Can You Use an FSA or HSA for Orthodontics?
Orthodontic treatment including braces and clear aligners is a qualified medical expense under FSA, HSA and HRA rules. Learn what's covered and how the reimbursement works.
4 minute read
Short answer
Yes. You can use your FSA, HSA or HRA to pay for orthodontics. The amounts you pay for the prevention and alleviation of dental disease include orthodontic treatment under IRS Publication 502. Braces, aligners and other orthodontic work are reimbursable outright.
Orthodontic treatment is reimbursable without a letter. You can pay your orthodontist with any card, and your FSA, HSA or HRA administrator reimburses you after.
The answer: orthodontics is reimbursable
The amounts you pay for the prevention and alleviation of dental disease are qualified medical expenses under FSA, HSA and HRA rules. Orthodontic treatment to correct bite problems and tooth alignment falls under this category because it treats a diagnosed dental condition.
How to pay for orthodontics
Pay your orthodontist with any card: FSA or HSA card, credit card, debit card, or cash. Your administrator reimburses you from your account after. You don't need a letter for orthodontic treatment, so you can pay whenever you start treatment.
For braces or aligners, the cost may be spread over multiple appointments and years. Each payment you make to your orthodontist is eligible for reimbursement. Keep your receipts and records from your orthodontist to submit with your reimbursement request. Under FSA and HSA plan rules, orthodontic work qualifies as a reimbursable medical expense.
When orthodontics is reimbursable, when it's not
Orthodontic treatment to correct a dental condition is reimbursable outright. This includes braces, clear aligners, retainers and other appliances used to fix bite problems, crowding or alignment issues. Because orthodontics treats a diagnosed dental problem, no letter of medical necessity is required.
The key distinction is medical versus cosmetic. Orthodontics is medical when it treats a functional problem: a misaligned bite that affects chewing, crowding that traps food and bacteria, spacing that causes jaw problems, or any alignment issue documented by your orthodontist as a dental condition. Cosmetic-only orthodontics is not reimbursable. If someone wants minor alignment adjustments purely for appearance with no underlying bite or dental health condition, that falls outside the qualified-medical-expenses rule.
In practice, most orthodontic work addresses a functional dental issue. Malocclusion and crowding affect how teeth function, not just how they look. Your orthodontist diagnoses the condition, and your FSA, HSA or HRA will reimburse the treatment as a qualified medical expense.
What counts as a dental condition
Orthodontists diagnose dental conditions that orthodontics treats. Malocclusion (improper bite), crowding, spacing, crossbite, overbite and underbite are all dental conditions. So is any alignment problem that affects chewing, speech or jaw function. Your orthodontist documents the condition, and that documentation is what makes your treatment a qualified medical expense.
You don't need to request a separate letter from your orthodontist for FSA or HSA reimbursement. Your invoice and records from the orthodontist showing the treatment are sufficient. The diagnosis is already documented in your orthodontic records.
Related dental and orthodontic expenses
Other dental work is reimbursable under the same rules. Cleanings, fillings, extractions and braces all fall under the prevention and alleviation of dental disease. Wisdom tooth extraction, if needed for orthodontic treatment, is also reimbursable.
The related category is dental care more broadly. Prescription glasses and contact lenses are reimbursable outright as medical devices. Like orthodontics, they're not cosmetic but functional care covered under federal tax law. Retainers and other orthodontic appliances follow the same rule as the braces themselves.
Getting orthodontics reimbursed with Burst
When the answer is 'with a letter', this is the letter. Request it from Burst in about two minutes, a licensed clinician reviews it, and it's typically in your inbox within 24 hours. $35 once. Burst then files the reimbursement claim with your FSA, HSA or HRA administrator, and the administrator pays you out of your account by deposit or check. If no letter is issued you pay nothing, and if the claim is denied you get the $35 back. One timing rule: the letter has to be dated on or before the purchase it covers, so request it first.
Get reimbursed for my orthodontics
Frequently asked questions
Are braces reimbursable from an HSA?
Yes. Braces are reimbursable outright from your HSA, FSA or HRA because they treat a dental condition like malocclusion or crowding.
What about clear aligners like Invisalign?
Yes. Clear aligners are reimbursable outright from your FSA, HSA or HRA for the same reason as braces. They correct bite and alignment problems.
Do I need a letter of medical necessity for orthodontics?
No. Orthodontic treatment is reimbursable outright with no letter required. Your orthodontist's diagnosis and records are sufficient documentation.
Can I use my FSA for orthodontic retainers?
Yes. Retainers and other orthodontic appliances needed after braces are reimbursable from your FSA, HSA or HRA.
Is orthodontics for adults reimbursable?
Yes. Orthodontic treatment for adults is reimbursable the same way as for children. Age doesn't change the medical-necessity rule.
Keep reading: Can You Use an FSA or HSA for Dental?, Are Prescription Glasses FSA or HSA Eligible?, What Can I Use My FSA Funds On?, and all guides on this topic.
Sources
IRS Publication 502 - Medical and Dental Expenses (dental disease prevention and treatment, including orthodontic work; the general definition of qualified medical expenses)
IRS Publication 969 - Health Savings Accounts and Other Tax-Favored Health Plans (how FSA, HSA and HRA accounts work; reimbursement for qualified medical expenses; eligibility and usage rules across account types)
