If you’re enrolled in a Flexible Spending Account (FSA) or a Health Savings Account (HSA) through your employer or health plan, you probably already appreciate one major benefit: using pre-tax dollars for healthcare-related expenses. These accounts let you save taxable income on eligible medical costs like prescriptions, doctor visits, dental care, and many over-the-counter remedies.
But the rules aren’t intuitive, and the list of things you can’t buy with FSA/HSA funds often surprises people. Unlike general health-oriented credit (like a flexible debit card), the IRS tightly defines what counts as a “qualified medical expense.” Anything outside that scope even if it seems related to your health won’t qualify without specific documentation like a Letter of Medical Necessity.
Below is an updated guide to common items and services that are not eligible for payment with FSA or HSA dollars.
Understanding the IRS Definition of Medical Expenses
Before we list specific exclusions, here’s the basic idea: both FSAs and HSAs follow IRS guidelines on qualified medical costs. These expenses must be intended to prevent, treat, diagnose, or cure a physical or mental health condition. If the item or service doesn’t meaningfully advance that purpose, it’ll likely be ineligible. Everyday products used for general health or well-being usually don’t meet this standard.
- Personal Hygiene and Toiletries
It might seem obvious that hygiene plays a role in health, but most personal care items even at the drugstore aisle aren’t eligible:
- Shampoo and conditioner
- Toothpaste and mouthwash
- Deodorants and soaps
- Perfume or cologne
- Facial cleansers and moisturizers
- Cotton swabs, toilet paper, and other toiletry basics
These are considered personal hygiene and are excluded because their primary purpose is general cleanliness or cosmetic maintenance not treatment of a medical condition. You can only claim such items if a medical professional prescribes them to treat a diagnosed issue.
So although a medicated lice shampoo with a prescription might qualify, everyday cleaners won’t.
- Cosmetics and Appearance-Focused Procedures
Cosmetic changes even if they improve confidence or self-esteem are generally not eligible:
- Makeup and beauty products
- Botulinum toxin (Botox) for aesthetic use
- Cosmetic dermatology procedures
- Hair removal, hair transplants, or beauty treatments
- Teeth whitening kits
These expenses fall outside qualified medical care because they’re primarily for appearance, not medical treatment. (Yes, professional teeth whitening and lactic acid body scrubs count here too) A procedure only becomes potentially eligible if it corrects a deformity or physical dysfunction for example, reconstruction after an injury.
- General Health Products and Supplements
Just because something is “health-related” doesn’t mean it qualifies under IRS medical expense rules:
- Vitamins and most herbal supplements
- Protein bars and general dietary supplements
- Energy drinks and sports nutrition
- Meal replacements
- Bug spray and sunscreen without medical necessity
By default, vitamins and supplements are not reimbursable unless a provider writes a Letter of Medical Necessity stating that a specific deficiency or medical condition justifies their use. Regular wellness products don’t meet that bar.
Even everyday items like bug repellent or non-SPF sunscreen, although they protect you in a general sense, are excluded because they’re not primarily for medical care.
- Fitness and Lifestyle Expenses
Maintaining fitness is great for long-term health, but many related costs are not covered:
- Gym or fitness class memberships
- Personal trainers and coaching
- Home exercise equipment (unless specifically prescribed with documentation)
- Yoga classes unless medically recommended
The IRS points to the fact that such activities improve general fitness or well-being, not necessarily treat a specific medical condition. In rare cases, certain equipment (like a specialized medical device) might qualify with a provider’s documentation, but most “wellness gear” does not.
- Childcare and Daily Support Services
- Daycare or babysitting costs
- Nanny or childcare services
- After-school programs
- General eldercare services
FSAs and HSAs are designed to cover healthcare, not dependent care. If your employer also offers a Dependent Care FSA (DCFSA), that account would cover childcare costs but not your medical FSA or HSA.
- Elective and Non-Essential Procedures
Procedures or products that are optional or “nice to have” fall outside qualified expenses unless there’s a documented medical need:
- Cosmetic dentistry (example, porcelain veneers)
- Elective surgeries that aren’t medically necessary
- Massage therapy for relaxation (only eligible if treating a diagnosed condition)
- Spa treatments or salon services
These things can be wonderful for personal care, but they aren’t generally considered medical care. Without a physician’s statement connecting the expense to a specific health condition, you’ll likely pay out of pocket.
- Insurance Premiums and Certain Financial Costs
Despite being part of your healthcare picture, you can’t use FSA funds to pay for:
- Health insurance premiums (FSA only)
- Long-term care insurance premiums
- Interest on health loans or credit cards used for medical bills
While HSAs offer more flexibility in some situations, direct use of FSA dollars for premiums and similar financial costs is generally not permitted.
- Everyday Clothing and Accessories
Basic clothing and lifestyle items are not eligible even if they sound related to health:
- Maternity clothes
- Everyday sunglasses (without prescription)
- Regular clothing
- Car seats or safety gear not documented as medically necessary
Unless an item is a medical device or prescribed by a clinician to treat a specific condition, it’s considered outside the realm of qualified medical care.
“Dual-Use” and Special Cases
Some items fall into grey areas. For example:
- Contact lens solution is eligible, while non-prescription eyeglasses are not.
- Prescription sunglasses qualify, but standard sunglasses do not.
- Certain sleep or posture products may be eligible with documentation supporting a medical purpose.
In practice, many reimbursements hinge on whether an expense directly treats or prevents a diagnosed medical condition, not just because it’s “health-oriented.”
How to Work Around Ineligibility
If your plan allows it, you might still make otherwise ineligible expenses eligible by obtaining a Letter of Medical Necessity (LMN) from your healthcare provider. This letter should:
- Identify your specific medical condition
- Explain why the item or service is necessary to treat that condition
- Align with IRS qualified medical expense criteria
If your provider supports it, you may be able to submit the LMN along with your expense for reimbursement.
In addition, FSA and HSA rules change periodically, so double-check current IRS guidance or consult your plan administrator before making large or ambiguous purchases. A little planning can go a long way toward maximizing those tax-advantaged funds.
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