FSA and HSA eligible expenses are medical, dental, and vision costs that you can pay for using pre-tax dollars from a Flexible Spending Account (FSA) or Health Savings Account (HSA). The IRS defines these as costs related to the diagnosis, cure, treatment, or prevention of disease, plus anything that affects a structure or function of the body. The list is broader than most people realize, covering everything from therapy copays and sunscreen to continuous glucose monitors and home accessibility modifications.
How FSAs and HSAs Work
Both accounts let you set aside money before taxes to pay for qualified medical expenses, which lowers your taxable income. The mechanics differ in important ways, though. An FSA is tied to your employer’s benefits plan. For 2025, you can contribute up to $3,300 per year. The biggest catch: most of that money expires if you don’t use it. Your employer may offer a grace period of a few extra months, or a carryover option that lets you roll up to $660 of unused funds into the next year, but only if you re-enroll.
An HSA pairs with a high-deductible health plan and has higher contribution limits: $4,300 for individual coverage or $8,550 for family coverage in 2025. Unlike an FSA, your HSA balance rolls over indefinitely and the account stays with you if you change jobs. You own it like a bank account, and unused funds can even be invested to grow over time.
Medical Services That Qualify
The core of eligible spending is straightforward: visits to doctors, surgeons, dentists, chiropractors, osteopaths, psychiatrists, and psychologists all qualify. So do hospital stays, nursing services, and ambulance rides. Physical therapy, mental health therapy, and psychiatric care are all eligible with a detailed receipt.
Prescription medications and insulin are covered. And since the CARES Act took effect in 2020, over-the-counter medications no longer need a prescription to be reimbursable. That includes pain relievers, allergy medicine, cold remedies, antacids, and similar drugstore staples.
Dental and Vision Expenses
Dental coverage goes well beyond emergency work. Cleanings, sealants, fluoride treatments, X-rays, fillings, braces, extractions, and dentures are all eligible. Vision expenses include eye exams, prescription eyeglasses, contact lenses, saline solution, and even laser eye surgery.
Items Most People Don’t Know About
Several everyday purchases qualify that catch people off guard:
- Sunscreen: Broad-spectrum sunscreen with SPF protection is eligible as a preventive health product.
- Menstrual care products: Tampons, pads, liners, cups, and sponges became eligible under the CARES Act for any amounts paid after December 31, 2019.
- First aid supplies: Bandages, thermometers, and blood pressure monitors qualify.
- Diagnostic devices: Blood sugar test kits and similar home monitoring tools are covered.
- Acne and eczema treatments: Skincare products with active ingredients like benzoyl peroxide, salicylic acid, or colloidal oatmeal can qualify when used to manage a specific skin condition.
- Transportation to medical care: Bus, taxi, train, or plane fares for medical appointments are eligible, along with out-of-pocket car expenses like gas or the standard medical mileage rate.
- Home modifications: If a modification’s main purpose is medical care, expenses like entrance ramps, widened doorways, and bathroom modifications qualify. These are intended for situations like accommodating a wheelchair or making a home accessible for someone with a chronic condition.
Wearable Devices and Health Tech
Specialized medical devices like continuous glucose monitors and FDA-cleared heart monitors (such as the KardiaMobile for detecting irregular heart rhythms) are HSA and FSA eligible. Blood pressure cuffs, whether traditional or smart versions like the Omron HeartGuide, also qualify.
Consumer fitness trackers and smart rings occupy a gray area. Devices like the Oura Ring or Apple Watch can qualify, but only with a Letter of Medical Necessity from your healthcare provider. Your doctor needs to document that continuous health monitoring is medically necessary for a specific condition you have, such as a cardiovascular issue, diabetes, sleep apnea, or a mental health disorder. Without that letter, a general-purpose fitness tracker is considered a personal expense.
Items That Require a Letter of Medical Necessity
Some expenses fall into a “maybe” category. They aren’t automatically eligible, but they become reimbursable if your medical provider writes a Letter of Medical Necessity confirming the item or service treats a specific diagnosed condition. Common examples include:
- Vitamins and supplements prescribed for a deficiency or medical condition
- Weight loss programs recommended to treat obesity or a related diagnosis
- Fitness trackers and smart rings used to monitor a chronic condition
- Massage therapy prescribed for a musculoskeletal condition
- Meditation devices like EEG headbands used for a mental health diagnosis
The letter typically needs to come from a licensed provider, name the condition being treated, and explain why the specific product or service is medically necessary. Keep this documentation on file; your plan administrator can request it at any time.
What Doesn’t Qualify
The IRS draws a firm line at anything cosmetic or related to general health and wellness rather than treating or preventing a specific medical condition. Teeth whitening, cosmetic surgery (like facelifts or liposuction performed for appearance), and general gym memberships are not eligible. Toiletries, most cosmetics, and nutritional supplements taken for general well-being also fall outside the rules.
The simplest test: if the expense treats, prevents, or diagnoses a medical condition, it likely qualifies. If it’s purely for appearance or general fitness without a medical directive, it doesn’t.
Key Differences Between FSA and HSA Eligibility
The list of qualified medical expenses is nearly identical for both account types, since both follow the same IRS definition. The practical differences are about the accounts themselves, not what you can buy with them.
FSAs are “use it or lose it” accounts with lower contribution caps ($3,300 in 2025). They work best if you can predict your medical spending for the year. If your employer offers a carryover, you get a small cushion of up to $660, but anything beyond that disappears. HSAs have higher caps ($4,300 individual, $8,550 family in 2025), no expiration on funds, and the flexibility to invest your balance. The tradeoff is that you need a high-deductible health plan to open one.
One notable difference: HSA funds can be used to pay for qualified long-term care insurance premiums, subject to age-based limits. FSAs generally cannot cover insurance premiums. Both accounts let you pay for eligible expenses incurred by your spouse and dependents, not just yourself.
How to Check Before You Buy
Many retailers now label products as “FSA/HSA eligible” on their websites, and dedicated FSA stores exist online. But eligibility can vary depending on your specific plan’s rules, so the safest approach is to check your plan administrator’s expense list. Most FSA and HSA providers maintain searchable databases of eligible items. When in doubt, buy the item, save your receipt with a detailed description, and submit it for reimbursement. If the item falls in the gray area, get that Letter of Medical Necessity before purchasing to avoid a denied claim.