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Checkpoint Contents Pension & Benefits Library Pension & Benefits Editorial Materials EBIA Benefits Compliance Library Cafeteria Plans XX. What Expenses Can Be Reimbursed Under a Health FSA? XX.M. Table of Common Expenses, Showing Whether They Are for "Medical Care"
M. Table of Common Expenses, Showing Whether They Are for "Medical
Administration Tip. In order to demonstrate that plan administrators are being reasonable, uniform,
and consistent in their interpretation of what's reimbursable and what's not, we recommend keeping
a table of how different types of expenses are handled.*
*ERISA plans are required to maintain reasonable procedures governing benefit claims that ensure
consistency in the claims approval process. See Section XXII for details.
The following table describes whether certain types of expenses qualify as medical care under Code §213(d) Code §213(d) for purposes of reimbursement by a health FSA or HRA, or for a tax-free distribution from an HSA. The table consists of three columns. We list various expenses in Column 1. In Column 2, we comment on whether the item is likely to be a qualifying expense, not a qualifying expense, or a potentially qualifying expense. In Column 3, we provide additional comments and special rules based on specific regulations, revenue rulings, private letter rulings, informal comments by IRS officials, and other guidance. For items for which there is no official guidance, our comments are based on our interpretation of available guidance. For more details, see the Key to using the Table below.
Cautions Regarding Use of the Table.
Additional Restrictions Apply. Confirming that an expense is for medical care under the Table does not mean that the expense is reimbursable under a health FSA or HRA or qualifies for a tax-free distribution from an HSA—other legal requirements must also be met. Requirements applicable under a health FSA are summarized in a short checklist in subsection B and are described in detail in subsections C through K; also see subsection L for a discussion of expenses that are difficult to administer. HRAs and HSAs are discussed in detail in Consumer-Driven Health Care (Thomson Reuters/EBIA, 2004-present, updated quarterly). Note also that some items in the Table might not be reimbursable under a health FSA or HRA if the health FSA or HRA contains exclusions, restrictions, or other limitations or requirements.
Caution Regarding Publication 502 Publication 502. On occasion, the Table makes reference to IRS Publication 502 IRS Publication 502, usually in circumstances where no other source was readily available. However, administrators should use Publication 502 Publication 502 only with caution. See subsection D .
Consult Other Subsections. The statements in Column 3 are only intended to briefly highlight general principles. For a full understanding of how to determine whether an expense is for medical care, read subsection D , which discusses generally applicable principles; also, if noted under the Table, consult subsection L .
Guidelines Only. Just because an item is listed as a qualifying expense doesn't mean that an administrator can ignore actual knowledge that the participant is using it for personal purposes. Nor does the fact that an item is generally known to be incurred or obtained primarily for personal, cosmetic, or general health purposes mean that an administrator can't be persuaded by credible evidence that an item is in fact being used for medical care.
Key to Using the Table:
Each item in the Table has been identified in column 2 as a "Qualifying expense," a "Potentially qualifying expense," or "Not a qualifying expense." These designations are the views of EBIA and are not in all cases based on official guidance—reasonable minds can differ on them. Each administrator will have to develop its own list of appropriate designations and decide how to use them in substantiating claims based on experience.
Qualifying Expense. These are expenses that are generally known to be incurred or obtained primarily for medical care. In other words, they are expenses that practically no one would incur or obtain unless they had a medical condition that prompted the expenditure. These "primarily medical" items or services are the types of expenses that normally qualify for reimbursement under a health FSA or HRA or for a tax-free distribution from an HSA if other health FSA, HRA, or HSA requirements are met. Potentially Qualifying Expense. These are expenses in one of the following categories: Expenses that are generally known to be used for both a medical purpose and a personal, cosmetic, or general health purpose. These dual-purpose expenses qualify for reimbursement under a health FSA or HRA or a tax-free distribution from an HSA only if there is appropriate proof that the expense was incurred/obtained primarily for medical care. In most cases, participants must show that the item or service is recommended by a medical practitioner to treat a specific medical condition. Medicines or drugs (other than insulin), which must be prescribed in order to qualify for reimbursement under a health FSA or HRA or a tax-free distribution from an HSA if incurred after December 31, 2010. See subsection L for details. Not a Qualifying Expense. These are expenses in one of the following categories: Expenses that are generally known to be incurred or obtained primarily for personal, cosmetic, or general health purposes and not primarily for medical care. These "primarily personal" expenses almost never qualify for reimbursement from a health FSA or HRA or for a tax-free distribution from an HSA. Expenses in this category theoretically could qualify in the extremely rare case where an individual can overcome a strong presumption of nonqualification and prove that, based on all the facts and circumstances and taking into account the prevailing IRS guidance, the item or service was incurred or obtained primarily to treat an existing medical condition diagnosed by a medical practitioner. Items or services for which reimbursement is not allowed under statutory or regulatory provisions, even if they might seem to be for medical care (for example, insurance premiums cannot be reimbursed by a health FSA). Health Care Reform: New Restrictions Apply to Medicines and Drugs Incurred After
December 31, 2010. Medicines and drugs (other than insulin) incurred after December 31, 2010
must be prescribed in order to qualify for reimbursement under a health FSA or HRA or for a tax-free
distribution from an HSA. See subsection L for further discussion.
Is Expense a
Comments and Special Rules
AA meetings,
Potentially qualifying See Alcoholism treatment.
Qualifying expense Expenditures for operations that are illegal do not qualify. *
Acne treatment
Potentially qualifying Because acne is considered a disease, the cost of acne treatment will generally qualify, † although over-the-counter (OTC) acne medications must
be prescribed if incurred after December 31, 2010. However, the cost of
regular skin care (face creams, etc.) does not qualify. And when the
expense has both medical and cosmetic purposes (e.g., Retin-A, which can
be used to treat both acne and wrinkles), a note from a medical practitioner
recommending the item to treat a specific medical condition is normally
required. See Drugs and medicines; Cosmetic procedures; Cosmetics;
Retin-A; Toiletries; and subsections L.1 and L.2.
Acupuncture
Qualifying expense ‡
Adaptive equipment
Potentially qualifying Includes various items that assist individuals in performing activities of daily living (e.g., feeding, bathing, toileting, and mobility). To qualify, the item
must be used to relieve or alleviate sickness or disability. To show that the
expense is primarily for medical care, a note from a medical practitioner
recommending the item to treat a specific medical condition (e.g., multiple
sclerosis or arthritis) is normally required. Where applicable, only amounts
above the cost of the regular version of the item will qualify. Depending on
the nature of the item, other special rules may apply. See Capital
expenses and Home improvements.
Adoption, pre-adoption
Qualifying expense Medical expenses incurred before an adoption is finalized will qualify, if the child qualifies as your tax dependent when the services/items are provided.
(Adoption fees and other nonmedical expenses incurred in connection with
an adoption may qualify for an adoption assistance credit (under Code §23)
Code §23) or for reimbursement under an adoption assistance program
(under Code §137).) Code §137).) a
Air conditioner
Potentially qualifying The primary purpose must be to treat or alleviate a medical condition, and the expense must not have been incurred "but for" the condition. b To show
that the expense is primarily for medical care, a note from a medical
practitioner recommending the item to treat a specific medical condition is
normally required. If it is attached to a home (such as central air
conditioning), only the amount spent that is more than the value added to
the property will qualify. c See Capital expenses.
Air purifier
Potentially qualifying To show that the expense is primarily for medical care, a note from a medical practitioner recommending the item to treat a specific medical
condition (such as a severe allergy) is normally required. d Several special
rules apply. See Air conditioner and Capital expenses.
*. Rev. Rul. 73-201, Rev. Rul. 73-201, 1973-1 C.B. 140.
†. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
‡. Rev. Rul. 72-593, Rev. Rul. 72-593, 1972-2 C.B. 180; IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
a. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses). For more information on adoption assistance programs,
see Fringe Benefits (Thomson Reuters/EBIA, 2006-present, updated quarterly).
b. Treas. Reg. §1.213-1(e)(iii). Treas. Reg. §1.213-1(e)(iii).
c. Treas. Reg. §1.213-1(e)(iii). Treas. Reg. §1.213-1(e)(iii).
d. Priv. Ltr. Rul. 8009080 Priv. Ltr. Rul. 8009080 (Dec. 6, 1979).
Is Expense a
Comments and Special Rules
Alcoholism treatment
Qualifying expense Amounts paid for inpatient treatment (including meals and lodging), at a
therapeutic center for alcohol addiction will qualify. See Health institute
fees; Lodging at a hospital or similar institution; Meals at a hospital or
similar institution; and Schools and education, residential.
Transportation expenses associated with attending meetings of an
Alcoholics Anonymous group in the community would also qualify if
attending due to a physician's advice that membership is necessary to treat
alcoholism. *
Allergy medicine
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after (Examples: Alavert, December 31, 2010. See Drugs and medicines.
Allergy treatment
Potentially qualifying Expenses generally won't qualify if the product would be owned even products other than
without allergies, such as a pillow or a vacuum cleaner. † However, an air
medicine (e.g.,
purifier or water filter necessary to treat a specific medical condition might household
qualify. ‡ The excess cost of a special version of an otherwise personal item
improvements to treat
(e.g., a vacuum cleaner with a HEPA filter) over the normal cost of the item allergies)
might also qualify if the special version of the item is necessary to treat a
specific medical condition. a To show that the expense is primarily for
medical care, a note from a medical practitioner recommending the item to
treat a specific medical condition is normally required. See Air purifier; Air
conditioner; and Capital expenses.
Potentially qualifying Nontraditional healing treatments provided by professionals may be eligible if provided to treat a specific medical condition, but the IRS looks at these
expenses very closely. b The treatments must be legal. And the expenses
may not qualify if the remedy is a food or a substitute for food that the
person would normally consume in order to meet nutritional requirements. c
It appears that drugs and medicines recommended by alternative healers to
treat a specific medical condition also can qualify as medical care,
although drugs and medicines incurred after December 31, 2010 must be
prescribed by an individual legally authorized to issue prescriptions in the
applicable state in order to qualify. See Drugs and medicines; Christian
Science practitioners; Special foods; and Vitamins.
Ambulance
Qualifying expense d
Analgesics
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after (Examples: Advil, December 31, 2010. See Drugs and medicines.
Aspirin, Tylenol) Antacids
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. e See Drugs and medicines.
Maalox, Prilosec OTC, Zantac) *. Rev. Rul. 63-273, Rev. Rul. 63-273, 1963-2 C.B. 112.
†. Informal, nonbinding remarks of Katherine Kiss, IRS, Office of Chief Counsel, Aug. 1998 ECFC Annual Symposium; see also Rev.
Rul. 76-80, Rev. Rul. 76-80, 1976-1 C.B. 71.
‡. Priv. Ltr. Rul. 8009080 Priv. Ltr. Rul. 8009080 (Dec. 6, 1979).
a. Rev. Rul. 76-80, Rev. Rul. 76-80, 1976-1 C.B. 71.
b. Treas. Reg. §1.213-1(e)(1)(ii); Treas. Reg. §1.213-1(e)(1)(ii); IRS Information Letters 2011-0045 IRS Information Letters 2011-0045
(June 6, 2011) and 2000-0410 2000-0410 (Nov. 27, 2000). See also IRS Information Letter (July 30, 1999).
c. Rev. Rul. 55-261, Rev. Rul. 55-261, 1956-1 C.B. 307.
d. Treas. Reg. §1.213-1(e)(1)(ii). Treas. Reg. §1.213-1(e)(1)(ii).
e. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
Is Expense a
Comments and Special Rules
Antibiotic ointments
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Bacitracin, Neosporin) Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Benadryl, Claritin) Anti-itch creams
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Benadryl, Cortaid, Ivarest) Appearance
Not a qualifying See Cosmetic procedures; Cosmetics; Toiletries; and subsection L.1.
Arthritis gloves
Qualifying expense Artificial limbs
Qualifying expense *
Artificial teeth
Qualifying expense †
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Asthma delivery
Potentially qualifying Delivery devices (e.g., inhalers and nebulizers) will qualify. Medications will devices and
qualify if incurred before 2011 but must be prescribed if incurred after medications
December 31, 2010. See Drugs and medicines.
Automobile
Potentially qualifying To show that the expense is primarily for medical care, a note from a medical practitioner recommending the item to treat a specific medical
condition (e.g., a physical handicap) is normally required. ‡ But see Capital
expenses. Expenses of operating a specially equipped car (other than for
medical reasons—see Transportation) do not qualify. a
Babysitting and child
Not a qualifying Babysitting, child care, and nursing services for a normal, healthy baby do expense b
not qualify as medical care. c But see Dependent care expenses and
Disabled dependent care expenses.
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Bandages, elastic
Qualifying expense *. Treas. Reg. §1.213-1(e)(1)(ii). Treas. Reg. §1.213-1(e)(1)(ii).
†. Treas. Reg. §1.213-1(e)(1)(ii). Treas. Reg. §1.213-1(e)(1)(ii).
‡. Rev. Rul. 66-80, Rev. Rul. 66-80, 1966-1 C.B. 57; see also Henderson v. Comm'r, T.C.M. 2000-321 (2000).
a. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
b. Rev. Rul. 78-266, Rev. Rul. 78-266, 1978-2 C.B. 123. See Section XXIV regarding expenses reimbursable under a dependent care
assistance program (DCAP).
c. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
Is Expense a
Comments and Special Rules
Bandages, for
Qualifying expense *
While unclear, medicated bandages likely should not be considered drugs or torn or injured
medicines that must be prescribed if incurred after December 31, 2010 in order to qualify. † See Drugs and medicines..
(Examples: Band-Aid, Curad) Behavioral modification
Potentially qualifying See Schools and education, residential and Schools and education,
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. ‡ See Drugs and medicines. Also see
Contraceptives; "Morning-after" contraceptive pills; and subsection
L.2.
Birthing classes
Potentially qualifying See Lamaze classes.
Qualifying expense They are diagnostic items. a See Diagnostic items/services and
monitoring devices
Blood storage
Potentially qualifying Fees for temporary storage may qualify under some circumstances, such as where the blood is collected as part of the diagnosis, treatment, or
prevention of an existing or imminent medical condition (e.g., in advance of a
scheduled surgery for use in a possible transfusion). Fees for indefinite
storage, just in case the blood might be needed, would not be considered
medical care. b "Temporary" is not defined; however, one consideration might
be whether the blood is stored and used within the same year. c Also see
Stem cell, harvesting and/or storage of and Umbilical cord, freezing
and storage of.
Blood-sugar test kits and
Qualifying expense They are diagnostic items. d See Diagnostic items/services and
test strips
Body scans
Qualifying expense Body scans employing MRIs and similar technologies are diagnostic
services. e See Diagnostic items/services and Screening tests.
Books, health-related
Potentially qualifying Will qualify only if recommended to treat an illness (such as asthma or diabetes) diagnosed by a physician. f The purpose of the expense must be
to treat the disease rather than to promote general health. To show that the
expense is primarily for medical care, a note from a medical practitioner
recommending the item to treat a specific medical condition is normally
required.
*. Rev. Rul. 2003-58, Rev. Rul. 2003-58, 2003-22 I.R.B. 959.
†. Informal, nonbinding remarks of Kevin Knopf, Attorney-Advisor, Office of Tax Policy of the Treasury Department, Mar. 4, 2011
ECFC Annual Conference.
‡. Rev. Rul. 73-200, Rev. Rul. 73-200, 1973-1 C.B. 140.
a. Treas. Reg. §1.213-1(e)(1)(ii) Treas. Reg. §1.213-1(e)(1)(ii) (allowing that payments for medical care include "medical, laboratory,
surgical, dental and other diagnostic and healing services").
b. See, e.g., IRS Information Letter 2010-0017 IRS Information Letter 2010-0017 (Nov. 2, 2009) and Priv. Ltr. Rul. 200140017 Priv. Ltr.
Rul. 200140017 (June 25, 2001).
c. Informal, nonbinding remarks of John Sapienza, IRS, Office of Chief Counsel, May 2002 ECFC Teleconference.
d. Treas. Reg. §1.213-1(e)(1)(ii) Treas. Reg. §1.213-1(e)(1)(ii) (allowing that payments for medical care include "medical, laboratory,
surgical, dental and other diagnostic and healing services") and Rev. Rul. 2003-58, Rev. Rul. 2003-58, 2003-22 I.R.B. 959.
e. See Treas. Reg. §1.213-1(e)(1)(ii) Treas. Reg. §1.213-1(e)(1)(ii) (allowing that payments for medical care include "medical,
laboratory, surgical, dental and other diagnostic and healing services"); see also Rev. Rul. 2007-72, Rev. Rul. 2007-72, 2007-50
I.R.B. 1154 (full-body electronic scan that served no nonmedical purpose was diagnostic and therefore was for medical care even
though it was obtained without a doctor's recommendation).
f. See, e.g., Halby v. Comm'r, T.C.M. 2009-204 T.C.M. 2009-204 (2009) (sex-therapy books and magazines did not qualify as
medical care expenses where they were not for treatment of a medical condition).
Is Expense a
Comments and Special Rules
Braille books and
Qualifying expense Only amounts above the cost of regular printed material will qualify. *
Breast pumps
Qualifying expense Breast pumps and other supplies that assist lactation will qualify. †
Breast reconstruction
Qualifying expense Will qualify to the extent that surgery was done following a mastectomy for surgery following
cancer. ‡ This is an exception to the general rules regarding cosmetic
procedures. See Cosmetic procedures.
Calamine lotion
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Capital expenses
Potentially qualifying Improvements or special equipment added to a home (for example, an Elevator or Inclinator) or other capital expenditures (such as Automobile
modifications for a physically handicapped person) may qualify if the
primary purpose of the expenditure is medical care for you (or your spouse
or dependent) and the expense would not be incurred "but for" this purpose. a
To show that the expense is primarily for medical care, a note from a
medical practitioner recommending the item to treat a specific medical
condition is normally required. How much of the expense would qualify
depends on the extent to which the expense permanently improves the
property. Also see subsection L.9.
Car modifications
Potentially qualifying See Automobile modifications.
Car seats
Not a qualifying Car seats for infants and children generally won't qualify. However, if a special car seat is needed because of an infant's or child's medical
condition, amounts above the cost of a regular car seat might qualify. See
Adaptive equipment and Automobile modifications.
Carpal tunnel wrist
Qualifying expense supports
Cayenne pepper
Potentially qualifying May qualify if used to treat or alleviate a specific medical condition and would not have been purchased but for the condition. To show that the
expense is primarily for medical care, a note from a medical practitioner
recommending the item to treat a specific medical condition is normally
required. b See Alternative healers; Special foods; Vitamins; and
subsections L.2, L.3, L.4, and L.7.
Chelation therapy
Qualifying expense Will qualify if used to treat a medical condition such as lead poisoning.
*. Rev. Rul. 75-318, Rev. Rul. 75-318, 1975-2 C.B. 88.
†. IRS Announcement 2011-14, IRS Announcement 2011-14, 2011-9 I.R.B. 532.
‡. Rev. Rul. 2003-57, Rev. Rul. 2003-57, 2003-22 I.R.B. 959. Health FSAs are potentially subject to the Women's Health and Cancer
Rights Act (WHCRA) and thus may be required to cover breast reconstruction surgery, prostheses, and certain other expenses
following mastectomy. See Section XXII.
a. Treas. Reg. §1.213-1(e)(iii). Treas. Reg. §1.213-1(e)(iii). See also Zipkin v. U.S., 86 AFTR 2d 2000-7052 86 AFTR 2d 2000-7052
(D. Minn. 2000) ($646,000 deduction approved for custom-building a house to accommodate medical condition).
b. IRS Information Letters 2010-0080 IRS Information Letters 2010-0080 (Mar. 31, 2010) and 2001-0297 2001-0297 (Dec. 31, 2001).
Is Expense a
Comments and Special Rules
Childbirth classes
Potentially qualifying See Lamaze classes.
Chinese herbal
Potentially qualifying See Alternative healers.
Qualifying expense *
Chondroitin
Potentially qualifying Will qualify if used primarily for medical care (for example, to treat arthritis). Won't qualify if used just to maintain general health. To show that the expense is primarily for medical care, a note from a medical practitioner recommending the item to treat a specific medical condition (for example, arthritis) is normally required.
Christian Science
Potentially qualifying Fees that you pay to Christian Science practitioners for medical care will qualify. † Fees for other purposes generally do not qualify. See Alternative
healers and subsection L.7.
Qualifying expense Claritin (loratadine), an
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after allergy drug
December 31, 2010. See Drugs and medicines.
Classes, health-related
Potentially qualifying Will qualify only if recommended to treat an illness (such as asthma or diabetes) diagnosed by a physician. The purpose of the expense must be
to treat the disease rather than to promote general health. To show that the
expense is primarily for medical care, a note from a medical practitioner
recommending the class to treat a specific medical condition is normally
required. See also Lamaze classes and Medical conference admission,
transportation, meals, etc.
Club dues and fees
Potentially qualifying See Health club fees.
COBRA premiums
Depends on whether Health FSA: COBRA premiums are not qualifying expenses. ‡
plan is a health FSA, HRA: COBRA premiums are qualifying expenses. a
HRA, or HSA; see HSA: COBRA premiums are qualifying expenses. b
next column for details Also see Insurance premiums.
Qualifying expense Will qualify if the underlying service/item qualifies.
Cold medicine
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Comtrex, Sudafed) Potentially qualifying Only cold/hot packs sold as medical supplies will qualify; those sold for other purposes (e.g., to keep beverages cold or hot) won't qualify. Hot water bottles and heating pads generally won't qualify.
*. Rev. Rul. 63-91, Rev. Rul. 63-91, 1963-1 C.B. 54.
†. IRS Information Letter 2000-0410 IRS Information Letter 2000-0410 (Nov. 27, 2000); Rev. Rul. 55-261, Rev. Rul. 55-261, 1955-1
C.B. 307, as modified by Rev. Rul. 63-91, Rev. Rul. 63-91, 1963-1 C.B. 54.
‡. Prop. Treas. Reg. §1.125-5(k)(4). Prop. Treas. Reg. §1.125-5(k)(4).
a. IRS Notice 2002-45, IRS Notice 2002-45, 2002-28 I.R.B. 93, Part II.
b. Code §223(d)(2)(C) Code §223(d)(2)(C) and IRS Notice 2004-2, IRS Notice 2004-2, 2004-2 I.R.B. 269, Q/A-27.
Is Expense a
Comments and Special Rules
Cold sore medicine
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Not a qualifying See Toiletries and Cosmetics.
Compression hose
Potentially qualifying Won't qualify if used for personal or preventive reasons. If used to treat or alleviate a specific medical condition, only the excess cost of the
specialized hose over the cost of regular hose will qualify. * To show that
the expense is primarily for medical care, a note from a medical practitioner
recommending the item to treat a specific medical condition is normally
required.
Qualifying expense Generally a qualifying expense. † While unclear, condoms with spermicide
likely should not be considered drugs or medicines that must be prescribed
if incurred after December 31, 2010 in order to qualify. Also see
Contraceptives and Drugs and medicines.
Contact lenses,
Qualifying expense Materials and equipment needed for using lenses (such as saline solution materials, and
and enzyme cleaner) will qualify if the lenses are needed for medical equipment
purposes, as will distilled water used to store and clean the lenses. ‡
Contact lens insurance will not qualify, however. See Insurance premiums.
Contact lenses for solely cosmetic purposes (for example, to change one's
eye color) do not qualify. See Cosmetics and subsection L.1.
Potentially qualifying See Birth-control pills; Condoms; "Morning-after" contraceptive pills;
and Spermicidal foam. Also see Sterilization procedures.
Controlled substances in
Not a qualifying If the substance violates federal law (e.g., the Controlled Substances Act), violation of federal law
the expense would not qualify even if a state law allows its use with a
physician's prescription (for example, marijuana or laetrile prescribed to treat
a specific medical condition). a See Drugs and medicines; Illegal
operations and treatments; and subsection D.
Co-payments
Qualifying expense Will qualify if the underlying service/item qualifies.
Cosmetic procedures
Not a qualifying Most cosmetic procedures do not qualify. This includes cosmetic surgery or other procedures that are directed at improving the patient's appearance and
don't meaningfully promote the proper function of the body or prevent or treat
illness or disease. Examples include face lifts, hair transplants, hair removal
(electrolysis), teeth whitening, and liposuction. There is an exception,
however, for procedures necessary to ameliorate a deformity arising from a
congenital abnormality, personal injury from an accident or trauma, or
disfiguring disease—these may qualify. b See Breast reconstruction
surgery following mastectomy. Also see Drugs and medicines and
subsections L.1 and L.2.
*. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
†. Informal, nonbinding remarks of Donna Crisalli, IRS, Office of Chief Counsel, May 2002 ECFC Teleconference.
‡. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses); Priv. Ltr. Rul. 7308270520A Priv. Ltr. Rul. 7308270520A
(Aug. 27, 1973).
a. Treas. Reg. §1.213-1(e)(1)(ii) Treas. Reg. §1.213-1(e)(1)(ii) and Rev. Rul. 97-9, Rev. Rul. 97-9, 1997-9 I.R.B. 4; see also IRS
Publication 502 (Medical and Dental Expenses). IRS Publication 502 (Medical and Dental Expenses).
b. Code §213(d)(9); Code §213(d)(9); see also Rev. Rul. 2003-57, Rev. Rul. 2003-57, 2003-22 I.R.B. 959.
Is Expense a
Comments and Special Rules
Cosmetics
Not a qualifying Cosmetics are articles used primarily for personal purposes, and are intended to be rubbed on, poured on, sprinkled on, sprayed on, introduced
into, or otherwise applied to the human body for cleansing, beautifying,
promoting attractiveness, or altering the appearance. * Examples include
skin moisturizers, perfumes, lipsticks, fingernail polish, eye and facial
makeup, shampoos, permanent waves, hair colors, toothpastes, and
deodorants. Also see Cosmetic procedures; Toiletries; and subsection
L.2.
Cough suppressants
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines. Also see Throat
Pediacare, Robitussin, Counseling
Potentially qualifying Will qualify if for a medical reason. Marriage counseling doesn't qualify. To show that the expense is primarily for medical care, a note from a medical
practitioner recommending the counseling to treat a specific medical
condition is normally required. Also see Psychiatric care and
Psychologist.
CPAP (continuous
Qualifying expense positive airway
pressure) devices
Crowns, dental
Potentially qualifying Will not qualify if they are obtained for a cosmetic reason. See Cosmetic
Crutches
Qualifying expense Will qualify whether purchased or rented. †
Dancing lessons
Potentially qualifying Generally the cost of dancing lessons, swimming lessons, etc., does not qualify, even if recommended by a medical practitioner, if the lessons are to
improve general health. ‡ But the expenditure might qualify if recommended
by a medical professional to treat a specific medical condition (such as part
of a rehabilitation program after surgery) and the expense would not have
been incurred "but for" the condition. To show that the lessons are primarily
for medical care, a note from a medical practitioner recommending them to
treat a specific medical condition is normally required.
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Dimetapp, Sudafed) Deductibles
Potentially qualifying Will qualify if the underlying item or service qualifies.
Dental floss
Not a qualifying Dental sealants
Qualifying expense *. Code §213(d)(9)(A) Code §213(d)(9)(A) and Treas. Reg. §1.213-1(e)(2). Treas. Reg. §1.213-1(e)(2).
†. Treas. Reg. §1.213-1(e)(1)(iii). Treas. Reg. §1.213-1(e)(1)(iii).
‡. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
Is Expense a
Comments and Special Rules
Dental services and
Qualifying expense Includes expenses incurred for the prevention and alleviation of dental procedures
disease. Preventive treatment includes the services of a dental hygienist or
dentist for such procedures as teeth cleaning, application of sealants, and
fluoride treatments to prevent tooth decay, but not Teeth whitening.
Treatment to alleviate dental disease includes X-rays, fillings, braces,
extractions, dentures, and treatment of other dental ailments. * When an
orthodontic treatment plan is paid up-front at the time of the first visit, some
health FSAs will apportion the reimbursements as services are provided
during the treatment plan. See subsection G.3 discussing how to reconcile
reimbursement requests involving a prepayment component with the claims
incurred requirement, particularly for orthodontia. Also see Prepayments.
Dentures and denture
Qualifying expense †
adhesives
Deodorant
Not a qualifying See Cosmetics and Toiletries.
expense ‡
Dependent care
Not a qualifying Such expenses won't qualify, even if you are paying for dependent care (for example, hiring a babysitter) so that you can receive medical care. a But see
Disabled dependent care expenses. Such expenses might be
reimbursable under a DCAP if applicable rules are met (but the same
expenses may not be reimbursed under a health FSA, HRA, or HSA and a
DCAP—there is no "double-dipping" allowed). Also see Babysitting and
child care.
Diabetic socks
Potentially qualifying Won't qualify if used for personal or preventive reasons. If used to treat or alleviate a specific medical condition, only the excess cost of the
specialized socks over the cost of regular socks will qualify. b To show that
the expense is primarily for medical care, a note from a medical practitioner
recommending the item to treat a specific medical condition is normally
required.
Diabetic supplies
Qualifying expense Includes Blood-sugar test kits and test strips; Glucose-monitoring
equipment; and Insulin.
Diagnostic
Qualifying expense Includes a wide variety of procedures to determine the presence of a disease or dysfunction of the body, such as tests to detect heart attack, stroke,
diabetes, osteoporosis, thyroid conditions, and cancer. c Also see Body
scans; Blood-pressure monitoring devices; Blood-sugar test kits and
test strips; Medical monitoring and testing devices; and other entries
throughout.
Diaper rash ointments
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after and creams
December 31, 2010. See Drugs and medicines.
(Example: Desitin) *. Treas. Reg. §1.213-1(e)(1)(ii); Treas. Reg. §1.213-1(e)(1)(ii); IRS Publication 502 (Medical and Dental Expenses). IRS Publication
502 (Medical and Dental Expenses).
†. Informal, nonbinding remarks of John Sapienza, IRS, Office of Chief Counsel, Nov. 5, 2003 ECFC Teleconference.
‡. Informal, nonbinding remarks of Harry Beker, Barbara Pie, and John Sapienza, IRS, Office of Chief Counsel, Oct. 22, 2003 ECFC
Teleconference.
a. Rev. Rul. 78-266, Rev. Rul. 78-266, 1978-2 C.B. 123. See subsection D.
b. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
c. Treas. Reg. §1.213-1(e)(1)(ii); Treas. Reg. §1.213-1(e)(1)(ii); see also Rev. Ruls. 2003-58, Rev. Ruls. 2003-58, 2003-22 I.R.B. 959
and 2007-72, 2007-72, 2007-50 I.R.B. 1154 (explaining that amounts paid for certain diagnostic procedures and devices are medical
care expenses under Code §213(d), Code §213(d), even when incurred by an individual without symptoms of illness; ruling addresses
annual physical exams, full-body electronic scans, and pregnancy test kits).
Is Expense a
Comments and Special Rules
Diapers or diaper
Potentially qualifying Regular diapers or diaper services for newborns do not qualify. But diapers or diaper services that are used to relieve the effects of a diagnosed medical
condition do qualify. * To show that the expense is primarily for medical care,
a note from a medical practitioner recommending the item to treat a specific
medical condition is normally required. See also Incontinence supplies
and subsections D.6 and L.15.
Diarrhea medicine
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Imodium, Kaopectate) Diet foods
Not a qualifying Special foods to treat a specific disease (such as obesity) do not qualify to the extent that they satisfy ordinary nutritional requirements. † Thus, food
associated with a weight-loss program, such as special pre-packaged
meals, would not qualify, since it just meets normal nutritional needs. See
Weight-loss programs and/or drugs prescribed to induce weight loss.
But see Special foods.
Dietary supplements
Potentially qualifying The cost of dietary supplements, nutritional supplements, vitamins, herbal supplements, and natural medicines does not qualify if they are merely
beneficial for general health (e.g., one-a-day vitamins). ‡ But may qualify if
recommended by a medical practitioner for a specific medical condition (for
example, a prescribed dosage to treat a vitamin deficiency). To show that
the expense is primarily for medical care, a note from a medical practitioner
recommending the item to treat a specific medical condition (e.g., 1,000 mg
of Vitamin B-12 daily to treat a specific vitamin deficiency) is normally
required. See Special foods; Mineral supplements; Vitamins; and
subsection L.3.
Disabled dependent
Potentially qualifying Such expenses will qualify if the expenses are for medical care of the disabled dependent. Note that some disabled dependent care expenses that
qualify as medical expenses may also qualify as work-related expenses for
purposes of the dependent care tax credit under Code §21 Code §21 or for
reimbursement under a dependent care assistance program under Code
§129. Code §129. The same expenses may not be used for more than one
purpose (for example, medical expenses reimbursed under a health FSA
cannot be used to claim a dependent care tax credit). a
DNA collection and
Potentially qualifying Such expenses generally won't qualify. But temporary storage may qualify under some circumstances, such as where the DNA is collected as part of
the diagnosis, treatment, or prevention of an existing or imminent medical
condition. b "Temporary" is not defined; however, one consideration might be
whether it is stored and used within the same plan year. c Also see
Umbilical cord blood storage.
Potentially qualifying Will only qualify to the extent that the doula provides medical care for the mother or child; services such as emotional support, parenting information,
child care, and housekeeping will not qualify. d See also Household help;
Lamaze classes; Midwife; and Nursing services.
*. Rev. Rul. 55-261, Rev. Rul. 55-261, 1955-1 C.B. 307, as modified by Rev. Rul. 63-91, Rev. Rul. 63-91, 1963-1 C.B. 54; Priv. Ltr.
Rul. 8137085 Priv. Ltr. Rul. 8137085 (June 17, 1981); IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
†. IRS Information Letter 2007-0037 IRS Information Letter 2007-0037 (Aug. 9, 2007); Treasury Tax Correspondence, 2006 TNT 144-
20 (July 19, 2006).
‡. Rev. Rul. 2002-19, Rev. Rul. 2002-19, 2002-16 I.R.B. 778; IRS Information Letter 2007-0037 IRS Information Letter 2007-0037
(Aug. 9, 2007).
a. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses). See Section XXIII for more information about the
dependent care credit vs. the DCAP.
b. See, e.g., IRS Information Letter 2010-0017 IRS Information Letter 2010-0017 (Nov. 2, 2009).
c. Informal, nonbinding remarks of John Sapienza, IRS, Office of Chief Counsel, May 2002 ECFC Teleconference.
d. Informal, nonbinding remarks of Donna Crisalli, IRS, Office of Chief Counsel, Aug. 12, 2011 ECFC Annual Symposium.
Is Expense a
Comments and Special Rules
Drug addiction treatment
Qualifying expense Amounts paid for an inpatient's treatment at a therapeutic center for drug
addiction will qualify. * See Alcoholism treatment.
Drug overdose,
Qualifying expense treatment of
Drug testing kits for
Not a qualifying Kits that test for the presence of controlled substances probably won't qualify, as they do not treat a medical condition. However, if the drug testing kit is used in the course of treating a medical condition, such as addiction, it could qualify. To show that the expense is primarily for medical care, a note from a medical practitioner recommending the item to treat a specific medical condition is normally required.
Drugs and medicines
Potentially qualifying Must be primarily for medical care (and not for personal, general health, or cosmetic purposes), legally procured, and generally accepted as medicines
and drugs. † In addition, expenses incurred after December 31, 2010 will
qualify only if the medicine or drug is prescribed or is Insulin. ‡ Prescriptions
must meet the legal requirements for a prescription in the state where the
expense is incurred. To show that a medicine or drug that can be obtained
without a prescription (i.e., an OTC drug) was prescribed, a prescription or
other documentation that a prescription was issued (e.g., a pharmacist's
receipt with the name of the purchaser or patient, the date and amount of the
purchase, and an Rx number) is required. a See subsections L.1 and L.2.
Also see Aspirin and other entries throughout for both prescription and OTC
drugs.
Dyslexia treatment
Potentially qualifying See Language training.
Ear piercing
Not a qualifying See Cosmetic procedures and subsection L.1.
Ear plugs
Potentially qualifying Will qualify if recommended by a medical practitioner for a specific medical condition (for example, to protect surgically implanted ear tubes). To show that the expense is primarily for medical care, a note from a medical practitioner recommending the item to treat a specific medical condition is normally required.
Ear wax removal drops
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after (Examples: Debrox, December 31, 2010. See Drugs and medicines.
Eczema treatments
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. b See Drugs and medicines.
*. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
†. Code §213(d). Code §213(d). See also Treas. Reg. §1.213-1(a)(1)(ii). Treas. Reg. §1.213-1(a)(1)(ii).
‡. Code §106(f), Code §106(f), as added by the Patient Protection and Affordable Care Act, Pub. L. No. 111-148 Pub. L. No. 111-148
(2010) (PPACA).
a. IRS Notice 2010-59, IRS Notice 2010-59, 2010-39 I.R.B. 396.
b. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
Is Expense a
Comments and Special Rules
Egg donor fees
Potentially qualifying Amounts paid for the egg donor fee, an agency fee, an egg donor's medical and psychological testing, and the legal fees for preparation of the egg donor
contract will qualify, if preparatory to a procedure performed on you, your
spouse, or your dependent. * Also see Fertility treatments; Sperm,
storage fees; Surrogate or gestational carrier expenses; and
subsection L.13.
Eggs and embryos,
Potentially qualifying Fees for temporary storage qualify, but only to the extent necessary for storage fees
immediate conception. Storage fees for undefined future conception probably
aren't considered medical care. "Temporary" is not defined; however, one
consideration might be whether it is stored and used within the same year. †
Also see Fertility treatments; Sperm, storage fees; Surrogate or
gestational carrier expenses; and subsection L.13.
Electrolysis or hair
Not a qualifying See Cosmetic procedures.
Elevator
Potentially qualifying Installing an elevator upon the advice of a physician so that a person with heart disease won't have to climb stairs may be medical care to the extent
of the amount in excess of value enhancement to the property. ‡ To show
that the expense is primarily for medical care, a note from a medical
practitioner recommending the item to treat a specific medical condition is
normally required. See Capital expenses and subsection L.9.
Exercise equipment or
Potentially qualifying Qualifies only if required to treat an illness (such as obesity) diagnosed by a programs
physician. a See subsection L.6. The purpose of the expense must be to
treat the disease rather than to promote general health, and the expense
must not have been incurred "but for" this purpose. b To show that the
expense is primarily for medical care, a note from a medical practitioner
recommending the item or program to treat a specific medical condition is
normally required. See Capital expenses; Health club fees; Pre-
payments; and Weight-loss programs and/or drugs prescribed to
induce weight loss.
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Comtrex, Robitussin) Eye drops
Potentially qualifying Will qualify if incurred before 2011. Medicated eye drops must be (Example: Visine) prescribed if incurred after December 31, 2010. See Drugs and
medicines.
Eye examinations,
Qualifying expense c
Materials and equipment needed for using the eyeglasses (such as eyeglasses, equipment,
eyeglass cleaners) also should be medical care. d Also see Contact lenses
*. Priv. Ltr. Rul. 200318017 Priv. Ltr. Rul. 200318017 (Jan. 9, 2003); IRS Information Letter 2005-0102 IRS Information Letter 2005-
0102 (Mar. 29, 2005); Magdalin v. Comm'r, T.C. Memo. 2008-293 (2008), aff'd 105 AFTR 2d 2010-442 105 AFTR 2d 2010-442 (1st
Cir. 2009).
†. Informal, nonbinding remarks of John Sapienza, IRS, Office of Chief Counsel, May 2002 ECFC Teleconference.
‡. Treas. Reg. §1.213-1(e)(1)(iii). Treas. Reg. §1.213-1(e)(1)(iii).
a. Disney v. Comm'r, 267 F. Supp. 1 267 F. Supp. 1 (C.D. Cal. 1967), aff'd on other issues, 413 F.2d 783 413 F.2d 783 (9th Cir.
1969).
b. IRS Information Letters 2010-0175 IRS Information Letters 2010-0175 (June 25, 2010) and 2003-0202 2003-0202 (Sept. 30, 2003).
c. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
d. Treas. Reg. §1.213-1(e)(iii) Treas. Reg. §1.213-1(e)(iii) provides that normally, if a capital expenditure (such as eyeglasses)
qualifies as a medical expense, expenditures for the operation or maintenance of a capital asset will also qualify, so long as the
medical reason for the capital expenditure still exists.
Is Expense a
Comments and Special Rules
Face creams
Not a qualifying See Cosmetics; Toiletries; and Cosmetic procedures.
Face lifts
Not a qualifying See Cosmetic procedures and subsection L.1.
Feminine hygiene
Not a qualifying Such expenses generally won't qualify, as they are ordinarily considered as products (tampons, etc.)
being used to maintain general health. See Toiletries and Cosmetics.
There may be exceptions (e.g., if a medical practitioner recommends the
product to alleviate a specific medical condition).
Potentially qualifying Will qualify to the extent that procedures are intended to overcome an inability to have children and are performed on you, your spouse, or your
dependent. * Examples are IVF (in vitro fertilization—including temporary
storage of eggs or sperm), surgery (including an operation to reverse prior
surgery preventing someone from having children), shots, treatments, and
GIFT (gamete intrafallopian transfer). Expenses paid to or for an in vitro
surrogate usually do not qualify, nor do egg donor expenses unless
preparatory to a procedure performed on you, your spouse, or a dependent. †
See Egg donor fees; Eggs and embryos, storage fees; Legal fees in
connection with fertility treatments; Pre-payments; Sperm, storage
fees; Surrogate or gestational carrier expenses; and subsection L.13.
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after medications
December 31, 2010. See Drugs and medicines.
(Examples: Aspirin, Motrin, Tylenol) Fiber supplements
Potentially qualifying Won't qualify if used for general health purposes or other personal reasons. May qualify if used to treat or alleviate a specific medical condition, and if
the expense would not have been incurred "but for" the condition. ‡ To show
that the expense is primarily for medical care, a note from a medical
practitioner recommending the item to treat a specific medical condition is
normally required. See Dietary supplements; Prenatal vitamins; and
Special foods.
First aid cream
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
First aid kits
Qualifying expense Must be for use by the participant, spouse, or other individual eligible for tax-free health coverage under the plan. Note that large first aid kits raise concerns about stockpiling.
Fitness programs
Potentially qualifying See Exercise equipment or programs.
Flu shots
Qualifying expense Immunizations to prevent disease will qualify, even though no medical
condition has been diagnosed. a
Fluoridation services
Qualifying expense Will qualify if recommended by a dentist to prevent tooth decay. The amount that qualifies is limited to the cost allocable to the current year.
*. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses); Magdalin v. Comm'r, T.C.M. 2008-293 (2008), aff'd 105
AFTR 2d 2010-442 105 AFTR 2d 2010-442 (1st Cir. 2009).
†. See IRS Information Letter 2002-0291 IRS Information Letter 2002-0291 (Aug. 12, 2002); Magdalin v. Comm'r, T.C.M. 2008-293
(2008), aff'd 105 AFTR 2d 2010-442 105 AFTR 2d 2010-442 (1st Cir. 2009).
‡. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
a. Informal, nonbinding remarks of Katherine Kiss, IRS, Office of Chief Counsel, August 1998 ECFC Annual Symposium.
Is Expense a
Comments and Special Rules
Fluoride rinses
Potentially qualifying Won't qualify if used to maintain general health or for other personal reasons (e.g., as a toiletry). May qualify if used to treat or alleviate a specific medical
condition, and if the expense would not have been incurred "but for" the
condition. * To show that the expense is primarily for medical care, a note
from a medical practitioner recommending the item to treat a specific
medical condition is normally required. Must be prescribed if incurred after
December 31, 2010. See Drugs and medicines.
Food thickeners
Potentially qualifying Whether food thickeners are a medical care expense is a question of fact that must be determined on a case-by-case basis. † To show that the
expense is primarily for medical care, a note from a medical practitioner
recommending the item to treat a specific medical condition is normally
required.
Potentially qualifying See Special foods; Meals; and Alternative healers.
Foreign countries,
Potentially qualifying In general, expenses incurred in other countries must meet the same medical care received in
requirements that would apply if the expenses were incurred in the U.S.
(e.g., the expenses must be primarily for medical care, may not be for a
cosmetic procedure, etc.). Note that the treatments must be legal in the
U.S. and the other country, and that special rules apply to medicines and
drugs obtained outside the U.S. See Cosmetic procedures; Illegal
operations and treatments; Prescription drugs and medicines
obtained from other countries; and subsection L.8.
Not a qualifying Founder's fees are amounts you pay under an agreement with a retirement home. Even if a portion is allocable to medical care, these expenses usually
do not qualify. ‡ See subsection L.10.
Not a qualifying expense a
Gambling problem,
Potentially qualifying Pathological gambling has been classified as an impulse control disorder by the American Psychiatric Association and thus, it could be argued, is a
mental illness. If so, its treatment would be a qualifying expense. See
Alcoholism treatment.
Gauze pads
Qualifying expense While unclear, medicated gauze pads likely should not be considered drugs
or medicines that must be prescribed if incurred after December 31, 2010 in
order to qualify. See Bandages and Drugs and medicines.
Potentially qualifying Would qualify to the extent that testing is done to diagnose a medical condition or to determine possible defects. b However, testing done just to
determine the sex of a fetus would not qualify.
Glucosamine
Potentially qualifying Qualifying expense Items such as blood-glucose meters and glucose test strips are diagnostic equipment
items and are primarily for medical care. c Also see Blood-sugar test kits
and test strips.
*. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
†. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
‡. See, e.g., Baker v. Comm'r Baker v. Comm'r, 122 T.C. 143 (2004).
a. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
b. Informal, nonbinding remarks of Donna Crisalli, IRS, Office of Chief Counsel, July 31, 2009 ECFC Annual Symposium. See also
Rev. Rul. 2007-72, 2007-50 I.R.B. 1154.
c. Treas. Reg. §1.213-1(e)(1)(ii) Treas. Reg. §1.213-1(e)(1)(ii) (allowing that payments for medical care include "medical, laboratory,
surgical, dental and other diagnostic and healing services"); see also Rev. Rul. 2003-58, Rev. Rul. 2003-58, 2003-22 I.R.B. 959.
Is Expense a
Comments and Special Rules
Guide dog
Qualifying expense Expenses of buying, training, and maintaining a guide dog used by a
physically disabled person would qualify; this includes the expenses of food
and inoculations. * Veterinary fees for such animals also qualify as medical
care. † Also see Service animal, to assist individual with mental health
disabilities and Veterinary fees.
Hair colorants
Not a qualifying See Cosmetics and Toiletries.
Hair removal and
Not a qualifying Such expenses generally won't qualify. ‡ See Cosmetic procedures; Drugs
and medicines; and subsections L.1 and L.2.
Hand lotion
Not a qualifying Such expenses generally won't qualify. See Cosmetics and Toiletries.
Hand sanitizer
Potentially qualifying Won't qualify if used for general health purposes or other personal reasons (e.g., as a toiletry). May qualify if used to treat or alleviate a specific medical
condition, and if the expense would not have been incurred "but for" the
condition. a Might also qualify where there is an imminent probability of
contracting a specific illness (e.g., from a household member who has a
contagious disease). A note from a medical practitioner recommending the
item to treat a specific medical condition (or if applicable, to prevent a
specific and imminent illness) is normally required.
Headache medications
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after (Examples: Advil, December 31, 2010. See Drugs and medicines.
Aspirin, Tylenol) Health club fees
Potentially qualifying Only in very limited circumstances would fees paid to a health club qualify. One instance might be where fees are incurred upon the advice of a medical
practitioner to treat a specific medical condition (e.g., rehabilitation after
back surgery or treatment for obesity). The expense must not have been
incurred "but for" the disease (for example, if you belonged to the health club
before being diagnosed, then the fees would not qualify). When treatment is
no longer needed, the fees would no longer qualify. To show that the
expense is primarily for medical care, a note from a medical practitioner
recommending it to treat a specific medical condition is normally required.
See Prepayments and Weight-loss programs and/or drugs prescribed
to induce weight loss.
Health institute fees
Potentially qualifying Qualifies only if the treatment at the health institute is prescribed by a physician who issues a written statement that the treatment is necessary to
alleviate a physical or mental defect or illness of the individual receiving the
treatment. b
Hearing aids
Qualifying expense Includes the costs of the hearing aid and its batteries, c as well as repair
expenses. d
*. Treas. Reg. §1.213-1(e)(1)(iii); Treas. Reg. §1.213-1(e)(1)(iii); Rev. Rul. 55-261, Rev. Rul. 55-261, 1955-1 C.B. 307; Rev. Rul. 57-
461, . Rev. Rul. 57-461, . Rev. Rul. 57-461, Rev. Rul. 57-461, 1957-2 C.B. 116 ("food, inoculations, and other expenses" of
maintaining guide dog were deductible as medical expenses); Rev. Rul. 68-295, Rev. Rul. 68-295, 1968-1 C.B. 92. See also Priv. Ltr.
Rul. 6806110470A Priv. Ltr. Rul. 6806110470A (June 11, 1968) and Priv. Ltr. Rul. 8033038 Priv. Ltr. Rul. 8033038 (May 20, 1980).
†. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
‡. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
a. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
b. Rev. Rul. 55-261, Rev. Rul. 55-261, 1955-1 C.B. 307.
c. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
d. IRS information Letter 2011-0055 IRS information Letter 2011-0055 (May 16, 2011).
Is Expense a
Comments and Special Rules
Hemorrhoid treatments
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Potentially qualifying May qualify if used to treat or alleviate a specific medical condition and would not have been purchased but for the condition. To show that the
expense is primarily for medical care, a note from a medical practitioner
recommending the item to treat a specific medical condition is normally
required. * See Alternative healers; Special foods; Vitamins; and
subsections L.2, L.3, L.4, and L.7.
HMO premiums
Depends on whether See Insurance premiums.
plan is a health FSA, HRA, or HSA Holistic or natural
Potentially qualifying See Alternative healers and subsection L.7.
healers, dietary
expense †
substitutes, and drugs
and medicines
Home care
Potentially qualifying See Nursing services.
Home improvements
Potentially qualifying May qualify if done to accommodate a disability. If the improvement is (such as exit ramps,
permanent and increases the value of the property, the expense will qualify widening doorways,
only to the extent that the improvement cost exceeds the increase in property value. If the improvement doesn't increase the property value at all,
then the entire cost may qualify. Items that usually don't increase property
value include constructing entrance or exit ramps, widening or modifying
doorways or hallways, installing railings or support bars to bathrooms,
lowering or modifying kitchen cabinets or equipment, moving or modifying
electrical outlets and fixtures, installing porch lifts, modifying fire alarms or
smoke detectors, modifying other warning systems, and modifying
stairways. ‡ To show that the expense is primarily for medical care, a note
from a medical practitioner recommending the item to treat a specific
medical condition is normally required. See Capital expenses; Elevator;
and Air conditioner.
Hormone replacement
Potentially qualifying Will qualify if used primarily for medical care (for example, to treat menopausal symptoms such as hot flashes, night sweats, etc.). Won't qualify if primarily for maintaining general health. To show that the expense is primarily for medical care, a note from a medical practitioner
recommending the therapy to treat a specific medical condition is normally
required. Must be prescribed if incurred after December 31, 2010. See Drugs
and medicines and subsections L.2, L.3, L.4, and L.7.
Qualifying expense Expenses of inpatient care (plus meals and lodging) at a hospital or similar
institution qualify if a principal reason for being there is to get medical care. a
Also see Nursing services; Meals at a hospital or similar institution;
and Lodging at a hospital or similar institution.
*. IRS Information Letters 2010-0080 IRS Information Letters 2010-0080 (Mar. 31, 2010) and 2001-0297 2001-0297 (Dec. 31, 2001).
†. See IRS Information Letter (July 30, 1999).
‡. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
a. Treas. Reg. §§1.213-1(e)(1)(ii) Treas. Reg. §§1.213-1(e)(1)(ii) and 1.213-1(e)(1)(v). 1.213-1(e)(1)(v).
Is Expense a
Comments and Special Rules
Not a qualifying Won't qualify, even if a medical practitioner recommends such help, unless the expenses qualify as nursing services. * See Nursing services. In some
cases, household services may qualify for reimbursement under a DCAP if
attributable in part to care of a qualifying individual (i.e., certain children
under age 13 and certain individuals who are physically or mentally
incapable of self-care). †
Humidifier
Potentially qualifying To show that the expense is primarily for medical care, a note from a medical practitioner recommending the item to treat a specific medical
condition (such as a severe allergy) is normally required. Several special
rules apply. See Air conditioner; Air purifier; and Capital expenses.
Potentially qualifying May qualify if the primary purpose is medical care and the expense would not be incurred "but for" this purpose. To show that the expense is primarily for medical care, a note from a medical practitioner recommending it to treat a specific medical condition is normally required. Potentially qualifying Will qualify if performed by a professional to treat a medical condition, or for other medical purposes (e.g., smoking cessation); won't qualify if for general
stress relief, personal enjoyment, or other personal purposes. To show that
the expense is primarily for medical care, a note from a medical practitioner
recommending it to treat a specific medical condition is normally required.
Also see Psychoanalysis and Therapy.
Illegal operations and
Not a qualifying Won't qualify, even if they are rendered or prescribed by licensed medical practitioners. ‡ See Controlled substances in violation of federal law
and subsection D.
Qualifying expense Immunizations to prevent disease (such as tetanus or well-baby shots) will
qualify, even if no medical condition has been diagnosed. a
Potentially qualifying May qualify to the extent of the amount in excess of value enhancement to the property, if the primary purpose is medical care and the expense would
not be incurred "but for" this purpose. b To show that the expense is primarily
for medical care, a note from a medical practitioner recommending the item
to treat a specific medical condition is normally required. See Capital
expenses and Elevator. Also see subsection L.9.
Qualifying expense Adult diapers used to relieve incontinence generally will qualify as medical
care expenses. c But see Diapers.
Infant formula
Potentially qualifying Ordinary infant formula won't qualify. d However, the excess cost of a special
formula to treat an infant's medical condition may qualify. e To show that the
expense is primarily for medical care, a note from a medical practitioner
recommending the item to treat a specific medical condition is normally
required. See also Special foods and subsection L.4.
Potentially qualifying See Egg donor fees; Eggs and embryos, storage fees; Fertility
treatments; Prepayments; Sperm, storage fees; Surrogate or
gestational carrier expenses; and subsection L.13.
Insect-bite creams and
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after ointments
December 31, 2010. See Drugs and medicines.
(Examples: Benadryl, Cortaid) *. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
†. See Section XXIV regarding expenses reimbursable under a DCAP.
‡. Treas. Reg. §1.213-1(e)(1)(ii). Treas. Reg. §1.213-1(e)(1)(ii). See also Halby v. Comm'r, T.C.M. 2009-204 T.C.M. 2009-204 (2009)
(illegal prostitution expenses were not for medical care).
a. Informal, nonbinding remarks of Katherine Kiss, IRS, Office of Chief Counsel, Aug. 1998 ECFC Annual Symposium.
b. Treas. Reg. §1.213-1(e)(1)(iii). Treas. Reg. §1.213-1(e)(1)(iii).
c. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
d. Priv. Ltr. Rul. 200941003 (July 1, 2009) and IRS Information Letter 2008-0039 IRS Information Letter 2008-0039 (Sept. 2, 2008)
(explaining that infant formula for the healthy baby of a woman who could not breastfeed due to a double mastectomy satisfied the
baby's normal nutritional needs and thus was properly viewed as food that the baby would normally consume, not as a medical
expense).
e. Informal, nonbinding remarks of Donna Crisalli, IRS, Office of Chief Counsel, Aug. 12, 2011 ECFC Annual Symposium.
Is Expense a
Comments and Special Rules
Insect repellent
Potentially qualifying May qualify when there is an imminent probability of contracting a specific (Examples: Cutter, illness from an insect bite (e.g., in a locality with a high incidence of Lyme disease or West Nile virus). *
Qualifying expense †
Equipment needed to inject the insulin, such as syringes or insulin pumps,
also qualifies as a medical expense. Also see Glucose-monitoring
equipment and Drugs and medicines.
Depends on whether Health FSA: Insurance premiums are not qualifying expenses. ‡
plan is a health FSA, HRA, or HSA; see HRA: The following premiums are qualifying expenses: premiums for next column for details traditional health insurance (including COBRA) and qualified long-term care insurance. (Note that reimbursing premiums for individual major medical insurance policies raises concerns under HIPAA, COBRA, and ERISA, and that qualified long-term care premium reimbursements are subject to an indexed annual limit.) The following insurance premiums are not qualifying expenses: premiums for employer-sponsored group health coverage that could be paid on a pre-tax basis under the employer's cafeteria plan, LTD insurance, fixed indemnity cancer insurance, and hospital indemnity insurance. HSA: Payments for health insurance premiums or contributions for self-funded health coverage generally aren't qualifying expenses. However, the following premiums will qualify for reimbursement from an HSA: COBRA coverage, a qualified long-term care insurance contract, any health plan maintained while the individual is receiving unemployment compensation under federal or state law, or, for those age 65 or older (whether or not they are entitled to Medicare), any deductible health insurance (e.g., retiree
medical coverage) other than a Medicare supplemental policy. (Note: Long-
term care insurance premium reimbursements that exceed the indexed
annual limit will be treated as taxable and may be subject to the additional
tax on distributions not used for qualified medical expenses.)
Also see COBRA premiums.
IVF (in vitro fertilization)
Potentially qualifying See Eggs and embryos, storage fees; Fertility treatments; Pre-
payments; Sperm, storage fees; Surrogate or gestational carrier
expenses; and subsection L.13.
Qualifying expense Such expenses will qualify if they are part of medical care. a
Potentially qualifying If a woman is having lactation problems and cannot breastfeed her child, then the expense of a lactation consultant helping to overcome this
dysfunction might qualify. b To show that the expense is primarily for medical
care, a note from a medical practitioner recommending it to treat a specific
medical condition is normally required.
Lactose intolerance
Potentially qualifying May qualify if used to treat or alleviate a specific medical condition. To show that the expense is primarily for medical care, a note from a medical practitioner recommending the item to treat a specific medical condition is normally required. See Dietary supplements.
Potentially qualifying Expenses may qualify to the extent that instruction relates to birth and not childrearing. c The fee should be apportioned to exclude instruction in topics
such as newborn care. Expenses for the coach or significant other do not
qualify. d See also Doula and Midwife.
*. Informal, nonbinding remarks of Donna Crisalli, IRS, Office of Chief Counsel, Aug. 12, 2011 ECFC Annual Symposium.
†. Code §§106(f), Code §§106(f), 223(d)(2)(A), 223(d)(2)(A), and 213(b). 213(b).
‡. Prop. Treas. Reg. §1.125-5(k)(4). Prop. Treas. Reg. §1.125-5(k)(4).
a. Treas. Reg. §1.213-1(e)(1)(ii). Treas. Reg. §1.213-1(e)(1)(ii).
b. Informal, nonbinding remarks of John Sapienza, IRS, Office of Chief Counsel, May 2002 ECFC Teleconference.
c. Priv. Ltr. Rul. 8919009 Priv. Ltr. Rul. 8919009 (Feb. 6, 1989).
d. Informal, nonbinding remarks of Katherine Kiss, IRS, Office of Chief Counsel, Aug. 1998 ECFC Annual Symposium.
Is Expense a
Comments and Special Rules
Potentially qualifying Such expenses will qualify for a child with dyslexia or an otherwise disabled child. * But amounts paid for regular schooling normally don't qualify. † To
show that the expense is primarily for medical care, a note from a medical
practitioner recommending it to treat a specific medical condition is normally
required. Also see Learning disability, instructional fees; Prepayments;
Schools and education, residential/special; and subsection L.14.
Laser eye surgery; Lasik
Qualifying expense Will qualify because the procedure is done primarily to promote the correct
function of the eye. ‡ Also see Radial keratotomy; Vision correction
procedures; and Prepayments.
Laser hair removal
Not a qualifying See Cosmetic procedures.
Late fees (e.g., for late
Not a qualifying Such fees would not be for medical care. a
payment of bills for
Laxatives
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Lead-based paint
Potentially qualifying The expense of removing lead-based paints from surfaces in the participant's home to prevent a child who has (or has had) lead poisoning from eating the
paint would qualify. b To show that the expense is primarily for medical care,
a note from a medical practitioner recommending it to treat a specific
medical condition is normally required. The surfaces must be in poor repair
(peeling or cracking) or be within the child's reach; the cost of repainting the
scraped area does not qualify. If instead of removing the paint, the area is
covered with wallboard or paneling, treat these items as Capital expenses.
The cost of painting the wallboard does not qualify. Also see Chelation
therapy.
Learning disability,
Potentially qualifying If prescribed by a physician, tuition fees paid to a special school and tutoring fees paid to a specially trained teacher for a child who has learning
disabilities caused by mental or physical impairments (such as nervous
system disorders) will qualify. c Also see Prepayments; Schools and
education, residential/special; and subsection L.14.
Legal fees, general
Potentially qualifying Legal fees may qualify as medical care if they bear a direct or proximate relationship to the provision of medical care—for example, if the medical
care could not have been provided without legal assistance. d Fees for legal
services retained to authorize treatment for mental illness may qualify. But
legal fees for management of a guardianship estate for conducting the affairs
of the person being treated or other fees that aren't necessary for medical
care do not qualify; e neither do divorce costs. f See Legal fees in
connection with fertility treatments.
*. See, e.g., Rev. Rul. 69-607, Rev. Rul. 69-607, 1969-2 C.B. 40 and Priv. Ltr. Rul. 8401024 Priv. Ltr. Rul. 8401024 (Sept. 30, 1983).
†. See, e.g., Coyne v. Comm'r, T.C. Memo 1982-262 (T.C. 1982) and Barnes v. Comm'r, T.C. Memo 1978-339 (T.C. 1978).
‡. Rev. Rul. 2003-57, Rev. Rul. 2003-57, 2003-22 I.R.B. 959 and IRS Publication 502 IRS Publication 502 (Medical and Dental
Expenses).
a. Informal, nonbinding remarks of Donna Crisalli, IRS, Office of Chief Counsel, Aug. 6, 2010 ECFC Annual Symposium.
b. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
c. See, e.g., Treas. Reg. §1.213-1(e)(1)(v); Treas. Reg. §1.213-1(e)(1)(v); Sims v. Comm'r, T.C. Memo 1979-499 (1979); and Rev. Rul.
78-340 Rev. Rul. 78-340, 1978-2 C.B. 124.
d. Priv. Ltr. Rul. 200318017 Priv. Ltr. Rul. 200318017 (Jan. 9, 2003) (legal fees for preparing a contract between the taxpayer and an
egg donor were found to be deductible as medical care). See also IRS Information Letter 2008-0033 IRS Information Letter 2008-0033
(July 21, 2008) (explaining that legal fees and mileage directly related to establishing a guardianship to provide medical care would
qualify as medical care expenses). But see Magdalin v. Comm'r, T.C. Memo. 2008-293 (2008) (legal fees and other expenses
incurred to father children through unrelated egg donor and gestational carriers were not for medical care where expenses were not
incurred to prevent or alleviate a physical or mental defect or illness of the taxpayer and did not affect a function or structure of the
taxpayer's body), aff'd 105 AFTR 2d 2010-442 105 AFTR 2d 2010-442 (1st Cir. 2009).
e. Rev. Rul. 71-281, Rev. Rul. 71-281, 1971-2 C.B. 165.
f. Smith v. Comm'r, T.C. Memo 1982-441 (1982).
Is Expense a
Comments and Special Rules
Legal fees in connection Potentially qualifying
May qualify if the legal fees are in connection with a medical procedure with fertility treatments
performed upon you (or your spouse or dependent). Legal fees for preparing
a contract for you to obtain a donated egg from an egg donor may also
qualify, if preparatory to a procedure performed on you, your spouse, or your
dependent. * In contrast, legal fees incurred in connection with a procedure
performed on a surrogate mother do not constitute medical care. See
Fertility treatments and Legal fees, general.
Lice treatment
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Lipsticks
Not a qualifying See Cosmetics and Toiletries.
Liquid adhesive for
Qualifying expense small cuts
Lodging at a hospital or
Qualifying expense Will qualify if a principal reason for being there is to receive medical care. †
Presumably, this would include the additional cost of a private room, ‡ but
not separately charged non-medical add-ons (e.g., Internet or cable TV). See
subsections L.8 and L.14. Also see Meals at a hospital or similar
institution and Schools and education, residential.
Lodging not at a hospital Potentially qualifying
Up to $50 per night will qualify if these conditions are met: (1) The lodging is or similar institution
primarily for and essential to medical care; (2) the medical care is provided
by a physician in a licensed hospital or medical care facility related to (or
equivalent to) a licensed hospital; (3) the lodging isn't lavish or extravagant;
and (4) there is no significant element of personal pleasure, recreation, or
vacation in the travel. a If a parent is traveling with a sick child, up to $100
may qualify ($50 for each person). Also see Meals not at a hospital and
subsection L.8.
Lodging of a companion
Potentially qualifying Will qualify if accompanying a patient for medical reasons and all of the conditions described under Lodging not at a hospital or similar
institution are also met. For example, if a parent is traveling with a sick
child, up to $100 per night ($50 for each person) will qualify. See Lodging
not at a hospital or similar institution. Also see subsection L.8.
Lodging while attending Not a qualifying
See Medical conference admission, transportation, meals, etc. and
a medical conference
expense b
Meals while attending a medical conference.
Long-term care
Depends on whether See Insurance premiums.
plan is a health FSA, HRA, or HSA *. Priv. Ltr. Rul. 200318017 Priv. Ltr. Rul. 200318017 (Jan. 9, 2003) (legal fees for preparing a contract between the taxpayer and an
egg donor were found to be for medical care where donated egg was to be implanted into taxpayer's body); Magdalin v. Comm'r, T.C.
Memo. 2008-293 (2008) (legal fees and other expenses incurred to father children through unrelated egg donor and gestational
carriers were not for medical care where expenses were not incurred to prevent or alleviate a physical or mental defect or illness of
the taxpayer and did not affect a function or structure of the taxpayer's body), aff'd 105 AFTR 2d 2010-442 105 AFTR 2d 2010-442
(1st Cir. 2009).
†. Treas. Reg. §1.213-1(e)(1)(v). Treas. Reg. §1.213-1(e)(1)(v).
‡. See Ferris v. Comm'r, 42 AFTR 2d 78-5674 42 AFTR 2d 78-5674 (7th Cir. 1978).
a. Code §213(d)(2). Code §213(d)(2).
b. Rev. Rul. 2000-24, Rev. Rul. 2000-24, 2000-19 I.R.B. 963.
Is Expense a
Comments and Special Rules
Long-term care services
Depends on whether Health FSA: Qualified long-term care services (defined as certain services plan is a health FSA, that a chronically ill individual requires and that are prescribed by a licensed HRA, or HSA; see health care practitioner under a plan of care) cannot be reimbursed on a tax- next column for details free basis, even if they otherwise qualify as medical care expenses. (To be chronically ill, an individual must be unable to perform two or more daily living activities for at least 90 days without substantial assistance from another individual, or have a severe cognitive impairment that requires substantial supervision to protect him or her from threats to health and safety.) It is unclear whether health FSAs can provide taxable reimbursement of such services or can reimburse "nonqualified" long-term care services to the extent that the services otherwise qualify as medical care expenses. See subsection L.10. HRA: For HRAs that are health FSAs, the health FSA rules will apply (see above). HRAs that are not health FSAs should be able to reimburse qualified long-term care expenses that otherwise qualify as medical care expenses. HSA: Long-term care services will qualify for reimbursement to the extent that the services otherwise qualify as medical care expenses.
Not a qualifying See Cosmetics and Toiletries.
Marijuana or other
Not a qualifying See Controlled substances and Illegal operations and treatments.
controlled substances in
expense *
violation of federal law
Masks, disposable
Potentially qualifying Won't qualify if used for general health purposes or other personal reasons. May qualify if used to treat or alleviate a specific medical condition, and if
the expense would not have been incurred "but for" the condition. † Might
also qualify where used to prevent a specific illness that is imminent (e.g., if
a household member has a contagious disease). A note from a medical
practitioner recommending the item to treat a specific medical condition (or,
if applicable, to prevent a specific and imminent illness) is normally required.
Potentially qualifying The costs of a massage just to improve general health don't qualify. ‡
However, if the massage therapy was recommended by a physician to treat
a specific injury or trauma, then it would qualify. a To show that the expense
is primarily for medical care, a note from a medical practitioner
recommending it to treat a specific medical condition is normally required.
See subsections D and L.15.
*. Treas. Reg. §1.213-1(e)(1)(ii) Treas. Reg. §1.213-1(e)(1)(ii) and Rev. Rul. 97-9, Rev. Rul. 97-9, 1997-9 I.R.B. 4; see also IRS
Publication 502 IRS Publication 502 (Medical and Dental Expenses).
†. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
‡. Informal, nonbinding remarks of Katherine Kiss, IRS, Office of Chief Counsel, Aug. 1998 ECFC Annual Symposium.
a. Informal, nonbinding remarks of Donna Crisalli, IRS, Office of Chief Counsel, May 2002 ECFC Teleconference.
Is Expense a
Comments and Special Rules
Qualifying expense Will qualify when incurred following a mastectomy for cancer. See Breast
special bras
reconstructive surgery following mastectomy.
Not a qualifying expense *
Not a qualifying In rare cases, a portion of the expenditure might qualify if a unique type of mattress is prescribed by a physician to treat a specific medical condition. †
Also see Capital expenses.
Meals at a hospital or
Potentially qualifying Meals that are part of the cost of inpatient care at a hospital or similar institution will qualify if a principal reason for the recipient's being there is to
receive medical care; the meals must be furnished as a necessary incident
to the individual's continuing medical care. Meals that are not part of
inpatient care generally won't qualify. It is unclear whether meals provided at
a hospital or similar institution for an outpatient who must remain at the
institution for continuing care for some period (e.g., following a medical
procedure) would qualify. ‡ See Lodging at a hospital or similar
institution; Meals of a companion; Schools and education, residential;
and Schools and education, special. Also see subsections L.8 and L.14.
Meals not at a hospital
Not a qualifying See Lodging not at a hospital or similar institution. Also see subsection
or similar institution
expense a
Meals of a companion
Not a qualifying Won't qualify even if accompanying a patient for medical reasons. See Lodging of a companion and subsection L.8.
Meals while attending a
Not a qualifying See Medical conference admission, transportation, meals, etc.
Medical alert bracelet or Qualifying expense
Will qualify if recommended by a medical practitioner in connection with treating a medical condition. b
Medical conference
Potentially qualifying Expenses for admission and transportation to a medical conference qualify, admission,
if they relate to a chronic disease suffered by you, your spouse, or your transportation, meals,
dependent and if the conference is primarily for and essential to the person in need of medical care. c Includes transportation expenses to the city where
the conference is held, plus local transportation to the conference. Most of
the time at the conference must be spent attending sessions on medical
information. The expenses of meals and lodging while attending the
conference don't qualify. d See subsection L.8.
*. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
†. Rev. Rul. 55-155, Rev. Rul. 55-155, 1955-1 C.B. 245; Rev. Rul. 55-261, Rev. Rul. 55-261, 1955-1 C.B. 307, as modified by Rev.
Rul. 63-91, Rev. Rul. 63-91, 1963-1 C.B. 54.
‡. Treas. Reg. §§1.213-1(e)(1)(iv) Treas. Reg. §§1.213-1(e)(1)(iv) and (v) (v) (referring to meals that are part of the cost of "inpatient
care" as an expenditure for medical care), and Rev. Rul. 2000-24, Rev. Rul. 2000-24, 2000-19 I.R.B. 963. See also Rev. Rul. 73-325,
Rev. Rul. 73-325, 1973-2 C.B. 75 and IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
a. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses). See also Levine v. Comm'r Levine v. Comm'r, 695 F.2d
57 (2d Cir. 1982).
b. Informal, nonbinding remarks of Donna Crisalli, IRS, Office of Chief Counsel, Aug. 1997 ECFC Annual Symposium.
c. Rev. Rul. 2000-24, Rev. Rul. 2000-24, 2000-19 I.R.B. 963.
d. Rev. Rul. 2000-24, Rev. Rul. 2000-24, 2000-19 I.R.B. 963.
Is Expense a
Comments and Special Rules
Medical information
Qualifying expense These are expenses paid to a plan to keep medical information so that it can plan charges
be retrieved from a computer databank for your (or your spouse's or
dependent's) medical care. *
Medical monitoring and
Qualifying expense †
Examples of such devices are blood-pressure monitors, syringes, glucose testing devices
kit, etc. Also see Blood-sugar test kits and test strips; Body scans;
Diagnostic items/services; Ovulation monitor; and Pregnancy test kits.
Medical records charges
Qualifying expense ‡
For example, the fee associated with transferring medical records to a new medical practitioner will qualify.
Medicines and drugs
Potentially qualifying See Drugs and medicines.
Menstrual pain relievers Potentially qualifying
Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Mentally handicapped,
Potentially qualifying The cost of keeping a mentally handicapped person in a special home (not a special home for
relative's home) on a psychiatrist's recommendation to help that person
adjust from life in a mental hospital to community living may qualify. a See
also Schools and education, residential and subsection L.14.
Qualifying expense b
See also Doula; Lamaze classes; and Nursing services.
Mineral supplements
Potentially qualifying Won't qualify if used to maintain general health. c But under narrow
circumstances, mineral supplements might qualify if recommended by a
medical practitioner for a specific medical condition (for example, a
prescribed dosage of iron daily to treat iron-deficiency anemia). To show that
the expense is primarily for medical care, a note from a medical practitioner
recommending the item to treat a specific medical condition is normally
required. See Dietary supplements and subsection L.4.
Missed appointment fees
Not a qualifying Such fees would not be for medical care.
Not a qualifying See Cosmetics; Toiletries; and Cosmetic procedures.
*. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
†. Treas. Reg. §1.213-1(e)(1)(ii) Treas. Reg. §1.213-1(e)(1)(ii) (allowing that payments for medical care include "medical, laboratory,
surgical, dental and other diagnostic and healing services").
‡. Cf. Rev. Rul. 71-282, Rev. Rul. 71-282, 1971-2 C.B. 166 (fee for retrieval of medical information from computer databank).
a. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
b. Informal, nonbinding remarks of Donna Crisalli, IRS, Office of Chief Counsel, Aug. 12, 2011 ECFC Annual Symposium.
c. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
Is Expense a
Comments and Special Rules
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after contraceptive pills
December 31, 2010. See Drugs and medicines. Also see Birth-control
pills and Contraceptives.
Motion sickness pills
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after (Examples: Bonine, December 31, 2010. See Drugs and medicines.
Motion sickness
Qualifying expense wristbands
Mouthwash
Not a qualifying Such expenses generally won't qualify. * See Cosmetics and Toiletries.
However, depending on the facts and circumstances, a special mouthwash
recommended by a medical practitioner for the treatment of gingivitis might
qualify. †
Nail polish
Not a qualifying See Cosmetics and Toiletries.
Nasal strips or sprays
Potentially qualifying Nasal sprays or strips that are used to treat sinus problems qualify as being primarily for medical care, as would those that are used to prevent sleep
apnea. ‡ However, nasal strips or sprays used to prevent run-of-the-mill
snoring wouldn't qualify, nor would those used by athletes. To show that the
expense is primarily for medical care, a note from a medical practitioner
recommending the item to treat a specific medical condition is normally
required. Note that medicated sprays must be prescribed if incurred after
December 31, 2010. See Drugs and medicines.
Potentially qualifying See Alternative healers; Drugs and medicines; Special foods;
Vitamins; and subsections L.2, L.3, L.4, and L.7.
Nicotine gum or patches Potentially qualifying
Such items are primarily for medical care when used for stop-smoking (Examples: Nicoderm, purposes and will qualify if incurred before 2011 but must be prescribed in order to qualify if incurred after December 31, 2010. See Drugs and
medicines.
Nonprescription drugs
Potentially qualifying See Drugs and Medicines.
and medicines
Norplant insertion or
Qualifying expense a
Also see Contraceptives; Birth-control pills; Vasectomy; and
Nursing services for a
Not a qualifying Won't qualify if the baby is normal and healthy. b
*. Informal, nonbinding remarks of Harry Beker, Barbara Pie, and John Sapienza, IRS, Office of Chief Counsel, Oct. 22, 2003 ECFC
Teleconference.
†. Informal, nonbinding remarks of Harry Beker, Barbara Pie, and John Sapienza, IRS, Office of Chief Counsel, Oct. 22, 2003 ECFC
Teleconference.
‡. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
a. Treas. Reg. §1.213-1(e). Treas. Reg. §1.213-1(e).
b. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
Is Expense a
Comments and Special Rules
Nursing services
Potentially qualifying Wages, employment taxes, and other amounts you pay for nursing services provided by a nurse or
(including extra costs for nurses' room and board) generally will qualify, whether provided in the participant's home or another facility. * The attendant
doesn't have to be a nurse, so long as the services are of a kind generally
performed by a nurse. These include services connected with caring for the
patient's condition, such as giving medication or changing dressings, as well
as bathing and grooming. But if the person providing nursing services also
provides household and personal services, the amounts must be accounted
for separately—only those for nursing services qualify. † Also see subsection
L.10 .
Nutritional supplements
Potentially qualifying See Dietary Supplements. ‡
Nutritionist's professional Potentially qualifying
May qualify if the treatment relates to a specifically diagnosed medical condition. Won't qualify if the expense is for general health. a To show that
the expense is primarily for medical care, a note from a medical practitioner
recommending the item to treat a specific medical condition is normally
required. Also see Special foods and subsections L.3 and L.4 .
Qualifying expense b
Occlusal guards to
Qualifying expense c
prevent teeth grinding
Potentially qualifying Will qualify if it treats or alleviates a medical condition. To show that the expense is primarily for medical care, a note from a medical practitioner recommending it to treat a specific medical condition is normally required.
One-a-day vitamins
Not a qualifying Online or telephone
Qualifying expense Will qualify, so long as the consultation's purpose is to obtain advice to treat consultation, medical
or mitigate a medical condition and the practice is legal in the applicable practitioner's fee for
state or other locality. d
Qualifying expense Will qualify if the operations are legal (and aren't cosmetic procedures). e
See Cosmetic procedures and subsection L.1 .
Qualifying expense Also see Eye examinations, eyeglasses, equipment, and materials.
Organ donors
Qualifying expense Qualifying expense Such expenses generally will qualify. f When an orthodontic treatment plan
is paid up-front at the time of the first visit, some health FSAs will apportion
the reimbursements as services are provided during the treatment plan. Also
see Dental services and procedures; Prepayments; and subsections
G.3 and L.1 .
Orthopedic shoe inserts
Qualifying expense Will qualify if used to treat injured or weakened body parts. g
*. Treas. Reg. §1.213-1(e)(1)(ii) Treas. Reg. §1.213-1(e)(1)(ii).
†. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
‡. Rev. Rul. 2003-102 Rev. Rul. 2003-102, 2003-38 I.R.B. 559. Although the IRS has declared this Ruling obsolete as of January 1,
2011 (see Rev. Rul. 2010-23, Rev. Rul. 2010-23, 2010-39 IRB 388), its logic would still seem to be applicable regarding nutritional
supplements.
a. Informal, nonbinding remarks of Katherine Kiss, IRS, Office of Chief Counsel, Aug. 1999 ECFC Annual Symposium.
b. Treas. Reg. §1.213-1(e)(1)(ii) Treas. Reg. §1.213-1(e)(1)(ii).
c. Informal, nonbinding remarks of Katherine Kiss, IRS, Office of Chief Counsel, Aug. 1996 ECFC Annual Symposium.
d. Informal, nonbinding remarks of Donna Crisalli, IRS, Office of Chief Counsel, Aug. 12, 2011 ECFC Annual Symposium.
e. Treas. Reg. §1.213-1(e)(1)(ii) Treas. Reg. §1.213-1(e)(1)(ii).
f. See IRS Information Letter (Feb. 19, 1997).
g. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
Is Expense a
Comments and Special Rules
Orthopedic shoes
Potentially qualifying Won't qualify if used for personal or preventive reasons. If used to treat or alleviate a specific medical condition, only the excess cost of the
specialized orthopedic shoe over the cost of a regular shoe will qualify. * To
show that the expense is primarily for medical care, a note from a medical
practitioner recommending the item to treat a specific medical condition is
normally required.
Qualifying expense †
Over-the-counter (OTC)
Potentially qualifying See Drugs and medicines.
Ovulation monitor
Qualifying expense ‡
Also see Medical monitoring and testing devices.
Qualifying expense This includes the expenses of oxygen and oxygen equipment for breathing
problems caused by a medical condition. a
Pain relievers
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Advil, Aspirin, Tylenol) Not a qualifying See Cosmetics and Toiletries.
Permanent waves
Not a qualifying See Cosmetics and Toiletries.
Personal trainer fees
Potentially qualifying Will qualify if a medical practitioner has recommended a supervised exercise regimen in order to treat a disease or injury (e.g., rehabilitation after surgery
or the treatment of obesity) and if incurred for a limited duration. b The
expense must not have been incurred "but for" the disease (e.g., if you were
working with a personal trainer before being diagnosed, the expense would
not qualify). To show that the expense is primarily for medical care, a note
from a medical practitioner recommending it to treat a specific medical
condition is normally required. See Weight-loss programs and/or drugs
prescribed to induce weight loss.
Petroleum jelly
Potentially qualifying Won't qualify if used to maintain general health or for other personal reasons (e.g., as a toiletry or a cosmetic). May qualify if used to treat or alleviate a
specific medical condition, and if the expense would not have been incurred
"but for" the condition. c To show that the expense is primarily for medical
care, a note from a medical practitioner recommending the item to treat a
specific medical condition is normally required.
*. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
†. Rev. Rul. 55-261 Rev. Rul. 55-261, 1955-1 C.B. 307, as modified by Rev. Rul. 63-91 Rev. Rul. 63-91, 1963-1 C.B. 54.
‡. Treas. Reg. §1.213-1(e)(1)(ii) Treas. Reg. §1.213-1(e)(1)(ii) (allowing that payments for medical care include "medical, laboratory,
surgical, dental and other diagnostic and healing services").
a. Rev. Rul. 55-261 Rev. Rul. 55-261, 1955-1 C.B. 307, as modified by Rev. Rul. 63-91 Rev. Rul. 63-91, 1963-1 C.B. 54.
b. Informal, nonbinding remarks of Harry Beker, Barbara Pie, and John Sapienza, IRS, Office of Chief Counsel, Oct. 22, 2003 ECFC
Teleconference.
c. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
Is Expense a
Comments and Special Rules
Qualifying expense *
Qualifying expense †
Pregnancy test kits
Qualifying expense ‡
Also see Medical monitoring and testing devices and Ovulation
monitor.
Prenatal vitamins
Potentially qualifying Obstetricians routinely recommend prenatal vitamins for the health of unborn children. If taken during pregnancy (a medical condition), prenatal vitamins
would be considered primarily for medical care. a Vitamins taken at other
times generally do not qualify. See Vitamins.
Not a qualifying Generally, prepayments for services/items that have not yet been incurred/obtained are not reimbursable under a health FSA. See Dental
services and procedures; Fertility treatments; and Orthodontia.
Prescription drug
Not a qualifying If an individual pays a fee for a card that provides for a 20% discount on all drugs, the fee would not qualify. In contrast, the cost of a prescribed drug
generally will qualify. See Drugs and Medicines.
Potentially qualifying See Drugs and medicines.
Prescription drugs and
Not a qualifying Importing prescription drugs from other countries generally will violate federal medicines obtained from expense
law. b However, a drug or medicine may qualify for reimbursement if (1) it is
purchased and consumed in the other country and is legal in both that
country and the U.S. or (2) the FDA announces that it can be legally
imported by individuals. See Drugs and medicines and subsection L.2.
Preventive care
Qualifying expense Will qualify if the tests are used for medical diagnoses. c Examples include
hearing, vision, and cholesterol screenings. Also see Body scans and
Diagnostic items/services.
Probiotics
Potentially qualifying Won't qualify if used to maintain general health or for other personal reasons. May qualify if used to treat or alleviate a specific medical condition, and if
the expense would not have been incurred "but for" the condition. d To show
that the expense is primarily for medical care, a note from a medical
practitioner recommending the item to treat a specific medical condition is
normally required.
Potentially qualifying Generally won't qualify if purchased for cosmetic purposes (for example, to treat male pattern baldness), even if recommended by a medical practitioner.
But the expense may qualify if it is to ameliorate a deformity arising from a
congenital abnormality, personal injury from an accident or trauma, or
disfiguring disease. See Cosmetic procedures and Drugs and medicines.
*. Rev. Rul. 2007-72, Rev. Rul. 2007-72, 2007-50 I.R.B. 1154 (annual physical exam is diagnostic and qualifies as a medical care
expense, even when individual lacks symptoms of illness).
†. Rev. Rul. 55-261, Rev. Rul. 55-261, 1955-1 C.B. 307, as modified by Rev. Rul. 63-91, Rev. Rul. 63-91, 1963-1 C.B. 54.
‡. Treas. Reg. §1.213-1(e)(1)(ii) Treas. Reg. §1.213-1(e)(1)(ii) (allowing that payments for medical care include "medical, laboratory,
surgical, dental, and other diagnostic and healing services"); see also Rev. Rul. 2007-72, Rev. Rul. 2007-72, 2007-50 I.R.B. 1154
(pregnancy test kit is for medical care).
a. Informal, nonbinding remarks of John Sapienza, IRS, Office of Chief Counsel, Nov. 5, 2003 ECFC Teleconference.
b. See IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses) and IRS Information Letter 2005-0011 (Mar. 14,
2005).
c. Priv. Ltr. Rul. 200140017 Priv. Ltr. Rul. 200140017 (June 25, 2001).
d. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
Is Expense a
Comments and Special Rules
Qualifying expense *
See Artificial limbs and teeth.
Qualifying expense Includes the cost of supporting mentally ill dependent at a special center
that provides medical care. †
Potentially qualifying Will qualify if provided for medical care, and not just for the general improvement of mental health, relief of stress, or personal enjoyment, nor if
the expense stems from training to be a psychoanalyst. ‡ To show that the
expense is primarily for medical care, a note from a medical practitioner
recommending it to treat a specific medical condition is normally required.
Also see Psychologist and Therapy.
Potentially qualifying Will qualify if the expense is for medical care, a and not just for the general
improvement of mental health, relief of stress, or personal enjoyment. b To
show that the expense is primarily for medical care, a note from a medical
practitioner recommending it to treat a specific medical condition is normally
required. Also see Therapy.
Qualifying expense c
Corneal ring segments (removable plastic half-rings that correct vision) would
also qualify. d See Laser eye surgery; Lasik and Vision correction
procedures.
Reading glasses
Qualifying expense e
Both prescription and nonprescription reading glasses would qualify. Also
see Eye examinations, eyeglasses, equipment, and materials.
Not a qualifying Generally won't qualify, unless used exclusively to treat a specific medical condition, as diagnosed and prescribed by a medical practitioner. See
Mattresses.
Rehydration solution
Qualifying expense f
(Example: Pedialyte) Rental cars
Potentially qualifying Potentially qualifying Generally won't qualify if purchased for cosmetic purposes (for example, to reduce wrinkles), even if recommended by a medical practitioner. But may
qualify if recommended by a medical practitioner for a specific medical
condition (e.g., acne vulgaris) and not for cosmetic purposes. To show that
the expense is primarily for medical care, a note from a medical practitioner
recommending it to treat a specific medical condition is normally required.
Must be prescribed if incurred after December 31, 2010. See Acne
treatment; Cosmetic procedures; Drugs and medicines; and
subsections L.1 and L.2.
*. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
†. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
‡. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
a. Rev. Rul. 75-187, Rev. Rul. 75-187, 1975-1 C.B. 92.
b. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
c. Priv. Ltr. Rul. 9625049 Priv. Ltr. Rul. 9625049 (June 21, 1996); Priv. Ltr. Rul. 200226003 Priv. Ltr. Rul. 200226003 (Mar. 7, 2002);
IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
d. Rev. Rul. 2003-57, Rev. Rul. 2003-57, 2003-22 I.R.B. 959.
e. Informal, nonbinding remarks of Katherine Kiss, IRS, Office of Chief Counsel, Aug. 1999 ECFC Annual Symposium.
f. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
Is Expense a
Comments and Special Rules
Potentially qualifying Generally won't qualify if purchased for cosmetic purposes. But may qualify if it is recommended by a medical practitioner for a specific medical
condition. To show that the expense is primarily for medical care, a note
from a medical practitioner recommending it to treat a specific medical
condition is normally required. Must be prescribed if incurred after December
31, 2010. See Propecia and Drugs and medicines. Also see subsections
L.1 and L.2.
Rubbing alcohol
Qualifying expense Will qualify when purchased for first-aid purposes (e.g., when purchased in
first-aid quantities in a pharmacy or first-aid section of a retail store). *
Potentially qualifying Generally won't qualify, unless a medical practitioner determines that the procedure is necessary to treat a specific medical condition. † To show that
the expense is primarily for medical care, a note from a medical practitioner
recommending it to treat a specific medical condition is normally required.
See Massage therapy and subsection L.6.
Safety glasses
Not a qualifying Probably won't qualify unless prescribed. ‡ See Eye examinations,
eyeglasses, equipment, and materials.
Schools and education,
Potentially qualifying Payments made to a residential school or program to treat an individual for behavioral, emotional, or addictive conditions (tuition, meals, and lodging)
will qualify if a principal reason for attending the program is to receive
medical care. (Ordinary education must be an incidental component.)
Whether someone is attending to receive medical care is a question of fact
that must be determined for each individual—just because a school or
program provides medical care to some individuals does not mean that it
provides medical care to all individuals. If a child is at a school because the
courses and disciplinary methods have a beneficial effect on the child's
attitude, the expenses won't qualify. See subsection L.14. Also see
Schools and education, special and Pre-payments.
Schools and education,
Potentially qualifying Payments made for a mentally impaired or physically disabled person to attend a special school (tuition, meals, and lodging) will qualify if a principal
reason for attending the school is to overcome or alleviate the disability.
(Ordinary education must be an incidental component.) This includes
teaching Braille to a visually impaired person, teaching lip reading to a
hearing-impaired person, and remedial language training to correct a
condition caused by a birth defect. If a child is at a school because the
courses and disciplinary methods have a beneficial effect on the child's
attitude, the expenses won't qualify. See subsection L.14. Also see
Schools and education, residential and Prepayments.
Qualifying expense Will qualify if the tests are used for medical diagnoses. a Examples include
hearing, vision, and cholesterol screenings. Also see Body scans and
Diagnostic items/services.
*. Although not official guidance, the Federal Flexible Spending Account Program treats rubbing alcohol as a reimbursable expense.
See the Federal "Eligible Expenses Juke Box," available at https://www.fsafeds.com/fsafeds/eligibleexpenses.asp (as visited Nov.
16, 2011).
†. IRS Information Letter 2000-0405 IRS Information Letter 2000-0405 (Dec. 29, 2000).
‡. Informal, nonbinding remarks of Katherine Kiss, IRS, Office of Chief Counsel, Aug. 1999 ECFC Annual Symposium.
a. Priv. Ltr. Rul. 200140017 Priv. Ltr. Rul. 200140017 (June 25, 2001).
Is Expense a
Comments and Special Rules
Service animal, to assist Potentially qualifying
Expenses of buying, training, and maintaining a service animal to assist an individual with mental
individual with mental health disabilities may qualify if the individual can show that he or she is using the service animal primarily for medical care to alleviate a mental defect or illness and would not have paid the expenses but for the defect or illness. * Also see Guide dog and Veterinary fees.
Shampoos
Not a qualifying Generally won't qualify. See Cosmetics and Toiletries.
Shaving cream or lotion
Not a qualifying See Cosmetics and Toiletries.
Shipping and handling
Qualifying expense Shipping and handling fees incurred to obtain an item that constitutes medical care (e.g., drugs or medicine) are inextricably linked to the cost of
the medical care and therefore qualify. † See subsection L.12 .
Sinus medications
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after (Example: Sudafed) December 31, 2010. See Drugs and medicines and Nasal strips or
sprays.
Skin moisturizers
Not a qualifying See Cosmetics and Toiletries.
Qualifying expense Probably qualifies if the person is under the care of a medical practitioner.
Potentially qualifying Amounts paid for drugs used to stop smoking would qualify if incurred before medications
2011 but must be prescribed if incurred after December 31, 2010. ‡ See
Drugs and medicines; Nicotine gum or patches; and subsection L.2.
Qualifying expense Amounts paid for a smoking-cessation (stop-smoking) program would qualify. a See Smoking-cessation medications and subsection L.2.
Not a qualifying Generally won't qualify. See Cosmetics and Toiletries.
Special foods
Potentially qualifying Will qualify if prescribed by a medical practitioner to treat a specific illness or ailment and if the foods do not substitute for normal nutritional
requirements. b Food modified for special diets (e.g., gluten-free) may also
qualify, but only to the extent that the cost of the special food exceeds the
cost of commonly available versions of the same product. c To show that the
expense is primarily for medical care, a note from a medical practitioner
recommending it to treat a specific medical condition is normally required.
See subsection L.4; see also Infant formula.
*. IRS Information Letter 2010-0129 IRS Information Letter 2010-0129 (May 11, 2010).
†. Informal, nonbinding remarks of Harry Beker, Barbara Pie, and John Sapienza, IRS, Office of Chief Counsel, Oct. 22, 2003 ECFC
Teleconference.
‡. Rev. Rul. 99-28, Rev. Rul. 99-28, 1999-25 I.R.B. 6.
a. Rev. Rul. 99-28, Rev. Rul. 99-28, 1999-25 I.R.B. 6.
b. See, e.g., Rev. Rul. 2002-19, Rev. Rul. 2002-19, 2002-16 I.R.B. 778, Rev. Rul. 55-261, Rev. Rul. 55-261, 1955-1 C.B. 307, Priv.
Ltr. Rul. 200941003 Priv. Ltr. Rul. 200941003 (July 1, 2009) (infant formula for the healthy baby of a woman who could not breastfeed
due to a double mastectomy was a personal expense; because the formula satisfied the baby's normal nutritional needs, it was food
that the baby would normally consume and was not a medical care expense), and Treasury Tax Correspondence, 2006 TNT 144-20
(July 19, 2006).
c. See, e.g., Randolph v. Comm'r, 67 T.C. 481 67 T.C. 481 (1976).
Is Expense a
Comments and Special Rules
Speech therapy
Qualifying expense *
Sperm, storage fees
Potentially qualifying Fees for temporary storage might qualify, but only to the extent necessary for immediate conception. Storage fees for undefined future conception
probably aren't considered to be for medical care. "Temporary" is not defined;
however, one consideration might be whether it is stored and used within the
same year. † Also see Fertility treatments; Eggs and embryos, storage
fees; Surrogate or gestational carrier expenses; Prepayments; and
subsection L.13.
Spermicidal foam
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines. Also see Contraceptives.
St. John's Wort
Potentially qualifying Will qualify if used primarily for medical care (for example, to treat a diagnosed medical condition such as depression); won't qualify if used to maintain general health. To show that the expense is primarily for medical care, a note from a medical practitioner recommending the item to treat a specific medical condition is normally required.
Stem cell, harvesting
Potentially qualifying Might qualify if there is a specific and imminent medical condition that the and/or storage of
stem cells are intended to treat. For example, the cost of harvesting and
storing stem cells because a newborn has a birth defect and the stem cells
would be needed in the near future might be allowable. ‡ But collection and
storage indefinitely, just in case an item might be needed, is not medical
care. a See DNA collection and storage; Prepayments; and Umbilical
cord blood storage.
Qualifying expense Sterilization means the cost of a legally performed operation to make a
person unable to have children. b Also see Vasectomy.
Qualifying expense See Smoking-cessation programs.
Student health fee
Potentially qualifying A fee that is simply the cost of belonging to the program won't qualify. Expenses for specific medical services might qualify.
Sunburn creams and
Potentially qualifying Will qualify if used to treat a sunburn (and not as regular skin moisturizers), ointments, medicated
but must be prescribed if incurred after December 31, 2010. See Drugs and
(Example: Solarcaine) medicines. Also see Sunscreen.
Sunglasses
Potentially qualifying Prescription sunglasses would qualify. Allowable amounts include the expenses of eye examinations, eyeglasses, and lenses needed for medical
reasons. It is unclear whether nonprescription sunglasses or clip-on
sunglasses recommended by a physician to alleviate an eye condition would
qualify. c
*. Rev. Rul. 55-261, Rev. Rul. 55-261, 1955-1 C.B. 307, as modified by Rev. Rul. 63-91, Rev. Rul. 63-91, 1963-1 C.B. 54.
†. Informal, nonbinding remarks of John Sapienza, IRS, Office of Chief Counsel, May 2002 ECFC Teleconference.
‡. See ABA Joint Committee on Employee Benefits, Questions and Answers for the IRS, Q/A-3 (May 11, 2002) (as visited Aug. 30,
2011). See also IRS Information Letter 2010-0017 IRS Information Letter 2010-0017 (Nov. 2, 2009).
a. See, e.g., IRS Information Letter 2010-0017 IRS Information Letter 2010-0017 (Nov. 2, 2009) and Priv. Ltr. Rul. 200140017 Priv. Ltr.
Rul. 200140017 (June 25, 2001).
b. Rev. Rul. 73-603, Rev. Rul. 73-603, 1973-2 C.B. 76.
c. IRS Information Letter 2000-0073 IRS Information Letter 2000-0073 (June 30, 2000).
Is Expense a
Comments and Special Rules
Sun-protective (SPF)
Potentially qualifying Won't qualify if used to maintain general health or for other personal reasons. May qualify if used to treat or alleviate a specific medical condition (e.g., melanoma) and if the expense would not have been incurred "but for" the condition, but only the excess cost of the specialized garment over the
cost of ordinary clothing will qualify. To show that the expense is primarily
for medical care, a note from a medical practitioner recommending the item
to treat a specific medical condition is normally required. Also see
Sunscreen and Sunscreen, cosmetics or similar products with.
Qualifying expense There is no official guidance, but an IRS official has informally commented
that sunscreen will likely qualify as a medical care expense because its sole
purpose is to prevent sunburn and that sunscreen is not a medicine or drug. *
Some plans may take a more cautious approach, for example by
reimbursing only products at or above a specified SPF (e.g., 15, due to
recent FDA guidance). † Also see Sunscreen, cosmetics or similar
products with and Suntan lotion.
Sunscreen, cosmetics or Potentially qualifying
There is no official guidance, but an IRS official has informally commented similar products with
that the excess cost of the version of the item with the sunscreen over the
cost of the regular item would probably qualify. ‡ Some plans may take a
more cautious approach, for example by reimbursing only products at or
above a specified SPF (e.g., 15, due to recent FDA guidance) a or not
reimbursing the excess cost of items with a sunscreen component. Also
see Sunscreen and Suntan lotion.
Not a qualifying Suntan lotion and similar products generally won't qualify. Also see Sunscreen and Sunscreen, cosmetics or similar products with.
Supplies to treat
Qualifying expense Will qualify if the medical supply is used to diagnose or treat a specific medical condition and isn't a personal comfort item. Also see Bandages
and Crutches.
Support braces
Qualifying expense Will qualify if used for injured or weakened body parts. b
Qualifying expense Generally will qualify. See Operations.
Surrogate or gestational Not a qualifying
Such expenses generally won't qualify, even if they are for medical care of the surrogate/gestational carrier or her unborn child. c The procedure must be
performed upon you, your spouse, or your dependent in order to be medical
care. Also see Fertility treatments; Egg donor fees; Eggs and embryos,
storage fees; Legal fees in connection with fertility treatments;
Sperm, storage fees; and subsection L.13.
Potentially qualifying Such expenses generally won't qualify, but there are some exceptions. d See
Dancing lessons and subsection D.
*. Informal, nonbinding remarks of Donna Crisalli, IRS, Office of Chief Counsel, Aug. 12, 2011 ECFC Annual Symposium; but see
IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009) (characterizing sunscreen as a dual-purpose item
that may qualify if used to treat or alleviate a specific medical condition, and if the expense would not have been incurred but for the
condition).
†. See FDA Sheds Light on Sunscreens (June 14, 2011) (as visited Aug. 30, 2011).
‡. Informal, nonbinding remarks of Donna Crisalli, IRS, Office of Chief Counsel, Aug. 12, 2011 ECFC Annual Symposium; but see
IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009) (characterizing sunscreen as a dual-purpose item
that may qualify if used to treat or alleviate a specific medical condition, and if the expense would not have been incurred but for the
condition).
a. See FDA Sheds Light on Sunscreens (June 14, 2011) (as visited Aug. 30, 2011).
b. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
c. IRS Information Letter 2002-0291 IRS Information Letter 2002-0291 (Aug. 12, 2002); Magdalin v. Comm'r, T.C. Memo. 2008-293
(2008), aff'd 105 AFTR 2d 2010-442 105 AFTR 2d 2010-442 (1st Cir. 2009).
d. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
Is Expense a
Comments and Special Rules
Swimming pool
Potentially qualifying Such expenses generally won't qualify if the swimming pool is used for recreation. However, if the swimming pool is used primarily for medical care
by someone who has been diagnosed with a medical condition and a
medical practitioner has substantiated that the pool is part of the medical
treatment, then the cost of maintaining the pool might qualify. * Also see
Capital expenses.
Tanning salons and
Not a qualifying See Cosmetic procedures. In rare cases, they might qualify if
recommended for a specific medical condition (such as a skin disorder), so
long as there is no personal element or use of the equipment by other family
members. †
Taxes on medical
Qualifying expense Such expenses generally will qualify to the extent that the tax is imposed on services and products
qualified medical care services/items. This includes local, sales, service, and other taxes. See subsection L.12. Not a qualifying Won't qualify if tooth discoloration is simply the result of aging, and the whitening is done for cosmetic purposes. ‡ But if tooth discoloration (rising to
the level of a deformity) was caused by disease, birth defect, or injury,
expenses for teeth whitening might qualify. a See Cosmetic procedures and
subsection L.1.
Telephone for hearing-
Qualifying expense The expenses of buying and repairing special telephone equipment for a hearing-impaired person will qualify. b This includes teletypewriter (TTY) and
telecommunications device for the deaf (TDD) equipment. See Capital
expenses.
Television for hearing-
Qualifying expense Equipment that displays the audio part of television programs as subtitles for hearing-impaired persons will qualify. But the amount that qualifies is limited
to the excess of the cost over the cost of the regular item. For example, the
cost of a specially equipped television qualifies only to the extent that it
exceeds the cost of a regular model. c See Capital expenses.
Qualifying expense Will qualify if provided for medical care (and not just for the general
improvement of mental health, relief of stress, or personal enjoyment). d Also
see Psychoanalysis; Psychologist; Schools and education,
residential/special; and subsection L.14.
Qualifying expense Will qualify if for medical use. See Supplies to treat medical condition.
Throat lozenges
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after (Examples: Cepacol, December 31, 2010. See Drugs and medicines. Also see Cough
Toiletries
Not a qualifying A toiletry is an article or preparation that is used in the process of dressing and grooming oneself. Examples include toothpaste, shaving cream or
lotion, and cologne. Also see Cosmetics.
Toothache and teething
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after pain relievers
December 31, 2010. See Drugs and medicines.
(Example: Orajel) *. See Emanuel v. Comm'r, T.C. Summary Opinion 2002-127 (2002).
†. Informal, nonbinding remarks of Katherine Kiss, IRS, Office of Chief Counsel, Aug. 1998 ECFC Annual Symposium.
‡. Rev. Rul. 2003-57, Rev. Rul. 2003-57, 2003-22 I.R.B. 959.
a. Informal, nonbinding remarks of Donna Crisalli, IRS, Office of Chief Counsel, May 2002 ECFC Teleconference.
b. Rev. Rul. 71-48, Rev. Rul. 71-48, 1971-1 C.B. 99; Rev. Rul 73-53, Rev. Rul 73-53, 1973-1 C.B. 139.
c. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
d. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
Is Expense a
Comments and Special Rules
Not a qualifying Won't qualify even if a dentist recommends special ones (such as electric or battery-powered) to treat a medical condition like gingivitis. Toothbrushes are
items that are used primarily to maintain general health—a person would still
use one even without the medical condition. Thus, they are not primarily for
medical care. * See Toiletries and Cosmetics.
Toothpaste
Not a qualifying Won't qualify even if a dentist recommends a special one to treat a medical condition like gingivitis. Toothpaste is an item that is primarily used to
maintain general health—a person would still use it even without the medical
condition. Thus, it is not primarily for medical care. † But topical creams or
other drugs (e.g., fluoride treatment) used to treat a dental condition would
qualify, so long as they are primarily for medical care. See Cosmetics;
Drugs and medicines; and Toiletries.
Qualifying expense Includes surgical, hospital, and laboratory services as well as transportation
expenses for organ donors. ‡
Transportation costs of
Not a qualifying A disabled individual's commuting costs to and from work are personal disabled individual
expenses and not expenses for medical care. a However, the costs incurred
commuting to and from
for transportation to and from work may be medical expenses if the employment itself is explicitly prescribed as therapy to treat a medical
condition. b
Transportation expenses Qualifying expense
Will qualify if the transportation is primarily for and essential to medical care. for person to receive
c Includes car and rental car d expenses; bus, taxi, train, plane, and ferry
medical care
fares; and ambulance services. Instead of actual car expenses, a standard
mileage rate (19 cents per mile for January–June 2011; 23.5 cents per mile
for July–December 2011) for use of a car to obtain medical care is allowed.
Parking fees and tolls can also qualify. e See subsection L.8.
Transportation of
Potentially qualifying Will qualify in some cases. Transportation expenses of the following persons someone other than the
will qualify: (1) a parent who must go with a child who needs medical care; person receiving
(2) a nurse or other person who gives injections, medications, or other medical care
treatment required by a patient who is traveling to get medical care and is
unable to travel alone; and (3) an individual who travels to visit a mentally ill
dependent, if such visits are recommended as part of treatment. See
Transportation expenses for person to receive medical care and
Lodging not at a hospital or similar institution.
Transportation to and
Potentially qualifying See Medical conference admission, transportation, meals, etc. Also
from a medical
see subsection L.8. Potentially qualifying See Exercise equipment or programs; Capital expenses; and
Tuition evidencing
Qualifying expense Will qualify to the extent that charges for medical expenses are separately separate breakdown for
broken down in a bill for tuition for a college or private school and are for specific qualified medical services/items that have been incurred/obtained
(and are not premiums for medical care generally). See Student health fee
and Insurance premiums.
*. Informal, nonbinding remarks of Harry Beker, Barbara Pie, and John Sapienza, IRS, Office of Chief Counsel, Oct. 22, 2003 ECFC
Teleconference.
†. Informal, nonbinding remarks of Harry Beker, Barbara Pie, and John Sapienza, IRS, Office of Chief Counsel, Oct. 22, 2003 ECFC
Teleconference.
‡. Rev. Rul. 73-189, Rev. Rul. 73-189, 1973-1 C.B. 139.
a. See, e.g., Alderman v. Comm'r, T.C. Summary Opinion 2004-74 T.C. Summary Opinion 2004-74 (2004) (citing cases).
b. Weinzimer v. Comm'r, T.C. Memo. 1958-137 T.C. Memo. 1958-137 (1958); Misfeldt v. Kelm, 44 AFTR 1033 44 AFTR 1033 (D.
Minn. 1951).
c. Code §213(d)(1)(B) Code §213(d)(1)(B) and Treas. Reg. §1.213-1(e)(iv). Treas. Reg. §1.213-1(e)(iv).
d. Priv. Ltr. Rul. 8321042 Priv. Ltr. Rul. 8321042 (Feb. 18, 1983).
e. IRS Notice 2010-88, IRS Notice 2010-88, 2010-51 I.R.B. 882; Rev. Proc. 2010-51, Rev. Proc. 2010-51, 2010-51 I.R.B. 883; IRS
Announcement 2011-40, IRS Announcement 2011-40, 2011-29 I.R.B. 56; and IRS Publication 502 IRS Publication 502 (Medical and
Dental Expenses). See the Table of Limits regarding the mileage rate for other years.
Is Expense a
Comments and Special Rules
Tuition for special-needs Potentially qualifying
Will qualify if the primary purpose is for medical care. * Includes reading
program for dyslexia. See Learning disability, instructional fees;
Schools and education, residential/special; Prepayments; and
subsection L.14.
Potentially qualifying Will qualify if used as a diagnostic tool to determine fetal health and development. Won't qualify if for other purposes (e.g., to obtain prenatal snapshots).
Umbilical cord blood
Potentially qualifying Collection and storage as a precaution to treat a disease or condition that might possibly develop in the future, just in case it is needed, is not medical
care. But might qualify if there is an existing or imminently probable disease
that the umbilical cord blood is intended to treat. † For example, the cost of
storing cord blood where a newborn has a birth defect and where the cord
blood would be needed in the near future might qualify. ‡ Also see Blood
storage; Stem cell, harvesting and/or storage of; and Prepayments.
Usual and customary
Qualifying expense Medical expenses in excess of an insurance plan's usual, customary, and reasonable charges qualify if the underlying expense is for medical care.
Qualifying expense Varicose veins,
Potentially qualifying Such expenses generally won't qualify if the procedure merely improves treatment of
appearance and doesn't meaningfully promote the proper function of the
body or prevent or treat illness or disease. May qualify if the procedure
promotes the proper function of the body or prevents or treats an illness or
disease. To show that the expense is primarily for medical care, a note from
a medical practitioner recommending it to treat a specific medical condition
is normally required. See Cosmetic procedures.
Qualifying expense a
See Sterilization procedures.
Qualifying expense Not a qualifying Such expenses generally won't qualify, as veneers are used primarily for cosmetic purposes. See Cosmetic procedures and Teeth whitening.
Potentially qualifying Will qualify if the veterinary fees are incurred for the care of a guide dog or other animal used by a disabled person. b Otherwise, no.
Qualifying expense Will qualify if prescribed by a physician to treat a medical condition. c See
Drugs and medicines.
*. See, e.g., Rev. Rul. 69-607, Rev. Rul. 69-607, 1969-2 C.B. 40 and Priv. Ltr. Rul. 200521003 Priv. Ltr. Rul. 200521003 (Mar. 1,
2005).
†. See, e.g., IRS Information Letter 2010-0017 IRS Information Letter 2010-0017 (Nov. 2, 2009) and Priv. Ltr. Rul. 200140017 Priv. Ltr.
Rul. 200140017 (June 25, 2001).
‡. Informal, nonbinding remarks of John Sapienza, IRS, Office of Chief Counsel, May 2002 ECFC Teleconference.
a. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
b. IRS Publication 502 IRS Publication 502 (Medical and Dental Expenses).
c. Informal, nonbinding remarks of Katherine Kiss, IRS, Office of Chief Counsel, Aug. 1998 ECFC Annual Symposium.
Is Expense a
Comments and Special Rules
Vision correction
Qualifying expense Medical procedures that correct vision, including laser procedures such as Lasik and radial keratotomy, qualify. * Also see Laser eye surgery; Lasik
and Radial keratotomy.
Vision discount
Not a qualifying Such expenses generally won't qualify. See Insurance premiums. In
contrast, expenses for actual medical treatment (such as an eye exam) generally will qualify.
Vitamins
Potentially qualifying Won't qualify if used to maintain general health (e.g., one-a-day vitamins). †
But under narrow circumstances, vitamins might qualify if recommended by
a medical practitioner for a specific medical condition (for example, a
prescribed dosage of Vitamin B-12 daily to treat a specific vitamin
deficiency). To show that the expense is primarily for medical care, a note
from a medical practitioner recommending the item to treat a specific
medical condition is normally required. See Prenatal vitamins; Dietary
supplements; Special foods; and subsection L.4.
Qualifying expense Will qualify if used to relieve sickness or disability.
Wart remover treatments Potentially qualifying
Although not addressed in IRS guidance, we believe such products are for (Example: Compound W) the treatment of a disease and thus would qualify as medical care but must
be prescribed if incurred after December 31, 2010. ‡ See Drugs and
medicines.
Weight-loss programs
Potentially qualifying Weight-loss programs will qualify if recommended by a physician to treat a and/or drugs prescribed
specific medical condition (such as obesity, heart disease, or diabetes) and to induce weight loss
not simply to improve general health. However, food associated with a
weight-loss program (such as special pre-packaged meals) would not
qualify, since it just meets normal nutritional needs. a To show that the
expense is primarily for medical care, a note from a medical practitioner
recommending it to treat a specific medical condition is normally required.
Drugs and medicines must be prescribed if incurred after December 31,
2010. See Diet foods; Drugs and medicines; Exercise equipment or
programs; Health club fees; Prepayments; Special Foods; and
subsection L.5.
Qualifying expense If used to relieve sickness or disability, amounts you pay for a wheelchair or
autoette and the upkeep costs will qualify. b Wheelchair cushions will also
qualify as a necessary accessory to the wheelchair. c
Potentially qualifying Might qualify if the wig is prescribed by a physician for the mental health of a patient who has lost all of his or her hair from disease or treatment (e.g.,
chemotherapy or radiation). d
*. Rev. Rul. 2003-57, Rev. Rul. 2003-57, 2003-22 I.R.B. 959.
†. Rev. Rul. 2003-102, Rev. Rul. 2003-102, 2003-38 I.R.B. 559. Although the IRS has declared this Ruling obsolete as of January 1,
2011 (see Rev. Rul. 2010-23, Rev. Rul. 2010-23, 2010-39 IRB 388), its logic would still seem to be applicable regarding vitamins.
‡. According to one dictionary definition, a wart is "caused by any of numerous genotypes of the human papillomavirus." U.S.
National Library of Medicine, MEDLINEplus: Medical Dictionary (as visited Nov. 17, 2011).
a. Rev. Rul. 2002-19, Rev. Rul. 2002-19, 2002-16 I.R.B. 778.
b. Treas. Reg. §1.213-1(e)(1)(iii). Treas. Reg. §1.213-1(e)(1)(iii).
c. IRS Information Letter 2009-0209 IRS Information Letter 2009-0209 (July 14, 2009).
d. Rev. Rul. 62-189, Rev. Rul. 62-189, 1962-2 C.B. 88.
Is Expense a
Comments and Special Rules
X-ray fees
Qualifying expense Will qualify if the X-rays are performed for medical reasons. *
Yeast infection
Potentially qualifying Will qualify if incurred before 2011. Must be prescribed if incurred after medications
December 31, 2010. See Drugs and medicines.
(Example: Monistat) YMCA day camp
Not a qualifying Such expenses generally won't qualify. However, if a camp is a special program that is therapeutic and treats a specific disability, then the expense
might qualify. † To the extent attributable to a qualifying individual under a
dependent care assistance program (DCAP), such expenses might be
reimbursable under a DCAP if applicable rules are met (but the same
expenses may not be reimbursed under a health FSA, HRA, or HSA and a
DCAP—there is no "double-dipping" allowed).
*. Treas. Reg. §1.213-1(e)(1)(ii) Treas. Reg. §1.213-1(e)(1)(ii).
†. See Emanuel v. Comm'r, T.C. Summary Opinion 2002-127 (2002).
2011 Thomson Reuters/EBIA. All rights reserved. 2011 Thomson Reuters/RIA. All rights reserved.

Source: http://www.pcschools.us/woad-local/media/benefits/hra/eligible_expenses_ebia_table_2011_12_20.pdf