HSA and FSA eligible expenses are medical, dental, and vision costs that you can pay for using pre-tax dollars from a Health Savings Account (HSA) or Flexible Spending Account (FSA). Both account types cover the same core categories of expenses, as defined by the IRS: anything used to diagnose, cure, treat, or prevent disease, or that affects a structure or function of the body. The list is broader than most people realize, covering everything from therapy sessions to sunscreen.
How HSAs and FSAs Work
Both accounts let you set aside money from your paycheck before taxes are taken out, then use that money to pay for qualifying health expenses. The tax savings are real: depending on your tax bracket, you effectively get a 20% to 35% discount on those purchases. But the two accounts have important structural differences that affect how you use them.
An HSA is yours permanently. You own the account, the money rolls over every year, and it stays with you if you change jobs or retire. For 2025, you can contribute up to $4,300 for individual coverage or $8,550 for family coverage. The catch is that you can only open an HSA if you’re enrolled in a high-deductible health plan.
An FSA is tied to your employer. You can contribute up to $3,300 in 2025, but the money generally follows a “use it or lose it” rule. Some employers offer a grace period or let you carry over up to $660 into the next year, but anything beyond that is forfeited. If you leave your job, unspent FSA funds typically go back to your employer.
Medical Services That Qualify
Most services you’d receive at a doctor’s office, hospital, or clinic are eligible. This includes office visits, lab work, annual physicals, surgeries, X-rays, and preventive screenings like mammograms and colonoscopies. Vaccinations are covered. So are ambulance rides and most transportation costs to get medical care, including bus, taxi, or plane fares. If you drive yourself, you can claim 21 cents per mile for 2025.
Fertility treatments, including in vitro fertilization, are eligible. Chiropractic care, acupuncture, and physical therapy all qualify. Pregnancy test kits and breast pumps with supplies are covered too.
Mental Health and Therapy
Psychiatric care, psychologist visits, and psychoanalysis are all eligible expenses. Therapy for treating a medical condition qualifies, though your plan may require a letter of medical necessity from your doctor along with a detailed receipt. Speech therapy and occupational therapy related to a medical condition or disability are also covered with documentation. Even massage therapy and light therapy qualify when used to treat a diagnosed condition.
Dental and Vision Expenses
Dental coverage goes well beyond cleanings. Fillings, extractions, braces, bridges, dentures, dental sealants, and fluoride treatments are all eligible. Cosmetic dental procedures are the main exception.
For vision, eligible expenses include eye exams, prescription eyeglasses, contact lenses, contact lens solution, and laser eye surgery like LASIK. If you pay copays, coinsurance, or deductibles for dental or vision care, those out-of-pocket costs are eligible too.
Over-the-Counter Products You Can Buy
Since the CARES Act took effect in 2020, over-the-counter medications no longer require a prescription to be eligible. This opened up a wide range of drugstore purchases:
- Pain relievers: ibuprofen, acetaminophen, aspirin, including children’s versions
- Cold and flu medicines: decongestants, cough syrups, cough drops
- Allergy medications: antihistamines and related relief products
- Digestive aids: antacids, laxatives, anti-diarrheal medicines
- Acne treatments: cleansers, gels, creams, and at-home light therapy kits
- Menstrual products: tampons, pads, cups, period underwear
- Sunscreen: broad-spectrum with SPF 15 or higher (tanning lotions without sunscreen do not qualify)
Medical Equipment and Supplies
First-aid supplies like bandages, antibiotic ointments, and premade first-aid kits are eligible. So are thermometers, blood pressure monitors, glucose meters, home urine test kits, and ovulation predictor kits. Larger medical equipment qualifies as well: crutches, wheelchairs, hearing aids (including batteries and repairs), CPAP machines, oxygen equipment, and prosthetics.
A few less obvious items also make the list. Humidifiers, air purifiers, hand sanitizer, face masks, latex gloves, and disinfecting wipes are all reimbursable. Pill cutters, pill storage containers, and oral syringes for dispensing medication count too.
What Doesn’t Qualify
The IRS draws a clear line: expenses must treat or prevent a specific medical condition. Anything “merely beneficial to general health” is excluded. That means general-purpose vitamins and supplements don’t qualify unless prescribed for a diagnosed deficiency. Gym memberships, cosmetic surgery (unless it corrects a deformity from disease, accident, or birth defect), teeth whitening, and health club dues are all ineligible.
Toiletries and personal care items like shampoo, toothpaste, and moisturizers without a medicinal purpose don’t count. Tanning lotions without sun protection are explicitly excluded. And any procedure that’s purely cosmetic, like Botox for wrinkle reduction, falls outside the eligible category.
How to Actually Use Your Funds
Most HSA and FSA accounts come with a debit card linked directly to your balance. Many retailers and pharmacies flag eligible items at checkout, making it easy to pay with your account card without filing paperwork. For services like doctor visits or therapy, you’ll typically pay with your card and keep the receipt.
If you pay out of pocket first, you can submit a claim for reimbursement. With an HSA, there’s no deadline for reimbursement, so you can pay now and reimburse yourself years later. FSA reimbursements need to happen within the plan year (plus any grace period your employer offers). Keep detailed receipts for anything that might require documentation, especially therapy, medical equipment, or items that could be mistaken for personal care products.
When eligibility is uncertain for a specific item, the safest approach is to check your plan administrator’s list of eligible expenses or look for the “HSA/FSA eligible” label that many online and in-store retailers now display on qualifying products.