A flexible spending account (FSA) covers medical, dental, and vision expenses you pay out of pocket—but not everything your doctor recommends

Your FSA money can pay for prescription drugs, copays, deductibles, dental work, glasses, and hearing aids. It cannot pay for cosmetic procedures, gym memberships, or over-the-counter medications unless a doctor writes a prescription for them. The IRS publishes a specific list of what counts as a medical expense, and if it is not on that list, your FSA administrator will reject the claim.

The catch: you must use the money within the plan year or lose it. Most FSAs run January through December, and you have until March 15 of the following year to submit claims for expenses you incurred in that calendar year. After that date, any unspent balance is forfeited to your employer. Some employers offer a grace period (usually 2.5 months into the new year) or a carryover of up to $610 per year, but you have to check your specific plan documents to know which applies to you.

Key Takeaways

  • FSA funds cover copays, deductibles, prescriptions, dental work, vision care, and medical equipment like crutches or blood pressure monitors.
  • Over-the-counter medications and supplies do not may have access to unless a doctor writes a prescription for them specifically.
  • You must use FSA money within the plan year plus a grace period or carryover window, or the balance disappears.
  • Cosmetic procedures, gym memberships, and general wellness products are not FSA-may be able to access, even if they improve your health.
  • Your FSA debit card or reimbursement form tells you when ready whether a purchase is may be able to access before you spend the money.

Medical expenses your FSA will cover

Copays and coinsurance are the most straightforward use. If your plan requires a $30 copay for a doctor visit, your FSA pays it. The same applies to coinsurance—the percentage of a bill you owe after insurance pays its share. Deductibles also may have access to, so if you have a $1,500 deductible and you meet it during the year, FSA funds can cover that amount.

Prescription medications are covered in full, whether they are brand-name or generic. If your insurance requires prior authorization or forces you to try a generic first, your FSA still covers the final prescription you fill. Insulin, inhalers, and maintenance medications all count. The prescription must come from a licensed provider—you cannot use FSA money for supplements or herbal remedies sold over the counter, even if a naturopath recommends them.

Medical equipment and supplies are may be able to access if they treat a specific condition. This includes blood glucose monitors and test strips, blood pressure cuffs, crutches, wheelchairs, orthopedic braces, hearing aids, and oxygen equipment. Bandages, gauze, and first-aid supplies count. Pregnancy tests and ovulation kits are covered. Sunscreen is not, because it is considered preventive rather than treatment.

Dental and vision care covered by FSA

Dental work is one of the largest FSA expenses for most people. Cleanings, fillings, root canals, crowns, extractions, and orthodontia all may have access to. If you are paying out of pocket for braces or Invisalign because your insurance does not cover it, your FSA can reimburse you. Dental implants and bridges are covered. Teeth whitening is not, because it is cosmetic.

Vision care includes eye exams, glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK or PRK) is covered if it corrects a refractive error. The frames, lenses, and any coatings you add all may have access to. If you buy prescription sunglasses, those are covered too. Non-prescription sunglasses are not, even if they have UV protection.

What your FSA will not cover

Cosmetic procedures are the clearest exclusion. Botox, dermal fillers, facelifts, and teeth whitening do not may have access to, even if a dermatologist performs them. The rule is whether the procedure treats a medical condition or straightforward improves appearance. If you have a deviated septum and get surgery to correct it, that is covered. If you get the same surgery to improve your appearance, it is not.

Over-the-counter medications and supplies are not covered unless a doctor writes a prescription for them. Aspirin, ibuprofen, cold medicine, allergy tablets, and antacids do not may have access to when you buy them at a pharmacy without a prescription. However, if your doctor writes a prescription for ibuprofen or any OTC drug, your FSA will cover it. This rule changed in 2020, and many people still do not know about it.

General wellness products are excluded. Vitamins, minerals, and supplements do not may have access to, even if they treat a deficiency. Gym memberships and fitness classes are not covered. Weight-loss programs and diet foods are not covered. Maternity clothes, diapers, and baby formula are not covered. The line is whether the item treats an existing medical condition or supports general health.

How to know if something is FSA-may be able to access before you buy it

Your FSA administrator provides a debit card or online portal where you can check may be able to access. If you swipe the card at a pharmacy or doctor's office, the system either approves the transaction or declines it in real time. If it declines, you know when ready that the item is not covered. Some merchants code items incorrectly in their system, so a decline does not always mean the item is ineligible—it may mean the store coded it wrong.

For mail-order purchases or items you are unsure about, contact your FSA administrator before you buy. They can tell you whether a specific product qualifies. Keep the receipt and any documentation from your doctor (like a prescription or a letter stating medical necessity) because your administrator may ask for proof when you submit a reimbursement claim.

The IRS maintains a publication called Publication 502, which lists may be able to access medical expenses in detail. Your FSA administrator's website usually has a searchable database of common items and whether they may have access to. If you cannot find the answer there, email the administrator with the product name and they will tell you yes or no.

The carryover and grace period rules that vary by employer

Most FSAs operate on a "use it or lose it" basis: money you do not spend by December 31 is forfeited. However, your employer can offer one or both of two exceptions. A grace period allows you to submit claims for expenses incurred in the prior year until mid-March of the current year. A carryover lets you roll up to $610 (in 2024) of unspent money into the next plan year.

Not all employers offer either option, and some offer one but not the other. Check your plan documents or call your benefits administrator to find out what applies to you. If your plan offers a grace period, you can spend money on expenses in January and February and still submit claims for them under the prior year's FSA. If it offers a carryover, you can deliberately leave some money unspent and use it next year.

Knowing your plan's rules matters because it changes how much you should contribute. If you have a grace period, you have more time to use the money. If you have a carryover, you can contribute more without fear of losing it all. If you have neither, you need to be more conservative in your contribution amount.

Frequently Asked Questions

Can I use my FSA to pay for my spouse's or child's medical expenses?

Yes. FSA money can pay for medical expenses of you, your spouse, and any dependent you claim on your tax return. The dependent does not have to be enrolled in your FSA plan—you can use your FSA funds to reimburse them for their own medical expenses. Keep receipts and documentation in case your administrator asks for proof.

Does my FSA cover prescription glasses and contacts?

Yes. Eyeglasses, contact lenses, contact lens solution, and eye exams all may have access to. The frames, lenses, and any add-ons like anti-glare coating or blue-light filtering are covered. Non-prescription sunglasses are not covered, but prescription sunglasses are.

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

The money is forfeited unless your employer offers a grace period or carryover. A grace period typically extends until March 15 of the following year and lets you submit claims for prior-year expenses. A carryover lets you roll up to $610 into the next plan year. Check your plan documents to see which, if either, applies to you.

Can I use my FSA for over-the-counter pain relievers like ibuprofen?

Not unless your doctor writes a prescription for them. Ibuprofen, aspirin, and other OTC medications do not may have access to when purchased without a prescription. However, if your doctor prescribes ibuprofen or any OTC drug, your FSA will cover it.

Are dental implants and orthodontia covered by FSA?

Yes. Dental implants, bridges, braces, Invisalign, and all other orthodontic work are FSA-may be able to access. Cosmetic dental work like teeth whitening is not covered. If the work corrects a functional problem or treats decay, it qualifies.