Are night guards and electric toothbrushes HSA or FSA eligible?

The short answer

A health savings account (HSA) or health flexible spending account (FSA) pays for “qualified medical expenses.” The IRS defines those as medical care, and IRS Publication 502 explains what that covers.

Dental treatment is on the list. Toothbrushes and toothpaste are not. The IRS doesn’t name night guards, but at least one plan administrator lists them as eligible when they’re for grinding. An electric toothbrush is still a toothbrush.

Check your plan. The IRS sets the outer limits, but your employer and the company that runs your plan decide which expenses it covers and how it handles each claim. This page explains the rules; it isn’t tax advice.

What the IRS counts as dental care

Publication 502 says medical expenses are costs to diagnose, treat, ease or prevent a disease, or to affect a part or function of the body. It excludes things that are only good for your general health.

For teeth, the IRS lets you count what you pay to prevent and ease dental disease. Its examples include:

• Cleanings, sealants and fluoride treatments
• X-rays and fillings
• Braces, extractions and dentures

WEX, an HSA and FSA administrator, adds crowns, bridges, root canals and implants to that list. Teeth whitening doesn’t count; Publication 502 says so directly, and WEX says cosmetic work such as veneers generally doesn’t either.

Night guards

A night guard protects your teeth when you grind or clench in your sleep. That puts it closer to treatment than to hygiene.

• A guard your dentist makes. It’s billed by the dental office like other dental treatment, which usually makes the claim simpler. Your plan still decides.
• A lab-made guard ordered online, or a drugstore guard. Lively, an HSA and FSA administrator, lists night mouth guards as eligible for HSAs, FSAs, HRAs and limited-purpose FSAs when they serve a medical purpose, such as grinding. Other administrators may ask you to show that purpose.

If your plan asks for proof, it may want a letter of medical necessity from your dentist. That’s a short note saying you grind and need a guard to protect your teeth. Fidelity notes that some expenses need one of these letters to be eligible.

If you have an HSA, you may also have a limited-purpose FSA, which the IRS allows alongside it for things like dental and vision care. Lively lists night guards as eligible under that type too.

Not sure you grind, or which guard to get? See custom vs over-the-counter night guards and jaw and tooth pain from grinding.

Electric toothbrushes

Here the IRS is fairly clear. Publication 502 says you can’t count items used for personal or family purposes, and it gives “a toothbrush and toothpaste” as its example. Fidelity says most everyday hygiene products don’t qualify. WEX says over-the-counter dental products like toothpaste aren’t eligible unless a dentist prescribes them.

Electric doesn’t change that on its own. A powered brush is still a toothbrush.

The IRS rule has one opening. Publication 502 says a personal item can count if it’s used primarily to prevent or ease a physical or mental disability or illness. Whether your plan applies that to an electric toothbrush, for example if a condition makes a manual brush hard to use, is up to the plan. Don’t count on it, and ask before you buy, not after.

If you’re paying out of pocket anyway, you don’t need an expensive brush. A timer and a pressure sensor do most of the work, and a basic model like the Oral-B Pro 1000 has both. See the best electric toothbrush.

How to check your plan

1. Look up your plan’s eligible-expense list. Most administrators publish one. Search it for “night guard,” “occlusal guard” and “toothbrush.”
2. Call or message the administrator if the item isn’t listed. Ask whether it’s eligible and whether they need a letter of medical necessity.
3. Get the letter before you buy, if they need one. Ask your dentist to name the condition and the item.
4. Keep the itemized receipt. For an FSA claim, the IRS requires a statement from an independent third party, such as the seller, showing the expense and the amount. For an HSA, the IRS says you must keep records showing the money went to qualified medical expenses.

Unused FSA money doesn’t always roll over. Some plans allow a grace period or a limited carryover, and some don’t, so check your plan’s deadline before you spend in a hurry.

Spending it where it counts

The most reliable way to use HSA or FSA money on your teeth is on care itself: checkups, cleanings, fillings, and fixing a problem before it grows. Those are clearly on the IRS list.

• Brush twice a day for two minutes with a fluoride toothpaste, and clean between your teeth once a day.
• If you wake up with a sore jaw or worn teeth, ask your dentist about grinding at your next visit.
• If a tooth already hurts, don’t wait for the new plan year. See what to do for a toothache right now.

No HSA or FSA? A dental savings plan can lower what you pay for treatment at participating dentists.