For some people with inflammatory bowel disease (IBD, Crohn’s disease, ulcerative colitis, or indeterminate colitis), yearly healthcare costs are exorbitant. This is true for myself, as there are yearly tests, check ups, and medications that insurance doesn’t fully cover.

For this reason, I’ve been using the Flexible Spending Account (FSA) program for many years. The FSA program is offered through an employer, similar to insurance plans. Every year, either as an individual or as a family, you decide on a dollar amount that will be automatically pulled from your paycheck and placed into a holding account.

Please note this article only covers an FSA, not a health savings account (HSA), health reimbursement arrangement (HRA), limited-purpose flexible spending account (LPFSA), or dependent care flexible spending account (DCFSA).

You Can Save Money, But You Need to Think About It

The reason why you’d want to do this is because it is taken out of your paycheck before taxes are taken out. This means that it lowers the amount of taxes you pay. The kicker is that the money can only be spent on certain things related to healthcare and that approval may be needed to make those purchases. 

What that approval looks like will depend upon how the plan is administered. It could be seamless by using an FSA credit card. Or, it could mean having to submit receipts to the FSA administrator and getting paid back.

This is a simplified explanation of FSAs, and anyone who needs to know more and wants to participate should talk to the human resources or insurance administrator at their employer. The broad strokes are similar, but there can be some nuances and differences between plans.

---

Helpful information about FSA plans:

• How to Estimate and Maximize Your Flexible Spending Account
• IRS Publication 502 (2022), Medical and Dental Expenses
• 15 Products You Didn’t Know You Could Buy with Your FSA

---

The Big Caveats

Here’s the first catch: you have to use the money every year. But there’s a loophole, in that some money can carry over if you don’t use it during the calendar year. For 2023, people can carry over $570 from 2022.

This is hopefully done automatically by the plan administrator, but people should absolutely check and make sure that everything is going as it should. In 2023, this will increase to $610. 

However, there is still a time limit on these carryovers, usually the end of the first quarter of the next year. This is true for 2023, with the expiration date being March 31. The money must be used by that time or it will be forfeit. 

I know: that’s messed up. But that’s the way it works. 

Here’s the second catch: FSA dollars can only be used for certain things. Now, for people with IBD, much of it might be used for medications and copays. Someone who is having a flare-up will probably burn through the allotted FSA dollars because the amount allowed is only a few thousand dollars. (But remember: you save taxes on that money, meaning that it’s a lot like getting a 30% off coupon for your healthcare costs.)

If you have money left over either at the end of any year, or in the beginning of the next year with a carryover, you should focus on spending it. It may be time to schedule a procedure or a test, or get some medication refilled, maybe even before you need more.

Or: you can buy some other stuff.

You Can’t Buy Just Anything, But You Can Get a Lot of Stuff

The list of things you can use FSA to pay for is quite long but it doesn’t include everything related to healthcare, for reasons that are pretty obtuse. However, there are many things related to digestive health that you can purchase.

The government provides a super list of all these things, and before spending your money, you should double check that, because it does change from year to year. However, you could also take some of the guesswork out of it by shopping at an online store that only carries things covered by a FSA. My insurer has such a store, and shopping there using my FSA dollars is seamless. Check if your plan has anything similar to make your life easier.

Now that I’ve covered my ass and told you to double-check everything, here’s a list of things related to IBD and general health that you may be able to buy with your FSA dollars:

• Acetaminophen (such as Tylenol)
• Acid reflux inclined sleep positioners or wedge pillows
• Acid relief (such as Nexium, Pepcid AC, Prilosec, Zantac)
• Anti-bacterial hand sanitizer (with at least 60% alcohol)
• Antacids (such as Alka-Seltzer, Gaviscon, Rolaids, or Tums)
• Arthritis gloves
• Bismuth subsalicylate (such as Kaopectate or Pepto Bismol)
• Catheters 
• Elevated toilet seats and toilet seat risers
• Enemas
• Fiber supplements (such as Benefiber or Citrucel)
• Simethicone Gas relief (such as Gas-X)
• Incontinence products (such as Always, Attends, Cora, Depends, Poise, Prevail, Tena, Tranquility)
• Laxatives (such as Dulcolax, Ex-Lax, MiraLAX)
• Ostomy care products
• Period products (menstrual cups, pads, period underwear, tampons) 
• Pill Boxes and pill clocks
• Rehydration solution
• Sharps container
• Sitz bath
• Sleep aids (Advil PM, Tylenol PM, Vicks ZzzQuil, Unisom)
• Stool softeners (such as Colace, Senokot)
• Sunscreen 
• Suppositories
• Transcutaneous Electrical Nerve Stimulation (TENS) Device
• Topical analgesics (such as Aspercreme, Voltaren)
• Walking aids (such as a cane or walker)

If You Have Access to an FSA, You Should Be Using It

An FSA is important because it saves you money overall. Some people don’t participate in these programs because they find them too difficult to manage. However, for people with IBD, it is literally leaving money on the table, so it’s worth spending the time and energy to figure out how the program works and using it.

Think of it this way: It used to be worse. I used to have to fax receipts and wait for a check in the mail. Today, most things in my plan are submitted automatically, and for those that aren’t, I can use the FSA debit card provided to me. Talk to your plan administrator about how to make the process as seamless as possible for you. 

Yes, it’s a pain in the ass and it means you have to talk to someone. But once you have it all set up, everything gets easier and you will theoretically use this throughout your working life.