Are Tissues (Kleenex) FSA or HSA Eligible?
Tissues and Kleenex aren't reimbursable from FSA, HSA or HRA accounts. They're personal care items. OTC cold medicine and humidifiers may qualify.
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Short answer
Tissues aren't reimbursable from an FSA, HSA or HRA. The IRS treats tissues as "an item ordinarily used for personal, living, or family purposes", the same category as household paper goods and toiletries. A letter doesn't change this.
If you have a cold or allergies, you can buy OTC cold, cough and allergy medicines outright, plus saline and nasal sprays with a Drug Facts label. A humidifier with a letter from a clinician naming your condition also qualifies.
The answer: tissues are a personal care item
Tissues, whether Kleenex or another brand, are "an item ordinarily used for personal, living, or family purposes" under IRS Publication 502. This is the same rule that keeps toothpaste, shampoo and soap off the reimbursable list. Tissues are everyday household items that serve general personal use, not medical treatment. No letter from a clinician can change this.
What's reimbursable for a cold or allergies
Tissues aren't an option, but your FSA, HSA or HRA can pay for the conditions tissues are meant to treat. The remedies qualify, through several routes. Here's what qualifies and how.
Item | FSA, HSA or HRA? | Notes |
|---|---|---|
Tissues (Kleenex, etc.) | Not reimbursable | Personal care item under Publication 502 |
OTC cold, cough and allergy medicines | Reimbursable outright | OTC medicines, reimbursable outright with no prescription since the CARES Act of 2020: pain relievers, decongestants, antihistamines, cough syrups |
Saline nasal spray with Drug Facts label | Reimbursable outright | Saline solutions and sprays marked with a "Drug Facts" label are OTC medicines, reimbursable the same way as cold and allergy medicines |
Humidifier (with a letter) | Yes, with a letter | Reimbursable if a clinician names a diagnosed condition it treats, like a respiratory condition, asthma or seasonal allergies |
How to use your account instead
OTC cold and allergy medicines and saline sprays deliver the same relief tissues offer, and they're actually reimbursable. Grab pain relievers, decongestants, antihistamines, cough syrups or saline sprays from any drugstore, supermarket or online retailer. Pay with your FSA, HSA or HRA card, or with any other card and get reimbursed afterward. Burst files the claim. The CARES Act of 2020 made over-the-counter medicines eligible without a prescription, and your account pays for qualified medical expenses like these out of your own balance.
A humidifier is a different route that works well for respiratory issues and ongoing allergies. Request a letter from Burst before you buy, dated on or before your purchase date. Once a clinician explains how the humidifier treats your diagnosed condition (like asthma, seasonal allergies or a chronic cough), Burst files the reimbursement claim with your administrator and you get paid back from your account.
Related items for colds and allergies
Tissues are only the first line of defense. Your FSA, HSA or HRA covers the actual remedies.
OTC cold, cough and allergy medicines like pain relievers, decongestants, cough syrups and antihistamines are reimbursable outright with no prescription or letter.
Saline nasal spray and saline rinse solutions with a Drug Facts label are OTC medicines, reimbursable outright.
Humidifiers are reimbursable with a letter if a clinician ties them to a diagnosed respiratory condition, allergies or similar diagnosis.
Prescription nasal sprays and decongestants are reimbursable outright as prescribed medicines.
Where Burst fits
Some purchases are only reimbursable with a letter of medical necessity: gym memberships, massage, fitness equipment, sleep and recovery products, and similar. Burst writes the letter and files the claim for $35, refunded if no letter is issued or the claim is denied. See how a letter works.
Frequently asked questions
Can I use my FSA for Kleenex?
No. Tissues including Kleenex are personal care items under IRS Publication 502, the same category as household paper products and toiletries. A letter from a clinician doesn't change that.
What cold medicine is FSA eligible?
OTC cold, cough and allergy medicines like pain relievers, decongestants, antihistamines and cough syrups are reimbursable outright with no prescription or letter. See the OTC medicine guide for the full list.
Is a humidifier FSA reimbursable?
A humidifier is reimbursable with a letter if a clinician names a diagnosed condition it treats, such as asthma, allergies or a respiratory condition. See the humidifier guide for details.
Can I get a saline spray reimbursed?
Yes. Saline nasal sprays and solutions with a Drug Facts label are OTC medicines reimbursable outright through FSA, HSA and HRA accounts.
Are allergy pills covered by HSA?
Yes. Antihistamines and other OTC allergy medicines are reimbursable outright from an HSA. They became eligible without a prescription through the CARES Act of 2020.
Does a prescription nasal spray count?
Yes. Any prescription nasal spray or decongestant prescribed by a doctor is reimbursable outright from your FSA, HSA or HRA account.
Keep reading: OTC cold, cough and allergy medicines, Humidifier eligibility, Complete list of FSA eligible expenses, and all guides on this topic.
Sources
IRS Publication 502 - Medical and Dental Expenses (personal use items including tissues, general definition of medical expenses, OTC medicines)
IRS Publication 969 - Health Savings Accounts and Other Tax-Favored Health Plans (HSA and HRA eligibility and qualified medical expenses)
Healthcare.gov Glossary (FSA, HSA and HRA account definitions)
