Does FSA Cover Orthotics? What You Need to Know
Unlock your FSA benefits for orthotics. Understand what's covered, necessary steps for reimbursement, and how to maximize your healthcare savings.
A Flexible Spending Account (FSA) offers a tax-advantaged way to pay for eligible healthcare expenses not covered by health insurance. Individuals can set aside pre-tax money from their paycheck for qualified medical costs. Understanding which specific expenses, such as orthotics, qualify for FSA reimbursement requires attention to IRS guidelines.
Eligibility for Orthotic Coverage
Orthotics can be covered by a Flexible Spending Account if they are considered a medical expense, meaning their primary purpose is to alleviate or treat a specific medical condition. The Internal Revenue Service (IRS) defines qualified medical expenses as amounts paid for the “diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.”
Custom-made orthotics, specifically designed to address an individual’s unique foot structure and medical needs, are generally eligible for FSA reimbursement when prescribed by a qualified medical professional. These devices treat or prevent conditions by realigning joints and redistributing pressure.
Over-the-counter (OTC) orthotic inserts or arch supports may also be eligible, but often require a prescription or a Letter of Medical Necessity (LMN). Without such documentation, general comfort inserts or those for athletic performance enhancement do not meet the criteria for a medical expense and are not eligible. The expense must be directly linked to treating a diagnosed medical condition, rather than simply for general well-being.
Necessary Documentation for Reimbursement
Individuals must gather specific documentation for orthotic expense reimbursement. A prescription from a qualified medical professional, such as a doctor, podiatrist, or chiropractor, is a primary requirement for many FSA claims involving orthotics. This prescription serves as evidence that the orthotics are intended to treat a specific medical condition.
An itemized receipt detailing the purchase is also essential. This receipt should clearly display the date of purchase, a description of the item (e.g., “custom orthotics” or “orthotic inserts”), the amount paid, and the name of the provider or vendor. Credit card receipts or canceled checks are not sufficient as they lack the necessary detail required by FSA administrators.
For items not automatically eligible or to strengthen a claim, a Letter of Medical Necessity (LMN) may be required. This letter, provided by the prescribing practitioner, must include the patient’s diagnosis, explain how the orthotics treat the specific medical condition, and indicate the duration for which they are needed. The LMN helps prove that the expense is for medical care.
Claim Submission Process
Once all necessary documentation, including the prescription, itemized receipt, and any required Letter of Medical Necessity, has been prepared, submit the claim for reimbursement. Most FSA administrators offer several convenient methods for submission, including online portals, mobile applications, mail, or fax.
When submitting online or via a mobile app, claimants upload digital images of their supporting documents directly to their account. For mail or fax submissions, printed copies of the completed claim form and all documentation are sent to the administrator’s designated address. It is advisable to keep personal copies of all submitted documents for record-keeping.
After submission, the FSA administrator reviews the claim to ensure it meets IRS requirements and plan guidelines. Approved reimbursements are typically issued via direct deposit or check. If the purchase was made using an FSA benefits debit card, some transactions may be automatically approved, but documentation might still be requested for verification.