Are Orthodontic Retainers Covered by FSA?

Flexible Spending Accounts (FSAs) are a valuable tool for managing healthcare costs. Many individuals wonder about the range of medical expenses these accounts can cover, including orthodontic retainers. Understanding FSA rules helps participants maximize benefits and plan for health-related expenditures.

FSA Basics and Eligible Expenses

A Flexible Spending Account allows individuals to set aside pre-tax money from their paycheck to pay for eligible healthcare expenses. This arrangement reduces taxable income, leading to potential tax savings. The Internal Revenue Service (IRS) defines eligible medical expenses in Internal Revenue Code Section 213(d). These are generally costs incurred for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.

Common examples of eligible expenses include co-payments, deductibles, and co-insurance payments for medical services. Dental care, vision care services like eye exams and contact lenses, and prescription medications also qualify. Over-the-counter medications and certain medical supplies are eligible.

Orthodontic Retainers and FSA Coverage

Orthodontic retainers are an eligible medical expense for FSA reimbursement. Orthodontic treatment corrects dental defects such as misaligned teeth or bite issues. Correcting these conditions goes beyond cosmetic enhancements, falling under the IRS definition of medical care that affects the structure or function of the body.

Retainers prevent teeth from shifting after braces are removed, contributing to oral health and preventing future dental problems. Expenses for such treatments are covered under FSA guidelines because they address a physical or dental condition. The cost of obtaining and maintaining orthodontic retainers can be paid for using FSA funds.

Submitting Your FSA Claim

Submitting a claim for FSA reimbursement requires specific documentation. An itemized receipt or detailed billing statement from the orthodontist is needed. This documentation must clearly show the provider’s name, the date the service was rendered, a description of the service (e.g., “orthodontic retainer”), and the amount charged.

If health insurance was involved, an Explanation of Benefits (EOB) from the insurance carrier is also important documentation. This EOB details what the insurance covered and the remaining amount owed by the patient, which is the portion eligible for FSA reimbursement. Some plan administrators may require a prescription or a letter of medical necessity to substantiate the claim. Claims can be submitted through an online portal, via fax, or by mail. Reimbursement occurs within three to five business days after the claim is processed.