Can You Use FSA for Breast Augmentation?

Flexible Spending Accounts (FSAs) offer a financial tool for managing healthcare costs. These employer-sponsored benefits allow individuals to set aside pre-tax dollars from their salary into a dedicated account. The primary purpose of an FSA is to pay for qualified medical expenses, which helps reduce an individual’s taxable income. Funds contributed to an FSA are not subject to federal income tax, Social Security, or Medicare taxes, providing a discount on healthcare expenditures. For 2025, the annual contribution limit for a healthcare FSA is typically $3,300 per employee, although this amount can be adjusted annually by the Internal Revenue Service (IRS).

Understanding Eligibility

Purely cosmetic breast augmentation procedures are generally not eligible for reimbursement through a Flexible Spending Account. The IRS defines qualified medical expenses as those incurred primarily for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body. Procedures performed solely to improve appearance, without addressing a medical condition, do not meet this criterion. Therefore, if the breast augmentation is sought for aesthetic enhancement, such as increasing breast size or altering shape for personal preference, it would typically be excluded from FSA coverage.

However, breast augmentation can be considered an eligible expense if it is deemed medically necessary. This exception primarily applies when the procedure corrects a deformity directly resulting from a congenital abnormality, a personal injury, or a disfiguring disease. A common example is reconstructive surgery following a mastectomy due to breast cancer, which is widely recognized as a medically necessary procedure eligible for FSA reimbursement. Other instances might include correcting severe breast asymmetry causing physical symptoms or functional impairment, or addressing deformities from significant trauma. The determination of medical necessity must be made by a licensed healthcare provider, who will attest that the procedure is necessary for the patient’s physical or mental health, not merely for cosmetic improvement.

Gathering Necessary Documentation

Once a breast augmentation procedure is deemed medically necessary by a healthcare provider, specific documentation is required for FSA reimbursement. A Letter of Medical Necessity (LMN) explains why the procedure is needed to treat a particular medical condition. This letter, provided by your physician or other licensed healthcare provider, must detail the patient’s specific diagnosed medical condition, the exact treatment needed, and how this treatment will alleviate the condition. It should also specify the duration for which the treatment is expected to be needed.

In addition to the LMN, you will need detailed financial records. These include itemized statements from the healthcare provider, which should clearly list the services received, the date of service, the provider’s name, and the amount charged. If insurance is involved, an Explanation of Benefits (EOB) form from your insurance carrier is also required. The EOB indicates what portion of the cost was covered by insurance and the amount you owe out-of-pocket, which is the amount typically eligible for FSA reimbursement. Maintaining copies of all these documents is important for your records and for verification requests.

Filing Your Reimbursement Claim

After gathering all the required documentation, the next step involves submitting your claim to the FSA administrator. Most administrators offer several methods for submission, including online portals, fax, or mail. When submitting a claim, you will typically need to complete a reimbursement request form, which can usually be found on your plan administrator’s website. This form must be accompanied by the supporting documents, such as the Letter of Medical Necessity, itemized statements, and any relevant Explanation of Benefits.

It is advisable to submit claims promptly after incurring the expense to ensure timely reimbursement and track your available FSA balance. While processing times can vary, claims are typically processed within a few business days, often ranging from three to seven working days. If the claim is incomplete or requires further clarification, the administrator may request additional information, which could delay the reimbursement process. Once approved, reimbursement is usually issued either through direct deposit to your bank account or by check.