Each year, roughly 22% of U.S. workers with flexible spending accounts forfeit hundreds of dollars in unused pre-tax funds, according to the 2023 FSA & HSA Benchmark Report from Devenir Group. Many of these people don’t realize that their FSA can cover more than just doctor’s copays, and others struggle to sort through the IRS’s strict eligibility rules. If you’re ready to stop leaving money on the table, this guide breaks down everything you need to know about What Items Are Eligible for Flex Spending, from daily healthcare staples to specialized medical gear, so you can use every dollar you set aside without wasting a cent.
What Counts as a Basic Eligible FSA Expense?
Flexible spending accounts use pre-tax dollars to offset out-of-pocket healthcare costs, so the IRS sets strict, clear guidelines for what qualifies. The core rule is that eligible flex spending items must be used to diagnose, treat, mitigate, or prevent a physical or mental health condition. You can’t use FSA funds for purely cosmetic purchases, like teeth whitening treatments or elective facials, as well as non-prescription vitamins that don’t come with a doctor’s note confirming a medical deficiency. You also can’t cover routine household items that don’t serve a healthcare purpose, like paper towels or laundry detergent, with your FSA dollars.
Now that we’ve covered the core eligibility rules, let’s dive into specific categories of eligible flex spending items, starting with over-the-counter medications and supplies.
Over-the-Counter Medications and Supplies
The CARES Act expanded FSA eligibility in 2020 to cover most over-the-counter (OTC) drugs and supplies without a prescription, a change that saved millions of Americans time and money. Before this update, you needed a doctor’s prescription for nearly all OTC items to use FSA funds, which made it harder to stock up on common healthcare staples.
Common eligible OTC medications include:
- Acid reducers like antacids or ranitidine
- Pain relievers like ibuprofen, acetaminophen, and aspirin
- Allergy medications like Claritin or Zyrtec
- Cold and flu remedies like cough syrup and throat lozenges
You can also use FSA funds for OTC medical supplies, like adhesive bandages, hydrocolloid dressings, digital thermometers, and hand sanitizer (when used to prevent infection, not just general cleaning). These items help treat or prevent common health conditions, making them eligible for reimbursement.
While most OTC items are now eligible, some still fall outside FSA rules. Here are a few common ineligible OTC products:
| Ineligible OTC Item | Reason for Exclusion |
|---|---|
| Teeth whitening strips | Cosmetic, no medical purpose |
| Vitamin C supplements without a doctor’s note | General wellness, no diagnosed deficiency |
| Mild over-the-counter acne treatments | Considered cosmetic skin care unless prescribed |
Next, let’s look at prescription medications and durable medical equipment, which are some of the most straightforward eligible FSA expenses.
Prescription Medications and Medical Devices
Prescription drugs are the most straightforward eligible flex spending items, as they’re explicitly designed to treat a diagnosed medical condition. This includes both brand-name and generic medications, as well as prescription-strength OTC drugs that require a doctor’s note. You can also use FSA funds to cover the cost of prescription refills and mail-order medications.
Durable medical equipment (DME) is another major category of eligible FSA expenses. DME refers to long-lasting items that are used for medical purposes and have no practical use for a healthy person. Common examples include wheelchairs, hospital beds, oxygen concentrators, and blood glucose monitors.
Other eligible prescription and DME items include:
- Prescription eyeglasses and contact lenses (including solution and protective cases)
- Hearing aids and hearing aid batteries
- Crutches, walkers, and canes
- Compression stockings prescribed by a doctor
You’ll need to keep a copy of your prescription and itemized receipt for IRS audits, and some FSA administrators require pre-approval for high-cost DME items like hospital beds or oxygen concentrators. Always check with your provider ahead of time to avoid rejected reimbursements.
Moving on to routine care that many people overlook, dental and vision expenses are major eligible flex spending categories.
Dental and Vision Care Expenses
Dental and vision care are two of the most common overlooked FSA-eligible expenses, and they can add up quickly over the course of a year. The IRS allows you to use FSA funds to cover most out-of-pocket dental and vision costs that aren’t fully covered by your insurance plan.
Eligible dental expenses include a wide range of services and products, such as:
- Professional cleanings, fillings, crowns, bridges, and extractions
- Dentures and partial denture plates
- Prescription fluoride treatments
- Orthodontic treatments like braces or Invisalign
You can use FSA funds for orthodontic treatments like braces or Invisalign, even if they’re marketed as cosmetic, because they correct medical conditions like misalignment that cause jaw pain or difficulty chewing. Vision care expenses covered by FSAs include annual eye exams, prescription eyeglasses, prescription sunglasses, contact lens solution, and laser eye surgery (like LASIK or PRK).
Keep in mind that you can’t use FSA funds for cosmetic dental or vision procedures that don’t treat a medical condition, like teeth whitening or decorative contact lenses. You also can’t cover routine vision care for non-prescription sunglasses or basic reading glasses without a doctor’s note.
Beyond physical health, mental health and behavioral health services are also eligible for FSA reimbursement, a relatively new expansion of IRS rules that has helped millions of Americans access care.
Mental Health and Behavioral Health Expenses
The IRS expanded FSA eligibility to cover mental health services in recent years, recognizing that mental health care is a critical part of overall wellness. According to the CDC, 1 in 5 U.S. adults experience mental illness each year, so this expansion was a major win for millions of Americans. Eligible mental health expenses must be for the diagnosis, treatment, or mitigation of a diagnosed mental health condition.
Common eligible mental health expenses include therapy sessions with a licensed therapist, psychologist, or psychiatrist, prescription psychiatric medications, and co-pays for inpatient or outpatient mental health treatment. You can also use FSA funds for support groups that are specifically designed to treat a diagnosed mental health condition.
One common question about mental health FSA eligibility is whether wellness apps or meditation subscriptions are covered. The short answer is no, unless the app or subscription is prescribed by a mental health professional as part of your personalized treatment plan. For example, if your doctor prescribes a meditation app to help manage chronic anxiety, you can use FSA funds to pay for the subscription.
You can’t use FSA funds for general wellness activities that aren’t tied to a diagnosed mental health condition. Here’s a quick list of common ineligible mental health-related expenses:
- Yoga classes unless prescribed by a doctor for a specific physical ailment
- Self-help books without a written treatment plan from a provider
- Gym memberships for general wellness
- Meditation apps without a prescription
Always get a written note from your provider confirming that the service is part of your treatment plan to avoid rejected reimbursements.
Not all flex spending accounts are for medical costs, though—dependent care FSAs are a separate type of pre-tax account with their own unique eligibility rules.
Dependent Care Flexible Spending Account Eligible Expenses
Dependent care FSAs (DCFSA) are designed to help you save pre-tax dollars on care for qualifying dependents, so you can work or look for work. A qualifying dependent includes a child under the age of 13, a disabled spouse, or a disabled dependent who can’t care for themselves and lives with you for at least half the year.
Common eligible dependent care expenses include:
- Daycare centers and in-home daycare providers
- After-school programs for school-age children
- Baby-sitting services while you work (not for vacation or personal time)
- Preschool and pre-kindergarten programs (but not kindergarten or higher grades)
In 2024, the IRS sets the maximum annual contribution limit for dependent care FSAs at $5,000 per household, or $2,500 if you’re married and filing separately. You also can’t contribute more than your earned income for the year, so if you earn $3,000 annually, you can only contribute up to $3,000 to your DCFSA.
Some ineligible dependent care expenses include summer camp (unless it’s a supervised program tied to your work schedule), tutoring for a child who doesn’t have a disability, and care provided by a spouse or a child under the age of 19. You’ll need to provide your FSA administrator with the provider’s name, tax ID number, and proof of payment to qualify for reimbursement.
Of course, it’s just as important to know what items are *not* eligible for flex spending, to avoid accidental overspending or rejected reimbursements.
Common Ineligible Flex Spending Items
Even within eligible categories, there are plenty of common purchases that the IRS deems ineligible for FSA reimbursement. These items fall into four main categories: cosmetic procedures, general wellness products, household goods, and non-qualifying travel or care expenses.
Here’s a breakdown of common ineligible flex spending items by category:
| Expense Category | Ineligible Items |
|---|---|
| Cosmetic Procedures | Teeth whitening, Botox, elective facials, laser hair removal |
| General Wellness | Vitamins without a doctor’s note, gym memberships, generic weight loss programs |
| Household Goods | Basic toothbrushes, hand sanitizer for general cleaning, paper towels |
| Travel & Daily Care | Flights to medical facilities (unless travel is required for treatment), vacation babysitting |
You also can’t use FSA funds for expenses that are fully covered by your insurance plan, unless your insurance requires you to pay a co-pay or deductible first. For example, if your insurance covers 100% of your doctor’s visits, you can’t use FSA funds to pay for those visits, but you can use FSA funds for the required co-pay.
If you’re ever unsure whether an item or service is eligible for FSA reimbursement, the best way to check is to reference the IRS’s official FSA eligibility list or contact your FSA administrator directly. Most administrators also have a search tool on their website that lets you look up specific items to see if they’re covered.
At the end of the day, flex spending accounts are designed to help you save money on qualified healthcare and dependent care costs, but you have to use the funds before the annual deadline (usually the end of the year, though some plans offer a grace period of up to 2.5 months into the next year). The key to maximizing your FSA is understanding exactly what items are eligible, from over-the-counter pain relievers to therapy sessions to in-home daycare for your young child. By planning ahead and keeping track of your receipts, you can avoid forfeiting any of the pre-tax dollars you worked hard to set aside.
Now that you have a complete breakdown of what items are eligible for flex spending, take 10 minutes this week to review your current FSA balance and map out your remaining expenses for the year. Jot down any needed medications, dental cleanings, or dependent care costs, and schedule any required appointments or orders ahead of time to avoid rushing at the last minute. If you have questions about your specific plan’s rules or eligibility, reach out to your HR department or FSA administrator—they’re there to help you make the most of your pre-tax contributions.