Health care costs could make anyone feel sick: In 2022, the average American spent over $13,000 on them.1 Luckily, some employers offer benefits that could help you save for those expenses, like health savings accounts (HSAs) and flexible spending accounts (FSAs). Still, it can be hard to know what health care expenses you can pay for with those tax-advantaged dollars. Here are some common qualified medical expenses that are HSA- and FSA-eligible, and other expenses that aren't.
What are HSA- or FSA-eligible expenses?
HSAs and FSAs both let you save money before it's been taxed to pay for qualified medical expenses. Any withdrawals are also tax-free, but only if you use them to pay for qualified medical expenses.2
An IRS document called Publication 502 determines what expenses are qualified. In the fine print, it defines qualified expenses as costs that are primarily for the purpose of alleviating or preventing a physical or mental disability or illness. This could include treatments that help diagnose, cure, mitigate, treat, or prevent illness or disease, or treatments affecting any part or function of the body. However, some of those expenses may require additional documentation, like a letter from a health professional. And these expenses can be for yourself, your spouse, or your qualified dependents, but they can't be expenses already covered by your health plan.
Yes, that's all a little confusing—so here's an item-by-item breakdown of HSA- and FSA-eligible expenses.
Common qualified medical expenses
These common medical expenses are HSA- and FSA-eligible.
Doctor visits and hospital stays: Costs for doctors, surgeons, or specialists can be paid for from your HSA or FSA. These can include costs from hospital services, surgery, and even lab expenses.
Prescription drugs: Typically, any medicine prescribed by a health care provider is HSA- and FSA-eligible. That could take the sting out of your next pharmacy visit.
Medical equipment: You can use your HSA or FSA to pay for most medically necessary equipment, like crutches, wheelchairs, or even CPAP machines for sleep apnea.
Preventive care: Preventive care is often covered by health plans but if not, you can also use funds from these accounts to pay for preventive care appointments and therapies. Vaccinations, physical exams, and screenings such as mammograms and colonoscopies are all eligible expenses for HSAs and FSAs.
Physical therapy: Treatments provided by licensed chiropractors and physical therapists are HSA- and FSA-eligible.
Dental: Your HSA or FSA funds can be used to pay for routine dental needs, like cleanings and fluoride treatments, or larger dental costs, like braces.
Vision: Even though your health plan may not cover a new pair of eyeglasses or your contact lens solution, both those expenses as well as other general vision costs can be paid for with HSA or FSA dollars. Laser eye surgery is an eligible expense too.
Family planning: You can use funds in your HSA or FSA to help offset the costs of birth control pills, fertility treatments, and pregnancy tests.
Health care–related travel: If you have to travel for surgery or a medical treatment (even if that travel is just a ride-share), your HSA or FSA funds can help get you there. Plus, those funds can help pay for hotel and meal expenses during your stay.
Postpartum care: A new addition can mean new additional costs. Your HSA or FSA can help pay for supplies related to breastfeeding, including a breast pump.
Common qualified over-the-counter expenses
If you didn't know you could use your HSA or FSA to pay for some over-the-counter medications and products, that could be because it's a recent change. The CARES Act passed in 2020 expanded the list of qualified medical expenses to include over-the-counter items. Some of the most common qualified over-the-counter expenses include:
Pain relievers: Both the generic and name-brand versions of common pain relievers such as ibuprofen, acetaminophen, and aspirin are covered. Kids' versions of these are also HSA- and FSA-eligible expenses.
Cold and flu medications: Drugs for treating cold and flu symptoms, including decongestants, cough syrups, and cough drops are eligible to be paid for out of your HSA or FSA.
Allergy medications: You can use your HSA or FSA to pay for many common allergy-relief meds, like antihistamines. That's nothing to sneeze at.
Digestive and heartburn aids: You can buy products like antacids, laxatives, and anti-diarrheal medicines with money from your HSA or FSA.
First-aid kits and supplies: Your HSA and FSA funds can be used to pay for common first-aid supplies like bandages, antibiotic creams and ointments, and thermometers. Many premade first-aid kits are HSA- and FSA-eligible too.
Menstrual-care products: Tampons, pads, period underwear, and other menstrual items are HSA- and FSA-eligible.
Acne medication: Some acne medications and treatments, like acne cleansers, gels, creams, and serums, can be paid for with your HSA and FSA. You can even use your HSA and FSA funds to pay for at-home light therapy kits.
Sunscreen: Yes, even certain sunscreens are HSA- and FSA-eligible. They just must offer broad-spectrum protection (blocking both UVA and UVB rays) and have an SPF of 15+.
Expenses that may qualify with a letter of medical necessity
Although a lot of health care products and services qualify for reimbursement from your HSA or FSA (like those mentioned before), some expenses require a letter of medical necessity from a health care provider in order to be eligible expenses. Health care providers can include doctors, chiropractors, nurses, physical and occupational therapists, and psychologists or psychiatrists.
A letter of medical necessity is a document from your health care provider that typically states your diagnosis, your need for a certain therapy or medical device, and the duration of your treatment.
Some common health care expenses that may be HSA- or FSA-eligible with a letter of medical necessity are weight-loss programs, special goods and supplements, accessibility home modifications, and lead-based paint removal.
What are FSA- and HSA-ineligible expenses?
Even though many common health-related costs are HSA- and FSA-eligible, there are some that don't qualify. According to the IRS, generally any expense that doesn't meaningfully promote the body's proper function or prevent or treat illness or disease is not HSA- or FSA-eligible. Some common expenses that typically aren't eligible include the following.
General fitness expenses: Costs for items that are beneficial for your general health but are not specifically for a medical condition or listed in a letter of medical necessity are ineligible. These could include gym memberships and workout equipment.
Vitamins and supplements: Typically, vitamins and supplements are not eligible expenses. However, if you have a medical condition that requires you to take a vitamin or supplement, a letter of medical necessity could make these expenses eligible.
Non-prescription sunglasses: Any eyewear that doesn't require a prescription doesn't qualify, regardless of how cool those shades might look.
Personal hygiene products: Most everyday hygiene products like toothpaste, deodorant, and shampoo don't qualify as eligible expenses.
Want to know whether something else is eligible to be covered by HSA or FSA dollars? If you have a Fidelity HSA, you can use the Fidelity Health® App to find out fast. Just scan a product's barcode to reveal whether it's a qualified medical expense.