When a product or service is labeled “FSA/HSA eligible,” it means you can pay for it tax-free using money from a Flexible Spending Account (FSA) or Health Savings Account (HSA). Both accounts let you set aside pre-tax dollars from your paycheck specifically for qualifying medical expenses, effectively saving you 20% to 35% on those costs depending on your tax bracket. But the IRS draws firm lines around what counts, and the rules aren’t always intuitive.
How FSA and HSA Accounts Differ
An FSA is tied to your employer’s benefits plan. You choose how much to contribute each year, and that money is deducted from your paycheck before taxes. The catch: FSAs are mostly use-it-or-lose-it. Your employer can offer either a grace period of up to 2.5 months after the plan year ends or allow a carryover of up to $660 into the next year, but not both. Any remaining balance beyond that disappears.
An HSA works differently. You need a high-deductible health plan to qualify, but the money rolls over indefinitely, year after year, with no expiration. For 2026, the contribution limit is $4,400 for individual coverage and $8,750 for family coverage. HSAs function like a long-term savings vehicle: unused funds can even be invested and grow tax-free.
Despite these structural differences, both accounts follow the same IRS rules for eligible expenses. If something qualifies for one, it almost always qualifies for the other.
What Qualifies as an Eligible Expense
The IRS defines eligible expenses broadly as costs for the “diagnosis, cure, mitigation, treatment, or prevention of disease.” In practical terms, this covers a wide range of medical, dental, and vision costs you’re already paying for. Here’s what falls clearly within the lines:
- Doctor and specialist visits: copays, annual physicals, urgent care, and specialist appointments
- Prescription medications: any drug that requires a prescription, including birth control pills
- Dental care: cleanings, X-rays, fillings, braces, extractions, dentures, sealants, and fluoride treatments
- Vision care: eye exams, prescription glasses, contact lenses, contact lens solution, and LASIK surgery
- Mental health: therapy sessions, psychiatric care, and substance abuse treatment
- Medical equipment: crutches, bandages, blood pressure monitors, and other diagnostic devices
- Reproductive health: breast pumps and supplies, fertility treatments, and breast reconstruction surgery
- Menstrual products: tampons, pads, liners, menstrual cups, and period underwear
- Acupuncture and chiropractic care: eligible with a receipt, no doctor’s note needed
Over-the-counter medications like pain relievers, allergy medicine, and antacids also qualify. This changed in 2020 when Congress removed the old requirement for a prescription on OTC drugs.
Items That Need a Doctor’s Note
Some expenses sit in a gray zone. They can be eligible, but only if a doctor writes a letter of medical necessity confirming the item treats a specific condition rather than serving general wellness. Common examples include:
- Massage therapy: eligible when prescribed for a diagnosed condition like chronic back pain, not for relaxation
- Exercise equipment: a treadmill or stationary bike can qualify if prescribed to treat a specific medical condition such as heart disease or obesity
- Weight loss programs: only eligible when a doctor diagnoses a condition like obesity or hypertension that the program treats
- Mattresses and humidifiers: eligible when prescribed for conditions like sleep apnea or severe allergies
- Sunglasses: eligible with a prescription or letter tying them to a medical need
- Wigs: eligible when hair loss results from disease or medical treatment
The letter doesn’t need to be elaborate. It typically states your diagnosis, the recommended item, and how it treats your condition. Keep it on file in case your plan administrator asks for documentation.
What’s Not Eligible
The IRS draws a hard line at anything done for “general health” or cosmetic purposes. This trips people up because some of these items feel medical but don’t meet the legal definition.
Cosmetic procedures like face lifts, hair transplants, teeth whitening, dental veneers, liposuction, and electrolysis are not eligible. The test is whether the procedure meaningfully treats a condition or just improves appearance. Toiletries and personal hygiene products, including toothpaste, shampoo, deodorant, soap, and mouthwash, are always ineligible regardless of where they’re sold.
Daily multivitamins, herbal supplements, and nutritional products taken for general well-being don’t qualify either. The same applies to gym memberships, fitness classes, YMCA dues, and swimming or dance lessons, even when a doctor recommends them for general health. A vacation prescribed “for stress” won’t qualify. Neither will maternity clothes, missed appointment fees, or warranties on medical devices.
The Dependent Care FSA Is a Separate Account
A Dependent Care FSA is often confused with a health care FSA, but it covers a completely different category of expenses: childcare and elder care costs that allow you to work. The annual limit is $5,000 per household ($2,500 if married filing separately).
Qualifying dependents include children under age 13 and adults (a spouse or other dependent) who are physically or mentally unable to care for themselves and live with you for more than half the year. The expenses must be work-related, meaning they allow you or your spouse to work or actively look for work.
Preschool, nursery school, and day camp costs all qualify. So do babysitters, nannies, and housekeepers whose work is at least partly for the care of a qualifying person. Kindergarten and higher grades do not qualify because the IRS considers those educational rather than caregiving expenses. Overnight camps are also excluded.
One important nuance: food, clothing, and entertainment costs aren’t eligible on their own, but small amounts bundled into a daycare or preschool bill that can’t be separated out are fine.
How to Actually Use Your FSA or HSA
Most FSA and HSA accounts come with a debit card linked to your account balance. When you buy an eligible item at a pharmacy, optical shop, or doctor’s office, the card draws from your pre-tax funds automatically. Many retailers now flag eligible items in their online stores, making it easy to filter for qualifying products.
If you pay out of pocket, you submit a claim to your plan administrator with a receipt showing the date, provider, and amount. HSA holders have an additional advantage: you can pay out of pocket now, save your receipts, and reimburse yourself from your HSA months or even years later. There’s no deadline for HSA reimbursement as long as the expense occurred after the account was established.
For FSA holders, timing matters more. Expenses must be incurred during the plan year (or within the grace period if your employer offers one). Since unused FSA funds largely expire, many people stock up on eligible supplies like contact lenses, first aid supplies, and menstrual products toward the end of their plan year to avoid losing money.
Prescription Sunglasses, Orthotics, and Other Surprises
A few eligible expenses catch people off guard. Prescription sunglasses are fully eligible. So are orthopedic shoe inserts, hearing aids and batteries, and the cost of travel to medical appointments (mileage, parking, tolls, and public transit fares). Braille books and magazines qualify for visually impaired individuals. Artificial teeth and prosthetic limbs are covered. Even home modifications like wheelchair ramps or widened doorways can qualify as medical expenses if they’re necessary for a medical condition, though the eligible amount is reduced by any increase in your home’s value.
The CARES Act also made certain COVID-related items eligible, though enforcement and plan coverage can vary. Latex gloves qualify with a receipt. Hand sanitizer, however, may require a letter of medical necessity depending on your specific plan administrator.