Flexible spending accounts cover a wide range of medical, dental, vision, and over-the-counter health expenses. The IRS defines eligible items broadly: anything used to diagnose, treat, prevent, or manage a disease or physical condition qualifies, as long as it’s not purely cosmetic. For 2025, you can contribute up to $3,300 to a health care FSA, and all of that money is tax-free when spent on qualifying items.
Medical Services and Practitioner Visits
Doctor visits, specialist appointments, and hospital services are all FSA-eligible. This includes copays, coinsurance, and deductibles you pay out of pocket. Beyond traditional medicine, your FSA covers acupuncture, chiropractic care, psychiatric and psychological services, nursing care, and physical therapy. Annual physicals, lab work, X-rays, and body scans all qualify too.
Fertility treatments for you, your spouse, or a dependent are eligible, as are pregnancy-related costs like prenatal visits, delivery, and breast pumps. Stop-smoking programs qualify. Weight-loss programs count if a doctor has diagnosed a specific condition like obesity, hypertension, or heart disease that the program is meant to treat.
Over-the-Counter Medications and Products
Since the CARES Act took effect in 2020, over-the-counter medications no longer require a prescription to be FSA-eligible. That means you can use your FSA for pain relievers, allergy medicine, cold and flu remedies, antacids, first aid supplies, bandages, and similar products straight off the shelf.
Menstrual care products are also explicitly covered under the same law. Tampons, pads, liners, menstrual cups, and sponges all qualify.
Dental Care
Most non-cosmetic dental work is eligible. This includes cleanings, fillings, crowns, bridges, dentures, dental sealants, extractions, and root canals. Braces and orthodontic treatment qualify. Dental copays, coinsurance, and deductibles count as well. The key dividing line is cosmetic versus medically necessary: teeth whitening and purely cosmetic veneers are not covered.
Vision Care
Eye exams, prescription eyeglasses, prescription sunglasses, contact lenses, and contact lens solution are all FSA-eligible. Laser eye surgery (LASIK) is covered. Reading glasses qualify even without a prescription. If you need specialized vision equipment or corrective procedures recommended by an eye doctor, those generally fall under the eligible umbrella as well.
Medical Equipment and Home Health Devices
Your FSA covers a long list of medical supplies and devices you’d use at home. Blood pressure monitors, thermometers, diabetic monitors, glucose test strips, and other over-the-counter testing kits are all eligible. Hearing aids, crutches, wheelchairs, walkers, and oxygen equipment qualify. So do artificial limbs and prosthetic devices.
Home modifications made specifically for medical reasons can also count. Entrance ramps, widened doorways, and handrails installed to accommodate a disability or medical condition are eligible expenses, though only the portion of the cost that doesn’t increase your home’s value qualifies. Guide dogs and other service animals, including their food and veterinary care, are covered.
Prescription Medications
All prescription drugs are FSA-eligible, including insulin (which doesn’t require a prescription to qualify). This covers medications for chronic conditions, short-term prescriptions like antibiotics, and specialty drugs. You’ll need a receipt showing the pharmacy filled a prescription.
Transportation and Travel for Medical Care
Getting to and from medical appointments counts as an eligible expense. Bus, taxi, train, and plane fares for trips primarily related to medical care qualify. If you drive, you can claim mileage or actual car expenses like gas and parking. Ambulance fees are covered. Lodging is eligible up to $50 per night for the patient and $50 per night for one caregiver when the trip is primarily for medical treatment.
Items That Need a Letter of Medical Necessity
Some items fall into a gray area. They’re not automatically eligible, but they become eligible if your doctor writes a letter of medical necessity explaining that the item treats a specific medical condition. Common examples include vitamins and supplements, massage therapy, ergonomic equipment, and certain specialty products like hair supplements. Your FSA administrator will require this letter before approving reimbursement, and the letter must come from a licensed medical provider who can document the diagnosis and explain why the item is medically necessary for you.
What Your FSA Won’t Cover
The IRS draws a firm line at cosmetic procedures and general wellness expenses that aren’t tied to a medical condition. Items that are typically ineligible include:
- Cosmetic procedures: Face lifts, hair transplants, teeth whitening, and hair regrowth products
- General fitness: Gym memberships, exercise equipment, and nutritional supplements (without a letter of medical necessity)
- Personal care: Toiletries, cosmetics, and general-use personal items
- Insurance premiums: You generally cannot use a health care FSA to pay insurance premiums
- Illegal treatments: Any operations or substances that are illegal under federal law
The test is straightforward: if the expense is primarily for appearance rather than health, it’s not eligible. If it treats a diagnosed condition, it almost certainly is.
Covering Dependents
Your health care FSA isn’t limited to your own expenses. You can use it to pay for eligible medical, dental, and vision costs for your spouse and your tax dependents. For children, they’re generally covered through the end of the year they turn 26 for health plan purposes, though FSA rules follow tax dependent status, which typically covers children under age 19 (or under 24 if they’re full-time students). A spouse or relative who is physically or mentally unable to care for themselves and lives in your home also qualifies.
A separate dependent care FSA covers a different set of expenses entirely: child care, daycare, and elder care for dependents under age 13, or for a spouse or household member who can’t care for themselves. This is a different account from a health care FSA, with its own contribution limits and rules.
Deadlines and the Use-It-or-Lose-It Rule
FSA funds generally expire at the end of your plan year. The IRS enforces a “use or lose” rule, meaning unspent money is forfeited. However, your employer’s plan may offer one of two safety valves (but not both). A grace period gives you an extra 2.5 months after the plan year ends to spend remaining funds. Alternatively, a carryover option lets you roll up to $660 into the next year.
Not every employer offers either option, and you’ll need to re-enroll in your FSA to take advantage of carryover. Checking your plan’s specific rules before the end of the year can save you from losing money. If you have funds left to spend, stocking up on eligible items like contact lenses, sunscreen, first aid kits, or OTC medications is a practical way to use the balance before your deadline hits.