What Can You Buy with an FSA? The Complete List
FSA money covers medical and dental expenses under IRS Publication 502. Some items are automatically eligible, others need a letter of medical necessity, and some never qualify.
9 minute read
Short answer
You can use your FSA (flexible spending account) to pay for medical and dental expenses under IRS Publication 502. This includes doctor visits, prescriptions, dental work, vision care, and medical equipment like crutches or hearing aids. Many other items are eligible with a letter of medical necessity naming a diagnosed condition.
Your plan administrator applies the IRS rules to your specific plan, and every plan document differs. This guide covers what the IRS allows. If you're unsure whether something qualifies, request a letter before you buy.
What an FSA covers
FSA money is set aside from your paycheck before taxes to cover medical expenses. The IRS defines a medical expense as "the costs of diagnosis, cure, mitigation, treatment, or prevention of disease and for the purpose of affecting any part or function of the body". Your plan administrator applies that rule plus your plan's own restrictions. HSA and HRA accounts follow the same IRS eligibility list. FSA money has a use-it-or-lose-it deadline set by your employer. An HSA balance carries over every year with no deadline to spend it.
Eligible items fall into three categories. Doctor visits, prescriptions, dental work and OTC medicines are reimbursable outright. Fitness and wellness purchases, and supplements, are reimbursable with a letter when a clinician ties them to a diagnosed condition. Cosmetic procedures and general toiletries bought for no condition are not reimbursable. Burst files the letter and claim for you if you need one.
How to read this list
Every item in the categories below lands in one of three columns: automatically eligible under IRS Publication 502, eligible only with a letter of medical necessity, or not eligible. A letter works because a licensed clinician documents that you have a diagnosed condition and the purchase treats it. Cosmetic work and items bought purely for appearance or convenience are not eligible.
OTC and pharmacy
The CARES Act restored coverage for OTC medicines. Most of the pharmacy aisle is reimbursable outright, no prescription and no letter needed. Vitamins and supplements are the exception: they need a letter naming the condition they treat. The IRS excludes them "unless they are recommended by a medical practitioner as treatment for a specific medical condition diagnosed by a physician".
Reimbursable outright. | Reimbursable with a letter. | Not reimbursable. |
|---|---|---|
Prescription drugs (antibiotics, blood pressure medications, insulin) | Vitamins and supplements, when a clinician ties them to a diagnosed condition | Toothpaste, mouthwash and cosmetic skincare |
OTC pain relievers, antacids, allergy medications, decongestants and antihistamines | Lip balm or skincare bought purely for appearance | |
Cold and cough medicine, sleep aids, and topical creams for eczema or rash | ||
Sunscreen (SPF 15 or higher, broad spectrum) and diabetes test strips |
Personal care and medical supplies
Braces, compression sleeves and positioning cushions are reimbursable with a letter once a clinician ties them to a diagnosed condition. The IRS otherwise excludes "the cost of an item ordinarily used for personal, living, or family purposes unless it is used primarily to prevent or alleviate a physical or mental disability or illness".
Reimbursable outright. | Reimbursable with a letter. | Not reimbursable. |
|---|---|---|
Bandages, gauze, first aid supplies | Compression sleeves for lymphedema or joint pain | Cosmetic facial products |
Heating pads | Braces and supports for injury or arthritis | Hair removal products |
Ice packs | Posture correctors for back pain | Nail care products |
Crutches, canes, walkers | Foam rollers for physical therapy | Deodorant or antiperspirant |
Wheelchairs and mobility devices | Back support cushions for chronic pain | Cosmetic procedures or injectables |
Incontinence supplies | Pillows designed for medical conditions | General grooming supplies |
Vision and dental
Reimbursable outright. | Reimbursable with a letter. | Not reimbursable. |
|---|---|---|
Eye exams and vision tests | Cosmetic eyebrow procedures | |
Eyeglasses and lenses (prescribed) | Sunglasses without a prescription | |
Contact lenses and lens solution (prescription) | ||
LASIK and other vision correction surgery | ||
Dental cleanings and exams | Cosmetic dentistry (veneers, teeth whitening for appearance) | |
Fillings, crowns, bridges | ||
Root canals and extractions | ||
Dental implants | ||
Dentures and adjustments | ||
Braces and orthodontia |
Medical devices and equipment
Medical devices are reimbursable outright under IRS Publication 502. Devices tied to fitness tracking or general comfort need a letter naming the condition they treat.
Reimbursable outright. | Reimbursable with a letter. | Not reimbursable. |
|---|---|---|
Hearing aids and batteries | Air purifiers, when a clinician ties them to a condition such as asthma or allergies | |
Artificial limbs | Humidifiers, when a clinician ties them to a chronic condition | |
Blood sugar test kits and glucose monitors | Fitness trackers, smartwatches and smart rings, when a clinician ties tracking to a diagnosed condition | |
Diagnostic thermometers | Electric toothbrushes, for a diagnosed gum condition | |
Pulse oximeters | ||
Scales for weight monitoring (medical) | ||
Blood pressure monitors for home use | ||
CPAP machines and supplies for sleep apnea | ||
Nebulizers for respiratory conditions |
Fitness and wellness services
Fitness and wellness purchases are reimbursable with a letter when a licensed clinician ties them to a diagnosed condition. The IRS allows this "if it is a treatment for a specific disease diagnosed by a physician (such as obesity, hypertension, or heart disease)". Without a diagnosis behind the purchase, it isn't reimbursable.
Reimbursable outright. | Reimbursable with a letter. | Not reimbursable. |
|---|---|---|
Physical therapy | Gym memberships, when a clinician ties them to a condition such as obesity, hypertension or back pain. See the gym membership guide | Wellness retreats or spa services |
Chiropractic treatment | Yoga or Pilates, when a clinician ties classes to a condition such as chronic pain | |
Acupuncture | Personal training, when a clinician ties sessions to rehab or a diagnosed condition | |
Speech therapy | Massage therapy, when a clinician ties it to a condition such as an injury. See the massage therapy guide | |
Occupational therapy | Fitness classes, when a clinician ties them to a diagnosed condition | |
Mental health counseling | Swimming or water aerobics, when a clinician ties sessions to arthritis or recovery | |
Psychotherapy sessions | Weight loss programs, when a clinician ties them to a diagnosed condition such as obesity |
Other services
Reimbursable outright. | Reimbursable with a letter. | Not reimbursable. |
|---|---|---|
Doctor office visits | Bariatric surgery (if medically necessary) | Life coaching or general counseling |
Hospital services and room charges | Organ transplant and related care | |
Laboratory tests | Stop-smoking programs (certain programs) | |
X-rays and imaging | Acupuncture supplies and equipment | |
Vaccinations | ||
Fertility treatments and IVF | ||
Medical transportation (bus/taxi to doctor) |
Dependent care (separate account)
If your employer offers a dependent care FSA, that account is separate from medical FSA funds and covers child care and elder care expenses only. It has nothing to do with medical expenses or letters of medical necessity. This guide covers the medical FSA, HSA and HRA only.
What changes by plan
The IRS Publication 502 list is the floor. Your plan document can be stricter. For example, one employer's FSA might cover dental work and vision care while another's doesn't. One plan might cap how much you spend on mental health services. Some employers place dental and vision in a limited-purpose FSA paired with an HSA instead of the main medical FSA.
Your plan's summary plan description or plan document states what it covers. Ask your benefits administrator or check your plan documents before spending. A letter of medical necessity can open up items that have a medical basis but aren't covered outright, so it's worth requesting one before you buy if you're unsure.
How reimbursement gets paid
Burst files the reimbursement claim with your FSA, HSA or HRA administrator on your behalf. The administrator pays you out of your account by direct deposit or check. Your money moves from the account to you. You never submit paperwork yourself, and you don't take the letter to the administrator. Burst handles it all.
The letter has to be dated on or before the purchase it covers, so request it before you buy.
Getting it reimbursed with Burst
Here's the practical route. Request a letter of medical necessity from Burst ($35 once, about two minutes). A licensed clinician reviews it and it's typically in your inbox within 24 hours. Burst files the reimbursement claim with your FSA, HSA or HRA administrator, who pays you out of your account by deposit or check. If there's no letter there's no charge, and a denied claim means your money back. The letter has to be dated on or before the purchase it covers, so do this step first.
Frequently asked questions
What can I buy with my FSA card?
Your FSA card pays for eligible medical expenses: doctor visits, prescriptions, dental work, vision care, hearing aids, and other items under IRS Publication 502. It can't be used for cosmetics or toiletries, and it won't cover a gym membership or fitness class without a letter of medical necessity on file first. When in doubt, request a letter before you use the card.
Can I buy over-the-counter medicine with my FSA?
Yes. The CARES Act restored coverage for OTC medicines: pain relievers, cold and cough medicine, antacids, and allergy medications are reimbursable outright, no prescription and no letter needed. Insulin, prescription or over-the-counter, is covered the same way. Vitamins and supplements are different: those need a letter of medical necessity tying them to a diagnosed condition.
Does my HSA have the same eligible list as my FSA?
Both FSA and HSA accounts use IRS Publication 502 for what's eligible. The IRS defines that shared standard as "amounts paid by the HSA beneficiary for 'medical care' (as defined in Code section 213(d))". The timing rules differ sharply. FSA funds follow use-it-or-lose-it at the end of the plan year, though some plans offer a grace period. An HSA balance carries over every year with no deadline to spend it. HRA accounts follow the same eligible items, but their timing rules vary by employer plan design.
What if my plan administrator denies the claim?
If your administrator denies the claim, Burst writes the appeal. No letter, no charge.
Can I use my FSA for gym memberships?
Yes, with a letter. A gym membership becomes eligible when a licensed clinician ties it to a diagnosed condition, such as obesity, hypertension or back pain. See the gym membership guide.
Are vitamins eligible?
Vitamins and supplements are eligible with a letter of medical necessity when a licensed clinician ties them to a diagnosed condition, such as a documented deficiency. Bought for general health with no diagnosis behind them, they don't qualify without one.
Keep reading: 75+ Surprising FSA/HSA Eligible Items, What's an FSA?, What's an HSA?, HSA vs FSA, and all guides on this topic.
Sources
IRS Publication 502, Medical and Dental Expenses (Defines a medical expense, and the rules behind vitamins and supplements, weight-loss programs, and ordinary personal-care items like braces and cushions)
IRS Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans (The shared definition of a qualified medical expense that FSA, HSA and HRA accounts all use, and HSA's non-expiring balance)
Instructions for Form 2441 (Confirms the dependent care FSA is a separate account for child and elder care, unrelated to the medical FSA this guide covers)
