Are Probiotics Covered by Your FSA Account?

A Flexible Spending Account (FSA) allows individuals to set aside pre-tax income for qualified medical expenses, saving money on healthcare costs. Many wonder if common health products like probiotics are covered. Understanding FSA eligibility rules is important for maximizing benefits.

General FSA Eligibility for Over-the-Counter Items

For an item to be considered a “qualified medical expense” by the Internal Revenue Service (IRS), it must primarily be for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for affecting any structure or function of the body. This definition distinguishes eligible expenses from those for general health or cosmetic purposes, which are generally not covered. For instance, vitamins or general wellness supplements typically do not qualify unless prescribed for a specific medical condition.

The CARES Act expanded the list of eligible expenses for FSAs. This legislation removed the prescription requirement for many over-the-counter (OTC) medications and products, making items like pain relievers, cold and flu medicines, and menstrual products FSA-eligible without a doctor’s note. However, this expansion specifically applies to OTC medicines and feminine hygiene products; it does not automatically extend eligibility to all dietary supplements or general health products.

Probiotics as Qualified Medical Expenses

While probiotics are consumed for general health, they are typically classified as dietary supplements. As such, they are generally not FSA-eligible without further documentation. To qualify for FSA reimbursement, probiotics must be recommended or prescribed by a licensed medical professional to treat a specific medical condition.

Examples of conditions where probiotics are medically necessary include irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), antibiotic-associated diarrhea, or certain vaginal and urinary tract infections. In these cases, a Letter of Medical Necessity (LMN) from a healthcare provider is required. An LMN should clearly outline the patient’s name, the specific medical diagnosis being treated, the particular probiotic recommended, and the duration of the treatment. This document serves as proof that the probiotic is being used for a medical purpose rather than general health improvement.

Steps for Using Your FSA Funds

Once eligibility for probiotics and necessary documentation, such as an LMN, has been secured, using FSA funds involves specific steps. Many FSA plans provide a debit card, linked directly to your FSA account. This card can be used at eligible merchants, including pharmacies and stores with health sections, to pay for qualified medical expenses directly at the point of sale. While using the FSA debit card often results in automatic approval, it is advisable to retain all receipts in case the FSA administrator requests further verification.

For purchases made without an FSA debit card, or if the merchant does not accept it, individuals must submit a claim for reimbursement. This typically involves completing a claim form provided by the FSA administrator, either online or on paper. The claim form must be accompanied by an itemized receipt showing the date of purchase, item description, cost, and provider or store name. If an LMN was required for probiotic eligibility, a copy of this letter should also be submitted with the reimbursement claim.

Maintaining thorough records is important for FSA compliance and potential audits by the IRS. This includes keeping all itemized receipts, copies of prescriptions, and Letters of Medical Necessity for a minimum of three years from the end of the plan year. These records validate that expenses were incurred for qualified medical purposes, ensuring smooth reimbursement and adherence to IRS regulations.