Understanding Hormone Replacement Therapy and Your FSA

If you're just starting out with an FSA, or even if you've had one for a while, it can be challenging to understand all the healthcare services eligible to use with your account. One way to keep this clear is to remember that the IRS only allows you to use your FSA for the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body . But that still leaves some room for discussion. For example, what about something like hormone replacement therapy (HRT)? Is HRT FSA eligible? Let's take a look at the conditions under which HRT would be considered eligible.

When is HRT covered by an FSA?

One purpose of HRT is to help patients deal with several symptoms of menopause. Because menopause is a recognized medical diagnosis, any treatments doctors use to help women deal with its symptoms and complications are covered under an FSA. Women that are menopausal have a higher risk of bone fractures, heart disease and stroke, so treating menopause is an important part of an overall health maintenance program.

There are many types of HRT treatments, depending on a patient's symptoms. For example, doctors can prescribe medication as well as gels, creams, and patches for patients that experience symptoms like hot flashes.

To be eligible for coverage under your FSA, your FSA administrator may require that your HRT treatment include a prescription and/or a Letter of Medical Necessity (LMN) to detail the diagnosis and overall need for the treatment. 

HRT expenses that aren't covered

The expenses for any non-prescription medication you take for menopause may be eligible for reimbursement under your FSA, but be sure to check with your plan administrator. It's also important to remember that HRT not specifically used to treat a medical condition like menopause or osteoporosis is likely not eligible for reimbursement with FSA funds. For example, if you're a healthy woman that wants to use HRT to maintain a good level of estrogen, that wouldn't be a qualified expense, and wouldn't be eligible for coverage with your FSA.

In other words, HRT is a treatment that needs the supervision of a medical professional. At least if you want it to qualify for flex spending. This is likely because studies have associated HRT with an increased risk of conditions that include stroke, heart disease, blood clots, and even breast cancer. These risks vary and depend on the kind of treatment plan your doctor orders for your menopause, including the dosage of estrogen you receive, and the length of time you take the medication.

Of course, we're not doctors, and you should always speak with your FSA administrator if you're unsure about any expenses you may incur and whether or not they will qualify under your plan. But if your physician determines HRT can provide you with relief from menopause symptoms and increase your quality of life, using your FSA may be able to help give you some additional peace of mind.


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