FSA Eligible Expenses: What You Can (and Can't) Buy With Your Flexible Spending Account in 2025

A Flexible Spending Account (FSA) lets you set aside pre-tax dollars to pay for qualifying health expenses — which means every dollar you spend from it goes further than a dollar spent from your regular paycheck. But the list of what qualifies isn't always intuitive, and spending FSA funds on ineligible items can create a tax headache. Here's a clear breakdown of how eligibility works and what generally falls inside — and outside — the lines.

How FSA Eligibility Is Determined

The IRS sets the baseline rules. To qualify, an expense generally must be for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for affecting a structure or function of the body. That definition comes directly from IRS Publication 502, which is the authoritative source for FSA and HSA eligible expenses.

A few important layers complicate the picture:

• Your plan administrator has final say. Employers and FSA administrators may apply slightly different rules or require documentation for certain items.
• Some expenses require a Letter of Medical Necessity (LMN). Items that straddle the line between medical and personal use — like a standing desk for back pain — often need written confirmation from a doctor to qualify.
• The CARES Act expanded eligibility for over-the-counter (OTC) medications and menstrual care products, and those expansions remain in effect. You no longer need a prescription to use FSA funds on most OTC drugs.

✅ Expenses That Are Clearly FSA Eligible

Medical and Dental Care

These are the core of FSA spending and are almost universally covered:

• Doctor visits, specialist appointments, and urgent care copays
• Prescription medications
• Dental exams, cleanings, fillings, crowns, and orthodontia
• Vision exams, prescription eyeglasses, and contact lenses
• Surgery and hospital stays (patient cost-sharing)
• Mental health therapy and psychiatric care
• Physical therapy and chiropractic care
• Hearing aids and batteries

Over-the-Counter Medications and Health Products

Since the CARES Act, a wide range of OTC items qualify without a prescription:

• Pain relievers (ibuprofen, acetaminophen, aspirin)
• Allergy and cold medications
• Antacids and digestive aids
• Acne treatment products
• Sleep aids
• Feminine hygiene and menstrual care products
• Bandages, gauze, and first aid supplies
• Sunscreen (SPF 15 or higher with broad-spectrum protection)
• Reading glasses

Durable Medical Equipment and Supplies

• Blood pressure monitors
• Blood glucose monitors and diabetic testing supplies
• Nebulizers and CPAP equipment and supplies
• Wheelchairs, crutches, and walkers
• Breast pumps and lactation supplies

⚠️ Expenses That Sometimes Qualify (With Conditions)

Some items require a Letter of Medical Necessity from a licensed healthcare provider to be eligible:

The LMN process isn't difficult, but it does require proactive coordination with your doctor before you spend.

❌ Expenses That Are Not FSA Eligible

Some items feel health-related but don't pass the IRS test:

• Gym memberships and fitness equipment (unless tied to a specific medical condition with documentation — and even then, approval is inconsistent)
• Vitamins and supplements taken for general health (not to treat a diagnosed deficiency or condition)
• Cosmetic procedures like teeth whitening, hair removal, or elective plastic surgery
• Toiletries — toothpaste, shampoo, soap, and similar personal care products
• Health insurance premiums (generally not eligible through a standard FSA)
• Babysitting and childcare (those belong to a Dependent Care FSA, a separate account type)
• Medical marijuana, even where legal at the state level, because it remains a Schedule I substance under federal law

💡 FSA vs. HSA: The Eligibility Overlap

The eligible expense lists for FSAs and Health Savings Accounts (HSAs) are largely the same — both trace back to IRS Publication 502. The key differences are in who can open each account, contribution rules, and rollover provisions, not in what you can spend the funds on. If an expense qualifies for one, it almost always qualifies for the other.

How to Verify Before You Spend

Because administrators and plan documents vary, the safest approach before making a gray-area purchase:

1. Check your FSA administrator's eligibility list. Most major administrators maintain searchable databases of qualifying items.
2. Reference IRS Publication 502 for the authoritative federal-level definition.
3. Talk to your doctor if you think an item might qualify with medical documentation — getting an LMN before you buy is much easier than getting reimbursed after the fact.
4. Save your receipts. Even clearly eligible expenses may require itemized receipts if your account is audited.

The "Use It or Lose It" Factor

Standard FSAs are subject to the "use it or lose it" rule — funds that aren't spent by the plan year deadline (or a grace period/rollover your employer may offer) are forfeited. This makes understanding eligibility more urgent than it might seem: you need to spend the money on qualifying expenses, not discover after the fact that what you bought doesn't count.

Rollover limits and grace period rules are set by your employer within IRS guidelines, so those specifics will vary by plan.

What Shapes Your Specific Situation

Whether a particular expense is covered for you depends on:

• Your FSA plan documents and which administrator manages it
• Whether your employer has added any restrictions beyond the IRS baseline
• Whether you have documentation for conditionally eligible expenses
• Which type of FSA you have — Health Care FSA, Limited-Purpose FSA, or Dependent Care FSA each cover different categories entirely

The IRS sets the outer boundaries. Your plan sets the working reality. When in doubt, verify before you swipe.