Does FSA Cover Probiotics? Here’s How to Get Reimbursed

Flexible Spending Accounts (FSAs) offer a tax-advantaged way to pay for healthcare expenses, allowing individuals to set aside pre-tax money for medical costs. Probiotics are often consumed for their benefits to digestive health. This article clarifies the circumstances under which probiotics may be eligible for FSA reimbursement.

Understanding FSA Eligibility

For an expense to qualify for reimbursement from an FSA, it must meet the Internal Revenue Service (IRS) definition of a “qualified medical expense.” This means expenses must be incurred primarily for the diagnosis, cure, mitigation, treatment, or prevention of disease, or to affect any body structure or function. Items or services intended solely for general health improvement without a specific medical purpose do not qualify.

While many over-the-counter (OTC) medicines and drugs are now eligible without a prescription, this does not automatically apply to all health-related products. For items with a dual purpose, a Letter of Medical Necessity (LOMN) is often required. An LOMN is a written statement from a licensed healthcare provider confirming that a specific item or service is medically necessary to treat a diagnosed condition.

Probiotics and Qualified Medical Expenses

Probiotics are not considered qualified medical expenses when used for general health maintenance or preventative care without a specific medical justification. However, they can become eligible for FSA reimbursement when prescribed by a healthcare provider to treat a specific medical condition or disease. Such conditions might include irritable bowel syndrome (IBS), Crohn’s disease, or antibiotic-associated diarrhea, where the probiotic is integral to the treatment plan.

To qualify probiotics for FSA reimbursement, detailed documentation is necessary. This includes a valid prescription from a licensed healthcare provider linking the probiotic’s use to a diagnosed medical condition. Alternatively, a Letter of Medical Necessity (LOMN) can be provided.

This LOMN should be on the healthcare provider’s letterhead or prescription form and clearly state the patient’s name, the diagnosed condition, the specific probiotic recommended, and the duration for which it is medically essential. Alongside the prescription or LOMN, itemized receipts for the probiotic are also required. This documentation transforms the probiotic from a general health supplement into a qualified medical expense.

Submitting Your FSA Claim

Once all necessary documentation, including the prescription or Letter of Medical Necessity and itemized receipts, has been gathered, you can submit your FSA claim. Most FSA administrators offer several methods for submission, such as online portals, mobile applications, or mail. When using an online portal or app, log in to your account and upload digital copies of your supporting documents.

The claim form requires specific information about the expense, including the date of purchase, merchant or provider name, item description, and total amount paid. Ensure all details are accurate and the itemized receipt clearly shows the necessary information. FSA claims are typically processed within one to two business days for approval. Reimbursement often follows quickly, with direct deposits usually appearing within one to three business days after approval. If documentation is insufficient, your FSA administrator may request additional information to avoid delays or denial of your claim.