What’s actually FSA eligible
Most people overestimate the IRS list of “qualified medical expenses” and underestimate the SIGIS list of FSA-eligible products. The two combined cover a much wider catalog than “prescriptions, copays, and glasses.” Once you know the categories, spending down a balance gets significantly easier.
This is the full 2026 list, organized by the three SIGIS classification tiers used by every FSA administrator in the country: always eligible, eligible with a Letter of Medical Necessity (LMN), and not eligible. For 2026, the IRS contribution limit is $3,400 per employee with a carryover cap of $680 for plans that offer it. (See What Happens to Unused FSA Money in 2026? for the carryover mechanics.)
The three-tier system
| Tier | Documentation needed | Examples |
|---|---|---|
| Always Eligible | None — buy with FSA card | SPF 15+ broad-spectrum sunscreen, Tylenol, contact lens solution, breast pumps |
| Eligible with LMN | Letter of Medical Necessity from a licensed provider | Most dietary supplements, weighted blankets, gym memberships for documented diagnoses |
| Not Eligible | N/A | Toothpaste, cosmetics, general fitness equipment, cosmetic procedures |
Eligibility is governed by IRS Publication 502 (the legal framework) and the SIGIS Eligible Product List Criteria (the operational ruleset every administrator uses to approve or decline transactions).
Always Eligible — no documentation needed
These items can be purchased with your FSA card directly, with no paperwork. The IRS and SIGIS classify them as having a primary medical purpose with no significant general-health overlap.
Vision care
Eyeglasses and prescription sunglasses, contact lenses, contact lens solution, eye drops (preservative-free and medicated), reading glasses, eye patches, vision exams, contact lens fittings, LASIK and other vision correction surgery, and orthokeratology lenses. See the full Vision Care category for current products.
First aid and medical supplies
First aid kits, bandages and gauze, antiseptic wipes, thermometers, blood pressure monitors, pulse oximeters, glucose meters and test strips, finger splints, ice packs, and instant cold compresses. Browse First Aid for the full list.
OTC medications
Pain relievers (Tylenol, Advil, Aleve, aspirin), allergy medication (Zyrtec, Claritin, Allegra, Benadryl), cold and flu remedies (Mucinex, NyQuil, DayQuil, Robitussin), digestive aids (Pepto-Bismol, Tums, Imodium, Prilosec OTC), topical antibiotics (Neosporin, Bacitracin), antifungal creams, hydrocortisone creams, and acne treatments with active medical ingredients. The CARES Act of 2020 permanently restored OTC medication eligibility without a prescription. See OTC Medications for the full set.
Sunscreen and skin protection
Sunscreen that is SPF 15 or higher and labeled broad spectrum (UVA + UVB protection). Coppertone, Sun Bum, Banana Boat, Neutrogena, La Roche-Posay, EltaMD — anything that meets both criteria qualifies. Sun-care lip balms with SPF that are sold as part of a sun-protection line are also eligible. Browse Sunscreen & Skincare for current products.
Baby, mom, and family
Breast pumps and accessories, breast pump supplies (bottles, storage bags, replacement parts), nursing pads, lanolin and nipple cream, postpartum recovery products (sitz baths, perineal sprays, ice packs), prenatal vitamins, baby thermometers, baby nasal aspirators, and infant electrolyte solutions. Pediatric thermometers and humidifiers also qualify. See Baby & Mom.
Pain relief and therapy products
Heating pads and electric heat wraps, hot/cold therapy packs, TENS units, knee/ankle/wrist/back braces, kinesiology tape, foot orthotics and shoe inserts (medical), cervical and lumbar pillows, massage guns marketed for therapeutic deep-tissue use, and percussion therapy devices. See Pain Relief & Therapy.
Diagnostic and monitoring devices
Glucose monitors and continuous glucose monitors (CGMs), insulin pens and syringes, lancets, blood pressure cuffs, pulse oximeters, peak flow meters, sleep apnea CPAP machines and supplies, hearing aids and hearing aid batteries, and medical-grade thermometers.
Feminine care and menstrual products
Tampons, pads, panty liners, menstrual cups, menstrual discs, period underwear, and yeast-infection treatments (Monistat). The CARES Act made menstrual care permanently eligible in 2020 — no prescription needed.
Dental and orthodontic supplies
Orthodontic treatment (braces, Invisalign), denture cleaners and adhesives, orthodontic wax, fluoride treatment for documented diagnoses, prescription mouthwash, and treatment for TMJ. Routine cleanings, fillings, root canals, crowns, and oral surgery are eligible as services. See Dental Care.
Mental health and therapy services
Therapy and counseling copays, out-of-pocket session fees with licensed providers, teletherapy (Talkspace, BetterHelp, Cerebral), psychiatric care and medication management, couples and family therapy with a licensed clinician, and ABA therapy. See Mental Health for products and the therapy guide for service eligibility.
Family planning and fertility
Pregnancy and ovulation test kits, fertility monitors, condoms, lubricants (medical), male and female contraception (when prescribed), and medical fertility treatments (IUI, IVF, egg freezing for medical reasons).
Mobility and accessibility
Wheelchairs, walkers, canes, crutches, mobility scooters, hospital beds, bedside commodes, grab bars and shower chairs (with documented medical need in some cases), and prosthetics.
Other always-eligible items
Acupuncture, chiropractic care, physical therapy, occupational therapy, speech therapy, smoking cessation programs and OTC nicotine products (gum, patches, lozenges), weight loss programs prescribed for a specific diagnosis (obesity, hypertension), and ambulance services.
Eligible with a Letter of Medical Necessity
These items are dual-purpose under SIGIS — they have both a medical use and a general-health or personal-care use. Your FSA can cover them only if a licensed provider documents a specific medical need.
- Most dietary supplements — multivitamins, vitamin D, fish oil, probiotics, herbal supplements, immune-support products, Emergen-C, Airborne. The three always-eligible exceptions are glucosamine/chondroitin, bulk-forming fiber laxatives, and prenatal vitamins.
- Blue light glasses without a vision correction component (with prescription correction, they’re always eligible).
- Compression hosiery below 30–40 mmHg (30–40 mmHg and above is always eligible).
- Massage chairs and general-wellness massage devices (therapeutic percussion devices for documented pain conditions are always eligible).
- Weighted blankets when prescribed for sensory or anxiety disorders.
- Air purifiers and humidifiers when prescribed for respiratory or allergy diagnoses.
- Gym memberships, fitness classes, yoga studios when prescribed for obesity, hypertension, or cardiac rehab.
- Light therapy lamps when prescribed for seasonal affective disorder.
- Meditation and mindfulness apps (Headspace, Calm) when prescribed for an anxiety or sleep disorder.
- Special diet foods prescribed for celiac disease, diabetes, or other documented conditions (only the incremental cost above standard food).
The LMN process: your provider writes a short letter describing the diagnosis, the recommended item, and why it treats or alleviates the condition. You submit it to your administrator, who either pre-approves the item or honors receipts on a case-by-case basis.
Not Eligible
The IRS draws a hard line at “general health” and “personal hygiene.” These items don’t qualify even with a doctor’s recommendation:
- Oral care — toothpaste, toothbrushes (electric included), mouthwash, dental floss, whitening products
- Cosmetics — makeup, perfume, deodorant, hairspray, shampoo, conditioner, body wash
- Cosmetic procedures — teeth whitening, hair restoration, elective plastic surgery, cosmetic Botox
- General fitness — exercise equipment (Peloton, treadmills, dumbbells), step counters, fitness classes
- General wellness — non-prescribed massage for relaxation, spa treatments, saunas
- Most dietary supplements without an LMN (see exceptions above)
- Health club dues without medical documentation
- Diapers (adult incontinence supplies are eligible; routine baby diapers are not)
- Insurance premiums for most plans (limited exceptions for COBRA, long-term care, and Medicare)
The surprising items most people miss
The fastest way to spend down a balance is to know the items that aren’t obvious. These all qualify without paperwork:
- Sunscreen (SPF 15+ broad spectrum) — see the whole category
- Acupuncture and chiropractic — full session cost
- Therapy and teletherapy — including Talkspace and BetterHelp (more detail)
- Breast pumps and supplies — even if you’re not currently nursing
- Foot orthotics and shoe inserts with a medical purpose (Powerstep, Superfeet medical line)
- Baby monitors with breathing or heart-rate sensors (Owlet, Nanit Pro)
- Pregnancy and ovulation tests — including premium fertility tracker monitors
- Period underwear — Thinx, Knix, and similar
- Reading glasses — even drugstore non-prescription readers
- Dental cleanings, eye exams, and physical therapy — services count the same as products
- Postpartum recovery products — sitz baths, witch hazel pads, perineal sprays
- CPR classes for a parent with a documented child medical condition
A note on services
Services are often the highest-value way to clear a remaining FSA balance. A single $200 therapy session, a $300 dental cleaning, or a $400 acupuncture series can convert hundreds of dollars in a single appointment. If you’re sitting on a balance over $400, services beat stockpiling consumables.
Use it before you lose it
Most FSAs expire December 31, 2026. Plans with a grace period extend that to March 15, 2027. Plans with carryover let you roll up to $680 into 2027 — but never both. (See FSA vs HSA in 2026 if you’re not sure which account type you have.)
Eligibility ultimately follows your specific plan document. Always check with your plan administrator for edge cases, especially LMN-required items and anything in the “depends on plan” gray zone.
If you know your remaining balance, the fastest path is the balance spend-down tool — enter what’s left and we’ll generate a curated bundle of eligible items that adds up to it. If you’d rather plan deliberately, browse eligible products by category instead.