Are Night Guards FSA Eligible?

Flexible Spending Accounts (FSAs) offer a valuable way for individuals to manage healthcare costs using pre-tax dollars. Many wonder if specific medical devices, such as night guards, qualify as eligible expenses. Understanding FSA criteria is important for maximizing these benefits. This article clarifies the eligibility of night guards and outlines the necessary steps for reimbursement.

Understanding Flexible Spending Accounts

A Flexible Spending Account is an employer-sponsored benefit that allows employees to set aside money from their paycheck on a pre-tax basis to pay for certain out-of-pocket healthcare expenses. These funds are typically not subject to federal income tax, Social Security, or Medicare taxes, which can lead to significant savings on eligible medical costs. The Internal Revenue Service (IRS) regulates what qualifies as an eligible expense, ensuring these accounts are used for their intended purpose of medical care.

Participants elect an annual contribution amount at the beginning of their plan year. This full amount is usually available on the first day of the plan year, regardless of how much has been contributed through payroll deductions. A defining characteristic of many FSAs is the “use-it-or-lose-it” rule, meaning funds not used by the end of the plan year are forfeited, though some plans offer a grace period or a limited carryover amount. Common expenses covered include co-payments, deductibles, prescription medications, and certain vision and dental care items.

Night Guard Eligibility Criteria

Night guards can be eligible for reimbursement through a Flexible Spending Account when they are used for a specific medical purpose. This eligibility hinges on establishing medical necessity, which typically means the night guard is prescribed or recommended by a dentist or doctor to treat a diagnosed medical condition. Conditions such as bruxism, which involves teeth grinding or clenching, and temporomandibular joint (TMJ) disorders are often reasons a night guard would be considered medically necessary.

A night guard used to prevent damage from teeth grinding due to bruxism is generally eligible. Conversely, mouthguards for sports protection or purely cosmetic dental devices are typically not covered. The IRS guidance emphasizes that the item’s primary purpose must be to alleviate or prevent a physical or mental defect or illness.

A healthcare professional’s recommendation or prescription is a fundamental requirement to demonstrate the medical necessity of the night guard. This documentation confirms the device is intended for the diagnosis, treatment, or mitigation of a specific medical issue. Without this substantiation, the expense may be considered for general health benefit, which is not eligible for FSA reimbursement.

Documentation and Reimbursement

To successfully claim reimbursement for a night guard from your Flexible Spending Account, precise documentation is required. You will need an itemized receipt from the purchase of the night guard, clearly showing the date of purchase, amount paid, and vendor’s name.

In addition to the purchase receipt, a prescription or a Letter of Medical Necessity (LOMN) from your treating dentist or doctor is essential. This letter should explicitly state the medical condition being treated, such as bruxism or a TMJ disorder, and explain why the night guard is necessary for its treatment.

Once you have gathered all the necessary documents, you can submit your claim to your FSA administrator. Most administrators offer several submission methods, including online portals, mobile applications, or traditional mail. After submission, claims are typically processed within a few business days to a couple of weeks, with reimbursement often issued via direct deposit or check. It is always advisable to retain copies of all submitted documentation for your personal records and for potential IRS substantiation requests.