A flexible spending account (FSA) covers medical, dental, and vision expenses that your insurance doesn't pay for

Your FSA money can go toward the out-of-pocket costs your health insurance leaves behind: copays, deductibles, coinsurance, and services your plan doesn't cover at all. The IRS maintains a specific list of what counts as a medical expense, and it is longer than most people think. You can use FSA funds for prescription drugs, over-the-counter medications (with a prescription), dental work, glasses, contact lenses, hearing aids, and therapy sessions. You can also use the money for medical equipment like crutches, wheelchairs, blood pressure monitors, and glucose meters.

The catch is that FSA funds must be used for expenses you incur during the plan year—typically January through December. Money left unspent at the end of the year does not roll over to the next year (with rare exceptions). This is why understanding what counts matters: you want to spend down your account on things you actually need, not waste the money because you were unsure what was allowed.

Key Takeaways

  • FSA funds cover copays, deductibles, coinsurance, and any medical service your insurance doesn't pay for, as long as the IRS classifies it as a medical expense.
  • Over-the-counter medications and medical supplies now count if you have a prescription from your doctor, even for common items like pain relievers or allergy medicine.
  • Dental and vision care—including routine cleanings, fillings, glasses, and contacts—are covered FSA expenses.
  • Money left in your FSA at the end of the plan year is forfeited, so tracking what you can spend helps you use the full amount.

Prescription and over-the-counter medications

Prescription medications are always FSA-may be able to access. This includes birth control pills, inhalers, antibiotics, blood pressure medications, and any other drug your doctor prescribes. You pay with your FSA debit card at the pharmacy, and the pharmacist verifies the prescription.

Over-the-counter medications changed in 2020. Before that year, you needed a prescription for any OTC drug. Now, you can use FSA funds for OTC medications—aspirin, ibuprofen, allergy medicine, antacids, cold medicine—but only if you have a written prescription from your doctor. A prescription for "ibuprofen 200 mg as needed for pain" counts. You cannot straightforward buy these items without a prescription, even though you could buy them without one at the pharmacy. Some FSA debit cards will reject OTC purchases if no prescription is on file, so it is worth asking your plan administrator whether you need to submit the prescription in advance or show it at checkout.

Dental and vision care

Dental expenses covered by FSA include routine cleanings and exams, fillings, root canals, crowns, extractions, orthodontia (braces), and dental implants. You can use FSA funds for the full cost of any dental work, whether your dental insurance covers part of it or not. If your dental plan has a copay or deductible, the FSA covers that portion. If you have no dental insurance, the FSA covers the entire bill.

Vision care works the same way. FSA funds cover eye exams, glasses, contact lenses, contact lens solution, and eye surgery like LASIK. You can use the money at any optometrist or ophthalmologist, and you do not need your medical insurance to cover the service first. If you wear contacts and glasses, you can use FSA funds for both in the same year.

Medical equipment and supplies

The IRS allows FSA funds for durable medical equipment—items that last longer than three years and serve a medical purpose. This includes wheelchairs, walkers, canes, crutches, hospital beds, and oxygen equipment. It also covers smaller items: blood glucose monitors and test strips, blood pressure cuffs, thermometers, heating pads, ice packs, and elastic bandages.

Medical supplies that are consumable (used up over time) also count: bandages, gauze, medical tape, incontinence products, and ostomy supplies. Diabetic supplies—lancets, test strips, syringes—are all FSA-may be able to access. If you have a chronic condition that requires ongoing supplies, your FSA can cover the cost of restocking throughout the year.

Mental health and therapy services

Copays and coinsurance for therapy, counseling, and psychiatric visits are FSA-may be able to access. This includes sessions with a therapist, psychologist, psychiatrist, or counselor, whether you see them in person or via telehealth. If your insurance plan requires a copay for mental health visits, you can use FSA funds to pay that copay. If you have a deductible that applies to mental health care, the FSA covers it.

Some people use FSA funds to pay for therapy that their insurance does not cover at all, or to see an out-of-network provider. In those cases, the full cost of the session is an FSA-may be able to access expense. Keep receipts from your provider showing the date, the service provided, and the amount paid.

What does not count as an FSA expense

Cosmetic procedures are not covered, even if they are performed by a doctor. Botox, facelifts, teeth whitening, and hair removal are not FSA-may be able to access. However, reconstructive surgery after an injury or illness does count, as does orthodontia for medical reasons (not purely cosmetic alignment).

General wellness items are not covered: vitamins, supplements, and over-the-counter health products without a prescription do not may have access to. Gym memberships and fitness classes are not FSA expenses. Toiletries like toothpaste and soap are not covered, even if they are medicated. If you are unsure whether something counts, your plan administrator can tell you, or you can check the IRS Publication 502, which lists all may be able to access medical expenses.

How to track and submit FSA expenses

Most FSA plans issue a debit card that you can use at pharmacies, doctors' offices, and medical suppliers. When you swipe the card, the expense is deducted from your FSA balance when ready. You do not need to submit a receipt unless the plan administrator asks for one later—and many do, randomly or for all purchases over a certain amount.

Keep receipts for at least three years. A receipt should show the date, the provider or merchant name, the service or item purchased, and the amount paid. If your plan asks for documentation and you cannot provide it, you may have to repay the FSA from your own pocket. Some plans use a third-party administrator that tracks your spending online; log in periodically to make sure the balance is accurate and that all your expenses have been recorded.

Frequently Asked Questions

Can I use my FSA for my spouse or children's medical expenses?

Yes. FSA funds can pay for medical expenses of your spouse and any dependent children, even if they are not covered under your health insurance plan. The expense must still be an may be able to access medical expense, but it does not matter who incurs it as long as they are your spouse or dependent.

What happens if I do not spend all my FSA money by the end of the year?

Most FSA plans have a "use-it-or-lose-it" rule: unspent money at the end of the plan year is forfeited. Some employers offer a grace period of up to 2.5 months into the next year to spend remaining funds, or a carryover of up to $640 (the amount changes yearly). Check your plan documents to see if either option applies to you.

Do I need to submit receipts every time I use my FSA debit card?

Not always. Many plans allow you to use the debit card without submitting a receipt at the time of purchase. However, the plan administrator may request receipts later to verify that expenses were may be able to access. Keep all receipts in case you are asked to provide them.

Can I use my FSA for preventive care like annual checkups or screenings?

Yes, if you have a copay or coinsurance for the visit, you can use FSA funds to pay that portion. However, many insurance plans cover preventive care with no copay, so you may not have an out-of-pocket cost to cover. Check your plan documents to see what preventive services are covered at no cost.

Are prescription glasses and contacts covered if I have vision insurance?

Yes. FSA funds can pay for glasses and contacts even if you have separate vision insurance. If your vision plan covers part of the cost and you pay the rest out of pocket, the FSA covers your portion. If you want to buy a second pair or upgrade to a more expensive frame, the FSA covers that too.