Diet Foods: FSA Eligibility

What are diet foods?

Well-balanced nutrition is essential for the long-term quality of life of individuals at any age, but for those with specific health problems, careful monitoring of one's diet is essential to warding off potential symptoms, preventing the acceleration of the condition and aiding in helping the patient continue a healthy lifestyle free from food-related triggers (U.S. Department of Health and Human Services). While food undoubtedly plays a major role in an individual's state of health, such as gluten-free foods for those with gluten allergies or healthy foods for those fighting obesity, reimbursement for specialty food items is largely ineligible with consumer-directed healthcare accounts like FSAs, HSAs and HRAs.

Why isn't diet food reimbursement eligible?

Under IRC 213(d)(1), which regulates the eligibility of medical products and services covered under consumer-directed healthcare accounts, "medical care includes amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." Diet foods do not fall under the classification of a medical product used to diagnose, cure, treat or prevent a legitimate medical condition, but rather it is a product used to promote an individual's "general health" and normal nutritional requirements, therefore it is not eligible for reimbursement.

However, in rare cases, some patients may be able to obtain a Letter of Medical Necessity (LMN) from a physician to submit a claim that will outline how specific foods are used to treat or prevent certain symptoms of a disease. For instance, gluten allergies make many patients susceptible to gastrointestinal issues after ingesting foods with gluten, but gluten-free foods can help to avoid these issues. In some cases, these would be eligible for reimbursement but only to the extent of the increased cost above what the non-specialty item would cost, not the full price of the gluten-free product itself. Because diet foods can very easily fall under the IRS's classification of "general health," it's important for account holders to speak with their benefits administrators and their doctors to investigate whether their dietary restrictions can be covered under their benefits.