Can You Use an FSA for a Toothbrush?

A Flexible Spending Account (FSA) is an employer-sponsored benefit that allows individuals to set aside pre-tax money from their paycheck to pay for eligible out-of-pocket healthcare expenses. This arrangement reduces taxable income, leading to potential tax savings. FSAs are designed to help manage various medical and dental costs throughout the year.

Understanding FSA Eligibility

Determining what qualifies as an “eligible medical expense” for FSA purposes is guided by Internal Revenue Service (IRS) regulations, primarily outlined in IRS Publication 502, “Medical and Dental Expenses.” These guidelines establish that expenses must be primarily for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.

Expenses that are merely beneficial to general health, cosmetic in nature, or for general well-being without a specific medical purpose are not eligible for reimbursement. For instance, items like vitamins, although beneficial, are not covered unless prescribed for a specific medical condition.

Dental Care and FSA Coverage

Regarding dental care, standard oral hygiene products like general-purpose toothbrushes, whether manual or electric, are not eligible for FSA reimbursement. These items are considered products for maintaining overall health and hygiene, rather than for treating or preventing a specific medical condition.

However, exceptions exist if a toothbrush is specifically prescribed by a dentist or doctor to address a diagnosed medical condition. For example, if a specialized toothbrush is required for gum disease, post-surgical care, or for individuals with certain disabilities that necessitate particular oral care, it may become eligible. In such cases, a Letter of Medical Necessity (LOMN) from the healthcare provider is required to substantiate the medical necessity.

Similarly, other common oral care items such as toothpaste, dental floss, and mouthwash are not eligible for FSA funds. Reimbursement for these items would only be possible if a healthcare professional prescribes them for a particular medical condition, supported by a Letter of Medical Necessity.

In contrast, actual dental treatments and procedures are eligible for FSA coverage. This includes preventative care like routine cleanings and check-ups, as well as restorative procedures such as fillings, crowns, extractions, and orthodontics.

Claiming Reimbursement

Once an eligible expense has been incurred and paid, individuals can seek reimbursement from their FSA. The reimbursement process requires specific documentation to verify the expense’s eligibility. This documentation includes an itemized receipt showing the date of service, the provider’s name, a description of the service or item, and the amount charged.

For expenses requiring a Letter of Medical Necessity, this document must be submitted along with the itemized receipt. The LOMN should clearly state the medical condition, the recommended treatment or product, and its direct relation to the condition. Many FSA administrators offer various methods for submitting claims, including online portals, mobile applications, or through mail and fax.

After submission, claims are processed within a few business days. Reimbursements are disbursed via direct deposit or check. It is important to retain copies of all documentation for personal records, as the individual remains accountable to the IRS for proving the eligibility of any submitted expense.