What you can buy with your HSA or FSA
A reference list of HSA and FSA eligible expenses — from copays and Rx to surprising items like sunscreen, period products, and over-the-counter meds.
Generally, anything that diagnoses, treats, mitigates, or prevents a medical condition is eligible. The IRS publishes the definitive list in Publication 502. The CARES Act (2020) expanded the list to include menstrual products and over-the-counter medications without a prescription.
Always eligible
- Deductibles, copays, and coinsurance for medical, dental, and vision care
- Prescription medications
- Over-the-counter medications (OTC) — pain relievers, allergy meds, antacids, cold meds
- Menstrual care products — tampons, pads, cups, liners
- Eye exams, prescription glasses, contact lenses, contact solution
- Dental cleanings, fillings, crowns, braces, dentures
- Mental health therapy and counseling
- Physical therapy, chiropractic care, acupuncture
- Medical equipment — crutches, blood pressure monitors, glucose meters, CPAP supplies
- First aid supplies — bandages, antiseptic, thermometers
Often eligible (sometimes needs a letter of medical necessity)
- Massage therapy (with a doctor's recommendation for a specific condition)
- Smoking cessation programs and nicotine patches
- Weight loss programs (only if prescribed for a specific medical condition like obesity)
- Special diet foods (only the difference between special food and normal food)
- Home modifications for accessibility (ramps, grab bars)
- Service animals trained to assist with a disability
- Lactation supplies and breast pumps
Not eligible
- Cosmetic procedures (whitening, hair removal, elective plastic surgery)
- Gym memberships or general fitness equipment (with rare exceptions)
- Vitamins and supplements taken for general health (specific medical needs only)
- Toiletries — toothpaste, mouthwash, shampoo
- Insurance premiums (with narrow exceptions: COBRA, Medicare, long-term care)
- Childcare (unless using a Dependent Care FSA)
FAQ
- Do I need to submit receipts?
For HSAs, no — but save them anyway. The IRS can audit you, and you'll need proof every withdrawal was for a qualified expense. For FSAs, your administrator will sometimes ask for receipts to verify card swipes.
- Can I use my HSA/FSA for someone not on my plan?
You can use it for your spouse and any tax dependents, even if they're on a different health plan. The expense just needs to be theirs.
- What's a Letter of Medical Necessity (LMN)?
A note from a healthcare provider stating that a borderline item is being recommended to treat a specific medical condition. Required to make items like massage therapy or weight loss programs eligible.