical services are may be able to access: physical therapy, chiropractic care, acupuncture, and fertility treatments. Pregnancy tests, contraceptives, and menstrual products are may be able to access. Sunscreen is not may be able to access (it's considered cosmetic), but medicated sunscreen prescribed for a skin condition may be.
What FSA money does not cover
Health insurance premiums—whether for medical, dental, or vision coverage—cannot be paid with FSA funds. This includes premiums for coverage through your employer, the ACA marketplace, or a private plan. The same rule applies to long-term care insurance premiums.
Cosmetic procedures and products are not may be able to access, even if performed by a doctor. Botox, teeth whitening, hair removal, and cosmetic surgery do not may have access to. Vitamins and supplements are not may be able to access unless prescribed by a doctor for a specific deficiency. General wellness products—fitness equipment, gym memberships, weight loss programs—are not may be able to access, even if your doctor recommends them for your health.
Over-the-counter medications without a prescription are not may be able to access (except insulin). This includes pain relievers, cold medicine, allergy medication, and antacids bought without a doctor's note. Toiletries and personal care items—toothpaste, deodorant, shampoo—are not may be able to access, even if they're medicated. Maternity clothes are not may be able to access. Babysitting and childcare are not may be able to access (though dependent care FSAs, a separate account type, do cover childcare).
How to know if something qualifies before you buy it
Your FSA administrator (the company that manages the account for your employer) publishes a list of may be able to access expenses, usually on their website or in your plan documents. Common administrators include WageWorks, HealthEquity, and Conduent. You can search their database by product name or category.
If you're unsure, ask your FSA administrator directly before you make the purchase. They can tell you whether a specific item or service is may be able to access under your plan. Some employers also have a benefits coordinator who can answer questions.
Keep receipts and documentation for everything you buy with FSA funds. Your administrator may ask for proof that an expense is medical in nature, especially for items that could be personal care (like sunscreen or a thermometer). A receipt alone may not be enough; you may need a doctor's note or prescription to show the item was medically necessary.
The use-it-or-lose-it rule and what happens to unspent money
FSA funds must be spent by December 31 of the plan year. If you don't spend the money, you lose it—there is no rollover to the next year. This is the biggest limitation of FSAs and the reason many people contribute conservatively.
Some employers offer a grace period (usually 2.5 months into the next year) during which you can still submit claims for the previous year's expenses. A few employers allow a small rollover—up to $610 in 2024, though this varies by year and employer. Check your plan documents to see if either option applies to you.
If you leave your job mid-year, you typically lose access to your FSA balance, though you may be able to continue coverage under COBRA (Consolidated Omnibus Budget Reconciliation Act). The rules vary by employer, so ask your benefits department before you resign.
How to submit claims and get reimbursed
Most FSA administrators let you submit claims online through a portal or mobile app. You upload a receipt and a description of the expense. Some administrators issue a debit card that you can use at pharmacies and medical offices, which automatically deducts from your FSA balance without requiring a separate claim.
Reimbursement timelines vary. Some administrators process claims within a few business days; others take one to two weeks. Keep copies of all receipts and documentation for at least three years in case your administrator audits your account.
If your claim is denied, the administrator will tell you why. Common reasons include missing documentation, an ineligible expense, or a receipt that doesn't clearly show what was purchased. You can resubmit with additional documentation if you believe the denial was wrong.
FSA vs. HSA: which account covers what
If your employer offers both an FSA and a Health Savings Account (HSA), the rules are similar but not identical. Both cover copays, deductibles, prescriptions, and medical equipment. The main differences: HSA funds roll over year to year (you don't lose unspent money), but you can only open an HSA if you're enrolled in a high-deductible health plan. FSAs are available to anyone with employer coverage, regardless of plan type.
HSAs also allow you to invest the money and withdraw it tax-free in retirement for any expense (not just medical), which makes them more flexible long-term. FSAs are simpler but riskier because of the use-it-or-lose-it rule. If your employer offers both, compare the contribution limits and your expected medical spending for the year to decide which makes sense for you.
Frequently Asked Questions
Can I use my FSA to pay for my health insurance premium?
No. Health insurance premiums—whether medical, dental, or vision—cannot be paid with FSA funds. You can use FSA money for copays and deductibles under that insurance, but not the premium itself.
What happens if I don't spend all my FSA money by the end of the year?
You lose it. FSA funds do not roll over to the next year. Some employers offer a grace period (usually through mid-February) to submit claims for the previous year, or a small rollover (up to $610 in 2024), but this varies. Check your plan documents or ask your benefits coordinator.
Can I buy over-the-counter pain relievers with my FSA?
Only if you have a prescription from a doctor. A note from your doctor saying "take ibuprofen for headaches" makes it may be able to access. Buying ibuprofen off the shelf without a prescription does not may have access to, even if you use it for a medical reason.
Are glasses and contact lenses covered by FSA?
Yes. Prescription eyeglasses, contact lenses, and eye exams are all FSA-may be able to access. This is true even if your health insurance doesn't cover vision care.
Can I use FSA money for my gym membership if my doctor recommends it?
No. Gym memberships and fitness equipment are not FSA-may be able to access, even with a doctor's recommendation. General wellness programs do not may have access to, though specific medical treatments like physical therapy do.