Can you use HSA or FSA money for period underwear? What the law says, and what your plan decides

What the law actually says

The CARES Act, signed in March 2020, changed the tax code so that "amounts paid for menstrual care products shall be treated as paid for medical care" for health savings accounts, and made the same change for health flexible spending arrangements and health reimbursement arrangements. It added a definition, now at 26 U.S.C. 223(d)(2)(D): a menstrual care product "means a tampon, pad, liner, cup, sponge, or similar product used by individuals with respect to menstruation or other genital-tract secretions." The change applies to expenses from January 1, 2020 onward. Before that date, period products were generally not eligible.

Where period underwear sits in that definition

The list names five product types and then says "or similar product." Period underwear is used for exactly the purpose the definition describes, and it works the way a pad works, worn externally to absorb menstrual flow. That is the argument for eligibility, and it is the one most plan administrators and eligibility lists have accepted; Thinx, for one, publishes a guide to paying with HSA and FSA dollars. But "similar product" is a judgment the statute leaves to whoever administers your plan, and administrators differ. The position we can support is: usually yes, not guaranteed, and a quick check with your plan before a large order is worth the two minutes.

How to pay so the claim goes through

There are two routes. The first is paying with the plan's debit card at a store that codes the purchase as an eligible medical item; some brand stores and pharmacy retailers do, and the transaction clears on the spot. The second is paying any way you like and submitting the receipt for reimbursement. For the second route the receipt matters: it should show the date, the amount, and a product description that makes clear what was bought ("period underwear," "leakproof underwear," the brand's tier name) rather than a bare style number. If a claim is questioned, the product page saved as a PDF and the statute wording above are usually enough; a letter of medical necessity is not required for menstrual care products the way it is for some other categories, though an administrator can still ask questions about a "similar product" item.

What about bladder-leak underwear and period swimwear?

The menstrual care definition is about menstruation. Washable bladder-leak underwear is a different category with different rules; incontinence products can be eligible when they are for a medical condition, and administrators often want that documented. Period swimwear is a harder case still, because it is also swimwear. If either matters to you, ask the plan before buying rather than assuming the period-underwear answer carries over.

Is it worth the paperwork?

Paying with pre-tax money lowers the real cost of a pair by roughly your marginal tax rate, which for many households is the difference between a pair costing full price and costing a quarter or so less. Over a full rotation of six to nine pairs that is real money, and it is money the disposables you are replacing were also eligible for. The cost page computes what a year of periods costs from live prices, and the budget guide ranks the cheapest verified pairs, so you can see what the saving is before deciding whether the claim is worth filing.

Sources

The legal facts above trace to:

• The definition and the "treated as paid for medical care" rule: 26 U.S.C. 223(d)(2)(A) and (D), via the Legal Information Institute at Cornell Law School.
• The change and its effective date (amounts paid after December 31, 2019; FSA and HRA reimbursements for expenses after that date): CARES Act, Public Law 116-136, section 3702, via govinfo.gov.
• Brand practice: Thinx, "Use Your HSA or FSA Dollars on Period Underwear." Read 2026-09-04.
• This page is general information, not tax advice; eligibility decisions rest with your plan administrator.