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What Counts as an FSA-Eligible Expense

A health FSA reimburses medical care your plan lists, plus over-the-counter medicine and menstrual care products. Insurance premiums are excluded.

published 2026-09-07 · figures checked 2026-09-07

A health FSA reimburses the medical care your plan lists, which generally tracks the medical and dental expense deduction. Over-the-counter medicine and menstrual care products are covered on top of it. Insurance premiums are not.

The FSA deadline calculator works on dates and balances rather than receipts, so this page covers the other half: what the money may be spent on, and on which date the spending counts.

The definition your plan starts from

Publication 969 sets the boundary in one sentence: “Qualified medical expenses are those specified in the plan that would generally qualify for the medical and dental expenses deduction.”

That deduction is defined in Publication 502: medical expenses “are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease and for the purpose of affecting any part or function of the body,” and they “must be primarily to alleviate or prevent a physical or mental disability or illness.”

Publication 502 also states the exclusion that catches most disputed items. Medical expenses “don’t include expenses that are merely beneficial to general health, such as vitamins or a vacation.”

Where the FSA list is wider than the deduction

The two lists are not identical, and the difference runs both ways. On the deduction side, Publication 502 says: “Except for insulin, you can’t include in medical expenses amounts you pay for a drug that isn’t prescribed.”

Publication 969 says something different for a health FSA: “Expenses incurred for over-the-counter medicine (whether or not prescribed) and menstrual care products are considered medical care and are considered a covered expense.”

The divergence has a date and two statutes behind it. Section 9003(c) of the Affordable Care Act added §106(f) to the Code, headed “Reimbursements for Medicine Restricted to Prescribed Drugs and Insulin”, for expenses incurred in taxable years beginning after December 31, 2010.

CARES Act §3702(c), in Public Law 116-136, struck that subsection and replaced it: “expenses incurred for menstrual care products (as defined in section 223(d)(2)(D)) shall be treated as incurred for medical care.” The section is titled “Inclusion of certain over-the-counter medical products as qualified medical expenses”, and §3702(d)(2) applies the change “to expenses incurred after December 31, 2019.”

The statute defines the term rather than leaving it to a vendor: a menstrual care product is “a tampon, pad, liner, cup, sponge, or similar product used by individuals with respect to menstruation or other genital-tract secretions.”

Where the FSA list is narrower

Publication 969 lists three things a health FSA may not reimburse:

Notice 2013-71 restates the first two when it describes what carried-over money can pay for: “certain section 213(d) medical expenses (excluding health insurance, long-term care services or insurance).”

Cosmetic work is outside the definition on both sides. Publication 502: “Generally, you can’t include in medical expenses the amount you pay for cosmetic surgery,” meaning “any procedure that is directed at improving the patient’s appearance and doesn’t meaningfully promote the proper function of the body or prevent or treat illness or disease.” Surgery to correct a deformity from a congenital abnormality, an accident or a disfiguring disease is includible.

“Incurred” is the date of the care

For an FSA the test is the date of service, not the date of payment. Prop. Treas. Reg. §1.125-6(a)(2)(ii): medical expenses “are incurred when the employee (or the employee’s spouse or dependents) is provided with the medical care that gives rise to the medical expenses, and not when the employee is formally billed, charged for, or pays for the medical care.”

Publication 502 flags the same split for its own readers. After explaining that the deduction follows the year of payment, it adds: “This is not the rule for determining whether an expense can be reimbursed by a flexible spending arrangement (FSA).”

Two operating rules follow from Publication 969. You must give the plan “a written statement from an independent third party stating that the medical expense has been incurred and the amount of the expense”, plus a statement that it was not reimbursed elsewhere. And “the FSA can’t make advance reimbursements of future or projected expenses”, so paying a deposit in December for surgery in February does not move the expense into the earlier year.

That date rule is also why the run-out period matters: it extends the submission deadline, recorded here as Set by your plan — often 60–90 days after the plan year ends¹, and never the service date.

Whose expenses count

Publication 969 lists the people whose expenses a health FSA may reimburse: you and your spouse, all dependents you claim on your return, certain people you could have claimed as a dependent, and your child who is under age 27 at the end of your tax year.

The election that funds all of it is capped at $3,400² for a plan year beginning in 2026.

Are over-the-counter medicines FSA eligible?

Yes, with or without a prescription. Publication 969 states that “expenses incurred for over-the-counter medicine (whether or not prescribed) and menstrual care products are considered medical care and are considered a covered expense,” a change CARES Act §3702 made for expenses incurred after December 31, 2019.

Are menstrual products FSA eligible?

Yes. Section 3702 of the CARES Act added §106(f) to the Code, treating expenses for menstrual care products as incurred for medical care, and defines the term as “a tampon, pad, liner, cup, sponge, or similar product.”

Can I use my FSA for insurance premiums?

No. Publication 969 lists “amounts paid for health insurance premiums” among the expenses you can’t receive FSA distributions for, alongside long-term care and amounts covered under another health plan.

What does “incurred” mean for an FSA?

It means the day the care was provided. Prop. Treas. Reg. §1.125-6(a)(2)(ii) states that the expense is incurred when the care is given, “and not when the employee is formally billed, charged for, or pays for the medical care.”

Is cosmetic surgery FSA eligible?

Generally not, because it falls outside the definition of medical care. Publication 502 excludes procedures “directed at improving the patient’s appearance” that do not “meaningfully promote the proper function of the body or prevent or treat illness or disease”, while allowing repair of a congenital abnormality, accident or disfiguring disease.

Whose medical expenses can my FSA reimburse?

Yours, your spouse’s, those of dependents you claim, certain people you could have claimed, and your child under age 27 at year end. Publication 969 sets out that list for health FSA distributions.

Why is my administrator’s list different from Publication 502?

Because Publication 969 defines a qualified medical expense as one “specified in the plan” that would generally qualify for the deduction. The plan document narrows the IRS definition; it cannot widen it.

Information, not advice. This is the reading version; the interactive calculator and the full page are at https://thresholds.pages.dev/fsa/eligible-expenses/.