What Is FSA and HSA Eligible? The Complete List

Short answer

FSA, HSA and HRA accounts can reimburse qualified medical expenses under IRS Publication 502, which covers a broad range of doctor visits, prescriptions, dental and vision care, medical equipment, and other healthcare costs. Some items are reimbursable outright. Others require a letter of medical necessity from a licensed clinician explaining the medical purpose.

This guide breaks down what each account covers by category, so you know what's reimbursable before you buy. The plan document governs the final decision for any FSA or HRA, and the administrator applies those rules when you file a claim. For an HSA, the IRS rules apply the same way across all plans.

What FSA, HSA and HRA accounts cover

FSA (health care flexible spending account), HSA (health savings account) and HRA (health reimbursement arrangement) all reimburse qualified medical expenses. The IRS defines a medical expense as "the costs of diagnosis, cure, mitigation, treatment, or prevention of disease" for affecting any part or function of the body. That standard covers doctor and hospital visits, prescriptions, dental and vision care, medical equipment, and many over-the-counter products, as long as insurance did not already pay for it. Some expenses are reimbursable without any extra documentation. Others require a letter from a licensed clinician explaining a diagnosed condition and how the expense treats it. A third category, such as cosmetic work and general wellness with no medical condition, is not reimbursable by any account.

The key difference: FSA balances follow a spending deadline set by the plan year, though some plans allow a limited carryover into the next year. HSA money runs on a different rule. The IRS notes that "amounts that remain at the end of the year are generally carried over to the next year". An HSA balance carries no annual spending deadline, and it moves with you if you change jobs or health plans. HRA balances follow whatever schedule your employer's plan sets. All three route claims the same way: Burst issues a letter of medical necessity where needed, files the claim with your account administrator, and the administrator pays you out of the account.

How to read the list

Every item you can buy falls into one of three categories, whether it is an FSA, HSA or HRA expense. Knowing which category an item lands in tells you what to do before you buy.

Reimbursable outright

These items are qualified medical expenses under IRS Publication 502 and need no letter. They are reimbursable as long as they are not covered by your insurance.

Reimbursable with a letter

These items require a letter of medical necessity. A licensed clinician reviews your situation, confirms a diagnosed medical condition, and explains in one sentence how the purchase treats it. If the honest explanation is about general wellness, appearance, or convenience with no medical condition, the answer is not reimbursable. Request your letter before you buy, because the letter's date has to be on or before the purchase date.

Not reimbursable

These items fall outside the IRS definition of medical expenses, either because they are cosmetic, general wellness with no condition, or not healthcare-related. No letter can change this.

OTC and pharmacy items

Over-the-counter medicines are reimbursable outright under the CARES Act: no prescription and no letter needed. Medications that treat pain, cold symptoms, allergies, or digestive issues are reimbursable outright because they address a specific medical problem. Sunscreen SPF 15 or higher is reimbursable outright under a long-standing IRS ruling. Vitamins and supplements are reimbursable with a letter when a clinician ties them to a diagnosed condition, and not reimbursable when bought for general wellness with no letter.

Personal care items

Personal care products split the same way as everything else: reimbursable when they treat a diagnosed condition, not reimbursable when they are bought for general upkeep or appearance. Everyday grooming and beauty items are not reimbursable under IRS Publication 502 because they are not medical care. Products that manage a specific health condition are reimbursable, sometimes outright and sometimes with a letter.

Vision and dental care

Vision and dental expenses are reimbursable across all account types when related to medical care and treatment. Cosmetic services are not. Routine eye exams, eyeglasses, contact lenses and prescription sunglasses correct a vision problem, so they are reimbursable. Routine dental care, fillings, root canals and orthodontics treat a dental condition, so they are too. Teeth whitening for appearance is cosmetic and not reimbursable. Whitening for a diagnosed discoloration condition caused by medication or disease may be reimbursable with a letter.

Medical devices and equipment

Medical devices are reimbursable when they treat a diagnosed condition, not a general wellness or comfort purpose. Most equipment used to manage a chronic condition or aid mobility, such as wheelchairs, hearing aids, blood glucose monitors and compression braces, is reimbursable outright because the medical purpose is clear. Items that blur the line between therapeutic and comfort, such as weighted blankets or ergonomic furniture, need a letter confirming they treat a specific diagnosed condition like anxiety, a sleep disorder or chronic pain.

Fitness and wellness

Fitness and wellness purchases are reimbursable with a letter of medical necessity. A licensed clinician has to name a diagnosed condition, such as obesity, hypertension, back pain, anxiety or a sleep disorder, and explain how the purchase treats it. Purely recreational spending with no diagnosed condition is not reimbursable.

Services and practitioners

Healthcare services and provider visits are reimbursable when they are medical treatment. Fees paid to a practitioner for diagnosis, treatment or therapy qualify, from routine primary care to specialist consultations, mental health therapy and surgical procedures. The administrator reimburses the cost as long as a licensed provider delivered it and insurance did not already cover it.

Family and dependent care

Medical expenses for your spouse and dependents are reimbursable from your FSA, HSA or HRA under the same rules as your own expenses. Dependent care for child care or elder care is different: employers offer a separate Dependent Care FSA for that purpose, and it has no connection to medical expenses or letters.

What changes by plan

The plan document and summary plan description that your employer provides govern what your specific FSA or HRA covers. The plan can be more restrictive than the IRS rules, requiring prior authorization for certain expenses or excluding categories the IRS permits. One employer's FSA might exclude acupuncture, while another allows it, and a second plan might require pre-approval for mental health services.

HSA rules are set by the IRS and apply the same across every account: any qualified medical expense under Publication 502 is reimbursable, and the dollar limits move every year. For 2026, the IRS set the health FSA salary-reduction limit at "$3,400", up from $3,300 in 2025, with a maximum carryover of $680. Check your plan document or your administrator to confirm whether a specific expense is covered.

How reimbursement gets paid

Reimbursement flows out of your FSA, HSA or HRA account to you. You pay the provider or retailer with any card (credit, debit or BNPL), Burst files the reimbursement claim with your administrator, and the administrator pays you by deposit to your bank account or by check. You never submit the letter or the claim yourself. The letter has to be dated on or before the purchase date, so request it before you buy.

Getting it 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.

Request my letter for $35

Frequently asked questions

Can I use my FSA or HSA to pay for over-the-counter products?

Yes. OTC medicines like pain relievers, cold medications, antacids and allergy medications are reimbursable outright from FSA and HSA accounts under the CARES Act, with no prescription and no letter needed. Sunscreen SPF 15 or higher is also reimbursable outright. Vitamins and supplements are reimbursable with a letter when a clinician ties them to a diagnosed condition.

Are gym memberships and fitness classes FSA or HSA eligible?

With a letter of medical necessity that ties the membership or class to a diagnosed condition, such as obesity, hypertension, back pain or anxiety, yes. A recreational membership with no diagnosed condition is not reimbursable. See how a letter works for a gym membership.

Can I use my HSA to pay for my spouse's medical expenses?

Yes. Medical expenses for your spouse and dependents are reimbursable from your HSA, FSA or HRA under the same rules as your own expenses. The same three-category system applies: outright, with a letter, or not reimbursable.

What is the difference between an FSA and an HSA?

The main difference is the deadline. FSA balances generally have to be spent within the plan year, though some plans allow a limited carryover. HSA balances carry over with no deadline and stay with you even if you change jobs. Both reimburse the same qualified medical expenses under IRS rules.

What happens if my FSA or HSA administrator denies my claim?

Burst refunds your letter fee if the claim is denied. You are not charged anything.

Do I need a letter for every FSA or HSA expense?

No. Many expenses are reimbursable outright without a letter: prescriptions, doctor visits, dental and vision care, and many medical devices. A letter is required only for expenses where the medical purpose is not obvious, such as certain OTC products or fitness expenses prescribed by a clinician.

Keep reading: What Can I Use My FSA Funds On?, What Can I Use My HSA Funds On?, 75+ Surprising FSA/HSA Eligible Items, HSA vs. HRA: The Difference, and all guides on this topic.

Sources

• IRS Publication 502, Medical and Dental Expenses (The IRS definition of a medical expense, and which categories (doctor visits, prescriptions, dental and vision care, medical equipment) qualify)

• IRS Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans (HSA eligibility rules and that an HSA balance carries over to the next year with no annual spending deadline, unlike an FSA)

• IRS, 2026 Tax Inflation Adjustments (health FSA and HSA figures) (The 2026 health FSA salary-reduction limit ($3,400) and maximum carryover ($680))