Surprising FSA and HSA Eligible Items

Short answer

Many FSA and HSA eligible items surprise people: menstrual care products, OTC cold and allergy medicines, sunscreen, fitness equipment, and even massage guns are all covered, either outright or with a letter of medical necessity from a clinician.

The difference is simple. Some items are qualified medical expenses under IRS rules and need nothing else. Others are reimbursable when a clinician ties them to a diagnosed condition and issues a letter. The rest fall outside FSA and HSA rules no matter what.

What FSA and HSA accounts cover

Both FSA and HSA accounts reimburse medical expenses. Publication 502 defines those as "the costs of diagnosis, cure, mitigation, treatment, or prevention of disease." That covers thousands of items beyond prescriptions and doctor visits.

Some are reimbursable outright with no prescription or paperwork. Others are reimbursable with a letter, meaning a licensed clinician reviews your situation, names a diagnosed condition, and explains in one sentence how the purchase treats it. Everything else isn't reimbursable.

How to read the list

The tables below organize items by category and show three possible outcomes:

• Outright: Reimbursable with no letter, no prescription, no extra paperwork.

• With a letter: Reimbursable when a licensed clinician ties it to a diagnosed medical condition and issues a letter of medical necessity.

• Not reimbursable: Outside FSA and HSA rules. A letter doesn't change this outcome.

Every row rests on Publication 502 or Publication 969, the IRS guides for medical expenses and health accounts. Where a rule comes from the CARES Act instead, the row says so.

OTC and pharmacy

Personal care

Vision and dental

Medical devices and equipment

Fitness and wellness

Services and treatments

Family and prevention

Family planning and prevention items sit in the surprising pile too. Condoms count, because Publication 969 says amounts paid for them "are treated as expenses for medical care under section 213(d)," so they are qualified expenses under an FSA, HRA or HSA.

Vaccines and lab tests are outright (see the services table). Special food is a narrow case. Ordinary diet food is out. Publication 502 says "the diet food and beverages substitute for what is normally consumed to satisfy nutritional needs." Gluten-free food for celiac disease is with a letter, and only the amount above a normal diet's cost counts.

Cool FSA eligible items

Cool FSA eligible items are the everyday ones nobody expects: menstrual care products, sunscreen, OTC cold medicine, hearing aids and contact lens supplies are all outright. Treadmills, massage guns and humidifiers are reimbursable when a clinician names a diagnosed condition. Condoms are covered too, per the family section above.

What changes by plan

The eligibility rules above apply to all FSA, HSA and HRA accounts under federal law. However, each employer's plan document may be more restrictive. Your specific plan may exclude some items or ask for more documentation before it pays.

Example: a gym membership is eligible with a letter under federal rules, but one employer's plan might ask for more documentation. Another plan might exclude fitness equipment altogether. Check your plan document or ask your administrator before you buy.

How reimbursement gets paid

You get reimbursed from your own FSA, HSA or HRA balance, paid to you by direct deposit or check. For items that need a letter, a licensed clinician reviews your situation through Burst and decides whether to issue one.

Burst files the claim on your behalf with your letter and receipt, and the administrator decides it under your plan's rules.

Getting it reimbursed with Burst

Burst handles the letter and the claim. You request the letter of medical necessity in about two minutes for $35, a licensed clinician reviews it, and it typically lands in your inbox within 24 hours. Burst files the reimbursement claim with your FSA, HSA or HRA administrator. The administrator pays you out of your account by deposit or check. No letter, no charge. Claim denied, money back. Request it before you buy, because the letter has to be dated on or before the purchase it covers.

Get reimbursed for my purchase

Frequently asked questions

What's the difference between FSA, HSA and HRA?

FSA is employer-sponsored with use-it-or-lose-it rules: unused money doesn't roll over. HSA is paired with a high-deductible health plan and the balance rolls over indefinitely. HRA is employer-funded only, and rules follow the plan document. All three use the same IRS definition of a medical expense, and the plan document sets the details.

Can I buy any fitness equipment with my FSA or HSA?

Yes, when a clinician ties it to a diagnosed condition and issues a letter. A treadmill for general fitness requires a medical reason, but with a clinician's recommendation for rehabilitation after a knee injury, it becomes reimbursable.

Are OTC medicines really eligible without a prescription?

Yes. The CARES Act 2020 restored OTC medicines to FSA and HSA eligibility. Pain relievers, allergy medicine, cold and cough remedies, antacids and sleep aids are all reimbursable outright.

Why would I need a letter for fitness or a mattress?

A letter proves the expense is for medical treatment, not general wellness. Your clinician names the condition (e.g., sleep apnea, chronic back pain) and explains how the item treats it. That's what the administrator reviews when it decides the claim under your plan.

Is sunscreen eligible?

Yes. Sunscreen with SPF 15 or higher, broad spectrum, is reimbursable outright under long-standing IRS guidance. Publication 502 doesn't name it, so don't look for it there.

Can I use my FSA or HSA for cosmetic procedures?

Not for appearance. Botox for lines, fillers and teeth whitening aren't reimbursable under Publication 502. The exception is a procedure that treats a diagnosed condition, which is how laser hair removal for hirsutism or chronic ingrown hairs can be reimbursed with a letter.

Keep reading: Complete guide to HSA and FSA eligible items, What can I use my FSA funds on, What can I use my HSA funds on, and all guides on this topic.

Sources

• IRS Publication 502 - Medical and Dental Expenses (item eligibility rules, medical-expense definition, OTC medicines, cosmetic surgery, health club dues, personal care items, dental treatment, eyeglasses, hearing aids, personal protective equipment)

• IRS Publication 969 - Health Savings Accounts and Other Tax-Favored Health Plans (HSA and FSA definitions, carryover rules, account types and comparison, condoms and medical care)