If you’re staring at a Flexible Spending Account balance and a deadline, the most expensive FSA eligible items are medical home modifications, service animals, orthodontia and dental implants, LASIK, hearing aids, and high-cost home medical devices like CPAP machines, AEDs, and continuous glucose monitors. For 2026, the contribution ceiling is $3,400 and the maximum carryover your plan can allow is $680, so a single well-chosen purchase can rescue money that would otherwise be forfeited.1FSAFEDS. New 2026 Maximum Limit Updates
One boundary worth setting up front: every item below has to qualify as medical care under federal tax law, meaning it must diagnose, treat, or prevent a disease, or affect a structure or function of the body.2Office of the Law Revision Counsel. 26 US Code 213 – Medical, Dental, Etc., Expenses Purchases made for general health or comfort don’t count, no matter how much they cost.3Internal Revenue Service. Frequently Asked Questions About Medical Expenses Related to Nutrition, Wellness and General Health Your plan may offer either a grace period of up to two and a half months or a carryover of up to $680, but not both. If it offers neither, unspent dollars simply disappear.4Internal Revenue Service. Notice 2013-71 – Modification of Use-or-Lose Rule for Health Flexible Spending Arrangements
Medical Home Modifications
Home improvements installed for a medical reason are the single largest FSA-eligible category. IRS Publication 502 lets you include the cost of special equipment installed in your home when its main purpose is medical care.5Internal Revenue Service. Publication 502 – Medical and Dental Expenses The deductible amount is the total cost minus any increase in your property’s value. Certain modifications are treated as never increasing home value at all, so the full cost qualifies:
- Entrance and exit ramps
- Widened doorways and hallways
- Bathroom railings, support bars, and grab bars
- Lowered kitchen cabinets and equipment
- Porch lifts and stairway lifts
- Modified fire alarms and smoke detectors
- Grading the ground for wheelchair access
Stairlifts run $2,500 to $12,000 depending on whether the staircase is straight or curved. Walk-in bathtubs, which serve people with mobility limitations, can cost $9,500 to $28,000 installed. Elevators generally do add value to a home, so only the portion of the cost exceeding that added value qualifies.5Internal Revenue Service. Publication 502 – Medical and Dental Expenses Ongoing operation and maintenance of a medically necessary improvement also qualifies, even when the original installation only partially qualified.
Service Animals
A fully trained service dog can cost $10,000 to $50,000 depending on the task training involved. Publication 502 lets you include the costs of buying, training, and maintaining a guide dog or other service animal that assists someone with a visual, hearing, or other physical disability.5Internal Revenue Service. Publication 502 – Medical and Dental Expenses Ongoing food, grooming, and veterinary care qualify as long as they keep the animal healthy enough to perform its duties. For someone who needs a medical alert dog or mobility assistance animal, this is potentially the largest FSA-eligible expense you’ll ever encounter.
Orthodontia and Dental Implants
Dental work is one of the most reliable ways to absorb a large FSA balance. Publication 502 covers amounts paid for the prevention and alleviation of dental disease and specifically lists braces, extractions, dentures, and fillings.5Internal Revenue Service. Publication 502 – Medical and Dental Expenses Teeth whitening is explicitly excluded.
Traditional metal braces typically cost $3,000 to $6,000. Clear aligners like Invisalign run $3,500 to $8,000. Lingual braces placed behind the teeth can reach $8,000 to $13,000. Because orthodontic treatment usually spans multiple years, you can allocate FSA contributions across plan years to cover payments as they come due. Only the portion not covered by dental insurance qualifies for reimbursement.
Single dental implants average around $2,100 per tooth, and a full set of implant-supported dentures can easily reach five figures. They’re eligible when they replace missing teeth or address structural dental problems. If you’re planning implant work, coordinate with your dentist’s payment schedule so the charges land inside your plan year.
Laser Eye Surgery
LASIK and similar corrective procedures are explicitly eligible. Publication 502 covers amounts paid for eye surgery to treat defective vision, including laser eye surgery.5Internal Revenue Service. Publication 502 – Medical and Dental Expenses The cost typically runs $1,500 to $3,500 per eye, putting both eyes between $3,000 and $7,000. Because that usually exceeds a single year’s FSA balance, many people split the cost between FSA funds and out-of-pocket payment. Pre-operative evaluations and post-operative medications related to the surgery also qualify. Correcting a refractive error is inherently medical, so no Letter of Medical Necessity is required, but keep your surgical receipt and itemized bill.
Hearing Aids
Hearing aids are eligible, and Publication 502 also covers batteries, repairs, and maintenance.5Internal Revenue Service. Publication 502 – Medical and Dental Expenses Since the FDA authorized over-the-counter hearing aids in 2022, prices have widened dramatically. OTC models start around $300 per pair. Prescription hearing aids from an audiologist run $2,000 to $6,000 per pair, enough to wipe out most or all of an FSA balance. No Letter of Medical Necessity is needed since hearing aids have no plausible non-medical use.
Home Medical Devices
Several categories of home medical equipment can absorb a substantial FSA balance in a single purchase or across recurring supply orders.
Automated External Defibrillators
A home AED typically costs $1,500 to $2,500. AEDs qualify as medical equipment because they diagnose and treat cardiac arrhythmias.2Office of the Law Revision Counsel. 26 US Code 213 – Medical, Dental, Etc., Expenses If someone in your household has a history of cardiac events, a physician’s recommendation strengthens the case, though AEDs are generally accepted without dispute.
CPAP Machines
Continuous positive airway pressure machines treat obstructive sleep apnea and generally cost $700 to $1,100 out of pocket. Higher-end auto-adjusting models with humidifiers and advanced data tracking push toward the top of that range. A sleep study diagnosis and prescription are standard requirements before your administrator will reimburse the purchase. Replacement masks, tubing, and filters are also eligible.
Continuous Glucose Monitors
CGM systems are a recurring high-cost expense. Monthly sensor and transmitter supplies run roughly $160 to $500 without insurance, adding up to $2,000 to $6,000 over a year. Some CGMs are now available over the counter, but your administrator will still want documentation tying the device to management of a diagnosed condition like diabetes. Recurring claims attract more scrutiny than one-time purchases, so keep your prescription and monthly receipts organized.
Therapeutic Equipment That Needs a Letter of Medical Necessity
Some high-priced items sit in a gray zone because they have obvious non-medical uses. Professional-grade percussion therapy devices generally cost $400 to $600. Massage chairs and adjustable hospital-grade beds can exceed $3,000. Orthopedic mattresses fall in the same category.
For any of these, your administrator will require a Letter of Medical Necessity from a licensed provider naming the specific diagnosis, explaining why standard furniture or equipment cannot provide the same therapeutic benefit, and stating the expected duration of treatment.6FSAFEDS. Letter of Medical Necessity Form Conditions like severe fibromyalgia, degenerative disc disease, chronic myofascial pain, or a documented injury are typical justifications. Without that documentation, expect a denial. Buying a percussion device because your shoulders are tight after desk work counts as general health and doesn’t qualify.3Internal Revenue Service. Frequently Asked Questions About Medical Expenses Related to Nutrition, Wellness and General Health
Premium Prescription Eyewear
Prescription eyewear is one of the simplest FSA expenses, and it’s easy to spend several hundred dollars on a single pair. Designer prescription frames run $400 to $800, and high-index lenses or photochromic coatings can add $200 to $400.7FSAFEDS. Eligible Health Care FSA Expenses Prescription sunglasses qualify as long as they correct a refractive error. Buying two pairs of prescription glasses near the end of a plan year is one of the easiest ways to drain a remaining balance.
Non-prescription blue light glasses and reading magnifiers sold without a prescription generally don’t qualify. The lenses must correct a diagnosed vision problem. Upgrades like progressive lenses, anti-reflective coatings, and scratch-resistant treatments are all eligible when attached to a corrective prescription.
Family Health and Skincare Technology
Breast Pumps and Lactation Supplies
High-end wearable breast pumps cost $400 to $600 and are explicitly eligible. Publication 502 covers breast pumps and supplies that assist lactation, though it excludes excess bottles used purely for food storage.5Internal Revenue Service. Publication 502 – Medical and Dental Expenses No Letter of Medical Necessity is needed.
Fertility Monitors
Fertility tracking devices range from about $150 to $300 and qualify for reimbursement. Wearable sensors and hormone-based ovulation monitors both fit within the statutory definition of medical care because they relate to a reproductive function of the body.2Office of the Law Revision Counsel. 26 US Code 213 – Medical, Dental, Etc., Expenses
Light Therapy Devices
LED and light therapy masks designed to treat diagnosed dermatological conditions like cystic acne or psoriasis typically cost $350 to $500. Eligibility hinges on whether the device is treating a medical condition rather than serving as a cosmetic tool. A dermatologist’s treatment plan linking the device to a specific diagnosis is the clearest path to reimbursement. Without it, expect a denial, because administrators know these products are heavily marketed for anti-aging.
Documentation That Protects Your Reimbursement
Every expensive FSA purchase should be backed by documentation before you buy, not after your claim gets questioned. For items with an obvious medical purpose like prescription eyeglasses, hearing aids, or CPAP machines, keep the prescription and an itemized receipt.
For dual-purpose items like mattresses, massage chairs, percussion therapy devices, and light therapy masks, get a Letter of Medical Necessity from a licensed provider before the purchase. It should include your diagnosis, an explanation of why the item is medically required, and the expected duration of treatment.6FSAFEDS. Letter of Medical Necessity Form Retroactive letters raise red flags with administrators and auditors.
For home modifications, keep a record of the property’s appraised value before and after the improvement. If the modification doesn’t add value, like grab bars or a widened doorway, the full cost is a medical expense.5Internal Revenue Service. Publication 502 – Medical and Dental Expenses If it does add value, like an elevator, only the excess qualifies. A real estate appraisal or a written contractor’s assessment gives you the evidence you need if the IRS ever asks.
Check with your specific plan administrator before any purchase over a few hundred dollars. FSA plans can impose their own restrictions on top of IRS rules, and a $3,000 surprise denial is a much worse outcome than a five-minute phone call.