Are Pillows FSA Eligible? The Role of Medical Necessity

Flexible Spending Accounts (FSAs) offer a tax-advantaged method for employees to pay for eligible healthcare expenses. These accounts are employer-sponsored benefits, allowing individuals to set aside pre-tax money from their paycheck for medical costs not covered by insurance. The funds in an FSA can be used for a variety of healthcare-related purchases, providing a valuable financial tool for managing health expenditures.

General FSA Eligibility Requirements

Expenses covered by an FSA must align with the Internal Revenue Service (IRS) definition of “medical care.” As outlined in IRS Publication 502, medical expenses are those primarily for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for affecting any structure or function of the body. This definition guides what qualifies for reimbursement. Expenses for general health improvement or personal comfort are typically not eligible for FSA reimbursement; an item or service must primarily address a medical condition.

Determining Pillow Eligibility

Pillows are generally considered personal comfort items and are therefore typically not eligible for FSA reimbursement. This classification holds true for standard pillows. However, certain specialized pillows can become eligible if a medical professional prescribes them to address a specific medical condition. The primary factor for eligibility is “medical necessity,” meaning the pillow directly treats or alleviates a diagnosed health issue.

Examples of specialized pillows that may qualify include cervical pillows for neck pain, orthopedic pillows for spinal issues, or wedge pillows for gastroesophageal reflux disease (GERD). These items are distinct from ordinary pillows because their design and intended use are therapeutic. A doctor’s recommendation or prescription is required to demonstrate this medical necessity, differentiating a therapeutic pillow from one used for general comfort.

Required Documentation for Reimbursement

To secure reimbursement for a specialized pillow, specific documentation is necessary. A Letter of Medical Necessity (LMN) is a required document that validates the medical purpose of the purchase. This letter must be provided by a licensed medical practitioner and detail the patient’s specific diagnosis, the type of pillow prescribed, and the medical reason for its necessity. The LMN should also specify how the pillow will alleviate the medical condition and the duration for which the expense is needed.

In addition to the LMN, a detailed receipt from the vendor is required. This receipt must clearly show the item purchased, its exact cost, and the date of purchase. The information on the receipt, particularly the item description, must correspond precisely with the item specified in the Letter of Medical Necessity. Without both the LMN and the matching detailed receipt, the claim may be denied.

Submitting Your FSA Claim

Once all necessary documentation, including the Letter of Medical Necessity and the detailed receipt, has been gathered, you can submit your FSA claim. Most FSA administrators offer multiple convenient methods for submission, such as online portals, mobile applications, or mail. For online or app submissions, you typically log into your account, select the option to submit a claim, and then enter details like the expense type, date of service, and the amount. You will be prompted to upload digital copies of your LMN and itemized receipt.

If submitting by mail, you will usually need to download and complete a claim form, then mail it along with physical copies of your documentation. After submission, claims are typically processed within a few business days for direct deposit reimbursements. You can often track the status of your claim through the administrator’s online portal. Your administrator may request additional information if the initial submission is incomplete or unclear.