You can use an FSA card to pay for a wide range of medical, dental, and vision expenses that diagnose, treat, or prevent a health condition, including doctor copays, prescriptions, eyeglasses, dental work, many over-the-counter products, and supplies like bandages and thermometers. What the IRS excludes is anything cosmetic or aimed at general wellness rather than a specific medical purpose. The line between the two categories decides whether a swipe goes through cleanly or gets flagged for repayment, so it pays to know where your purchase sits before checkout.
Medical Care, Copays, and Prescriptions
Most face-to-face health care qualifies. That covers copays, deductibles, and coinsurance for doctor visits, hospital stays, and emergency room treatment. Specialist visits, lab work, X-rays, and annual physicals are eligible even when you feel fine at the appointment.1Internal Revenue Service. Publication 502 – Medical and Dental Expenses Prescription medications are eligible across the board.
Behavioral health belongs on the yes list too. Psychiatric care, psychotherapy, and psychoanalysis received as medical treatment can be paid from your FSA.1Internal Revenue Service. Publication 502 – Medical and Dental Expenses Physical therapy, chiropractic visits, and osteopathic care qualify when they are part of medical treatment.
Travel for medical care is reimbursable in specific ways. If you drive to an appointment, pharmacy, or hospital, the IRS 2026 standard medical mileage rate is 20.5 cents per mile, plus parking and tolls.2Internal Revenue Service. 2026 Standard Mileage Rates Bus, taxi, and ambulance fares count when the trip is primarily for medical care. A grocery run that happens to include a pharmacy stop does not.
Over-the-Counter Products
The rules on over-the-counter items loosened permanently under the CARES Act. You no longer need a prescription to use your FSA card on pain relievers, cold and flu medicine, allergy medication, antacids, and similar products pulled straight off the shelf. Menstrual care products — tampons, pads, liners, cups, and sponges — became permanently eligible under the same law.3Internal Revenue Service. IRS Outlines Changes to Health Care Spending Available Under CARES Act
Basic supplies have long been eligible: bandages, first aid kits, thermometers, blood pressure monitors, and glucose testing supplies. Sunscreen with an SPF of 15 or higher is widely accepted as an FSA purchase.
Wearable Health Devices
Wearables split into two buckets. Devices whose primary purpose is measuring diagnostic vital signs, such as blood pressure, blood oxygen, heart rate, or ECG readings, are generally eligible without extra paperwork. Trackers built mainly around steps, calories, or general fitness usually need a letter of medical necessity before your plan will reimburse them. Mixed-purpose devices come down to what the device is primarily for.
Vision, Hearing, and Dental
Prescription eyeglasses, contact lenses, and the cleaning and saline solutions that go with them are standard FSA purchases. Prescription sunglasses qualify when they correct vision, and LASIK and other corrective laser eye surgery are eligible.4FSAFEDS. Eligible Health Care FSA Expenses Reading glasses bought off the shelf are also covered.
Hearing aids qualify, along with the batteries, repairs, and maintenance needed to keep them working.1Internal Revenue Service. Publication 502 – Medical and Dental Expenses Given the price tags involved, paying with pre-tax funds saves real money.
Dental care is broadly covered: cleanings, fillings, extractions, braces, dentures, and fluoride treatments all qualify.1Internal Revenue Service. Publication 502 – Medical and Dental Expenses
Family and Dependent Purchases
Breast pumps and lactation supplies are explicitly eligible, though the IRS excludes extra bottles used only for food storage.1Internal Revenue Service. Publication 502 – Medical and Dental Expenses Baby health monitors and specialized thermometers can be purchased with FSA funds when they serve a medical purpose rather than general childcare.
Adult incontinence products, including briefs, pads, and protective underwear, are eligible when they manage the effects of a medical condition. Diapers follow the same logic: not eligible for general use, but eligible when needed to relieve a specific disease or condition.1Internal Revenue Service. Publication 502 – Medical and Dental Expenses
Your FSA covers eligible expenses for more than just you. Funds can pay for your spouse’s care regardless of whether they have separate insurance, and for your children under age 27, even if the child does not live with you, is not a student, or files their own tax return. Anyone you claim as a tax dependent qualifies, and so do people who would qualify as your dependent except that they filed a joint return, earned too much income, or you could be claimed on someone else’s return.5Internal Revenue Service. Publication 969 – Health Savings Accounts and Other Tax-Favored Health Plans Purchases for friends, coworkers, or relatives outside those categories are not eligible.
Items That Need a Letter of Medical Necessity
A category of dual-purpose items can qualify only if your doctor writes a letter of medical necessity (LMN) tying the purchase to a diagnosed condition. Without one on file, your plan administrator will deny the reimbursement. The most commonly requested LMN items:
- Exercise equipment or gym memberships, when a doctor prescribes a supervised exercise program to treat a specific condition such as obesity or for cardiac rehabilitation.
- Ergonomic chairs or special mattresses prescribed for a diagnosed back condition; reimbursement is often limited to the price difference between the specialized item and a standard version.
- Air purifiers or humidifiers prescribed to treat a respiratory condition like asthma or severe allergies.
- Vitamins and supplements a medical practitioner recommends to treat a specific diagnosed condition, not for general wellness.1Internal Revenue Service. Publication 502 – Medical and Dental Expenses
- Wigs prescribed for the mental health of someone who has lost hair due to disease or treatment such as chemotherapy.
- Special foods such as gluten-free or salt-free items, where only the cost difference between the specialty food and its standard equivalent is reimbursable, and only when a doctor prescribes the diet for a specific condition.
If you think an expense might qualify, ask your doctor before buying so the letter is in hand when you submit the claim.
What You Cannot Buy
The IRS draws a firm line at anything that improves appearance or supports general well-being rather than treating a medical condition. Ineligible categories include:
- Cosmetic procedures such as face lifts, hair transplants, electrolysis, liposuction, and teeth whitening. The exception is cosmetic surgery to correct a deformity from a congenital abnormality, an accident, or a disfiguring disease; breast reconstruction after cancer treatment qualifies.1Internal Revenue Service. Publication 502 – Medical and Dental Expenses
- General hygiene products like toothpaste, non-medicated shampoo, deodorant, and regular soap.
- General-purpose vitamins. A daily multivitamin taken for overall health does not qualify; only supplements prescribed for a specific diagnosed deficiency are eligible.1Internal Revenue Service. Publication 502 – Medical and Dental Expenses
- Health club dues, personal training, and fitness programs without a doctor’s prescription for a diagnosed condition.
- Health insurance premiums, including COBRA premiums, cannot be paid from a health care FSA.
If you accidentally swipe your FSA card on something ineligible, the amount is typically reclassified as taxable income. Your plan administrator may ask you to repay the funds or provide documentation proving the expense was valid. If neither happens by the end of the plan year, you may receive a Form 1099 reporting the amount as income. FSAs do not carry the 20 percent additional tax that applies to misused health savings account funds; the consequence is income tax on the improperly spent amount, not a separate penalty.6Office of the Law Revision Counsel. 26 USC 223 – Health Savings Accounts
One boundary worth naming: a health care FSA and a dependent care FSA are separate accounts. Your health care FSA cannot pay for daycare or summer camp, and a dependent care FSA cannot pay medical bills.7FSAFEDS. Explore Your Options
Keep Your Receipts
Your plan administrator can ask you to prove any FSA purchase was for a legitimate medical expense; this is called substantiation, and the IRS expects you to keep records.1Internal Revenue Service. Publication 502 – Medical and Dental Expenses When your administrator requests documentation, they usually want five details: the patient’s name, the provider or merchant name and address, the date of service, a description of what was provided or purchased, and the amount you were charged.
An explanation of benefits from your insurance company is often the easiest document to submit because it contains all of these. For over-the-counter purchases, keep the itemized store receipt showing the product name. A credit card statement or canceled check alone is generally not accepted because it does not describe what was purchased. If your administrator cannot verify an expense and you do not respond, the amount may be reclassified as taxable income.