HSA and FSA eligible expenses are medical costs the IRS allows you to pay for using pre-tax dollars from a Health Savings Account or Flexible Spending Account. The list is broad: it covers everything from doctor visits and prescriptions to contact lenses, sunscreen, and even menstrual products. Understanding what qualifies can save you hundreds of dollars a year in taxes.
How HSA and FSA Eligibility Works
The IRS defines eligible expenses as costs related to the diagnosis, cure, treatment, or prevention of disease, or costs that affect any structure or function of the body. That’s the official language, but in practice it means most things you’d associate with medical care qualify. This includes payments to doctors, dentists, surgeons, and other practitioners, plus the equipment, supplies, and diagnostic devices you need along the way.
Both HSAs and FSAs follow the same core list of eligible expenses, defined under Section 213(d) of the tax code. The difference between the two accounts is mostly about who can open one and how the money behaves, not what you can spend it on.
Common Eligible Expenses
The full IRS list runs long, but here are the categories most people actually use:
- Doctor and specialist visits: Annual physicals, diagnostic tests, psychiatric care, and acupuncture all qualify.
- Dental care: Cleanings, X-rays, fillings, braces, dentures, fluoride treatments, and sealants.
- Vision care: Eye exams, eyeglasses, contact lenses, and corrective eye surgery like LASIK.
- Prescription medications and insulin: Any drug prescribed by a doctor, plus insulin even without a prescription.
- Hearing aids: The devices themselves, plus batteries, repairs, and maintenance.
- Diagnostic devices: Blood sugar test kits, blood pressure monitors, and similar home testing equipment.
- Breast pumps and lactation supplies.
- Pregnancy test kits.
- Artificial limbs and teeth.
- Stop-smoking programs.
- Guide dogs and service animals: Including the costs of buying, training, and maintaining them.
Less obvious expenses also qualify. If your doctor recommends special education for a child with a learning disability caused by a mental or physical impairment, those tutoring fees are eligible. Home modifications like entrance ramps, widened doorways, or bathroom renovations made for medical reasons can also be reimbursed, though the amount may be reduced by any increase in your home’s value.
Over-the-Counter Products and Menstrual Care
Before 2020, most over-the-counter medications required a prescription to be eligible. The CARES Act changed that. Since January 1, 2020, you can use HSA and FSA funds for over-the-counter medications and products without a prescription. That includes pain relievers, allergy medicine, cold and flu remedies, antacids, and similar drugstore staples.
The CARES Act also made menstrual care products eligible for the first time. Tampons, pads, liners, menstrual cups, sponges, and similar products all qualify. This is a permanent change, not a temporary provision.
Sunscreen, Lip Balm, and SPF Products
Sunscreen is eligible as long as it has an SPF of 15 or higher and provides broad-spectrum protection against both UVA and UVB rays. Most standard sunscreens meet this threshold. Lip balm with SPF 15 or higher also qualifies, since it serves the same protective function.
Where it gets tricky is combination products. A moisturizer with SPF that’s labeled and sold primarily as a sunscreen will typically qualify. But a tinted moisturizer or foundation that happens to include SPF usually won’t, because it’s marketed as a cosmetic rather than sun protection. The key is how the product is labeled: if “broad spectrum sunscreen” is the primary claim on the packaging, you’re generally in the clear.
Items That Need a Letter of Medical Necessity
Some expenses fall into a gray area. Gym memberships, supplements, massage therapy, and ergonomic equipment aren’t automatically eligible, but they can become eligible if your doctor writes a Letter of Medical Necessity. This letter must come from a licensed practitioner and needs to include your specific medical condition, the recommended treatment or product, and how long you’ll need it. For chronic conditions like multiple sclerosis, the duration can simply say “lifetime.”
The letter must also confirm the expense is medically necessary and not for general health or cosmetic purposes. That distinction matters: a gym membership prescribed to treat a diagnosed cardiovascular condition is different from one you use for general fitness. Without the letter on file, your plan administrator will deny the claim.
What’s Not Eligible
Cosmetic procedures like teeth whitening, hair transplants, and elective cosmetic surgery don’t qualify unless they correct a deformity from a congenital abnormality, injury, or disfiguring disease. General health items like vitamins and supplements are ineligible without that Letter of Medical Necessity. Toiletries, cosmetics marketed primarily for appearance, and non-medicated skincare products are also off the list.
Insurance premiums are a nuanced case. You generally cannot use FSA funds for insurance premiums. HSA funds can cover certain premiums in limited situations, such as COBRA continuation coverage or long-term care insurance, but not premiums for a standard health plan you pay while employed.
HSA vs. FSA: Key Differences in How They Work
While both accounts cover the same eligible expenses, the rules around contributing and spending differ significantly.
To open an HSA, you must be enrolled in a high-deductible health plan. For 2025, you can contribute up to $4,300 for individual coverage or $8,550 for family coverage. In 2026, those limits rise to $4,400 and $8,750 respectively. If you’re 55 or older, you can add an extra $1,000 per year. HSA funds roll over indefinitely, and the account stays with you even if you change jobs or retire.
FSAs are offered through your employer and don’t require a specific type of health plan. The contribution limit for 2025 is lower than an HSA’s, and the biggest catch is the use-it-or-lose-it rule. Your employer may offer one of two safety valves: a grace period of up to 2.5 extra months to spend remaining funds, or a rollover option. For the 2025 plan year, you can carry over up to $660 in unused funds into 2026, but only if you re-enroll. Your employer chooses which option to offer, if either. They can’t offer both.
How to Check Before You Buy
Many retailers now label products as “HSA/FSA eligible” online, and some stores have dedicated FSA aisles. Your plan administrator’s website will also have a searchable list of eligible expenses. When in doubt, keep your receipts. If an item is denied, you can often appeal with documentation showing the product’s medical purpose. For gray-area items, getting that Letter of Medical Necessity before you make the purchase saves you the hassle of fighting a claim after the fact.