Yes, co-payments (co-pays) are eligible for reimbursement with a Flexible Spending Account (FSA) or Health Savings Account (HSA).
Why Are Co-payments FSA/HSA Eligible?
A co-payment is a fixed dollar amount that you pay out of pocket for a covered healthcare service at the time of the visit or prescription fill. Because co-pays are part of your financial responsibility for receiving medical care, they are considered eligible medical expenses under IRS Code Section 213(d).
According to IRS Publication 502, co-payments for qualified medical, dental, vision, and prescription (Rx) services are reimbursable through FSA and HSA funds. If the underlying service is an eligible medical expense, the associated co-payment qualifies as well.
FSA- and HSA-eligible co-payments may include:
Office visit co-pays for primary care or specialists
Urgent care and emergency room co-pays
Co-pays for dental exams, cleanings, or procedures
Co-pays for vision exams or corrective eyewear
Co-pays for prescription medications
- Co-pays for therapy, mental health, or other eligible treatments
What’s Not Covered?
The following are not eligible:
Co-pays for services not considered medically necessary (e.g., elective cosmetic procedures)
Co-pays associated with treatments that are later reimbursed by another benefit plan
Insurance premiums — see the clarification below for important differences between FSAs and HSAs
FSA vs. HSA: Are Insurance Premiums Covered?
Insurance premiums are not the same as co-payments, and most of the time, they are not eligible for reimbursement — especially with FSAs.
FSA funds cannot be used to pay insurance premiums under any circumstance.
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HSA funds may be used for certain types of insurance premiums, but only in specific situations:
COBRA continuation coverage
Health insurance premiums during periods of unemployment
Qualified long-term care insurance premiums (subject to IRS annual limits)
Medicare premiums (Parts A, B, C, or D) if you're age 65 or older — not Medigap plans
If your payment is a fixed fee paid at the time of care, it’s a co-pay and likely eligible. If it’s a monthly charge to maintain coverage, it’s a premium and only HSA funds apply under limited conditions.
How to Use Your FSA or HSA for Co-payments
You can use your FSA or HSA card to pay co-pays at the time of service or when picking up a prescription. If you paid out of pocket:
Save your itemized receipt or invoice that shows the co-payment amount
Retain your Explanation of Benefits (EOB) from your insurance provider when applicable
Submit the documentation to your FSA or HSA administrator if required for reimbursement
For additional details on eligible medical expenses, refer to IRS Publication 502.
