How to Use Your FSA or HSA Before the Year Ends: What to Know in Maryland

By Dr. Ryan Kneessi, ND

Every year around this time, patients ask me whether they can use the money left in their FSA before it runs out. It is a great question, because the end of the year sneaks up quickly and the rules can feel confusing. In this article, I want to walk through what FSAs and HSAs are, how the year-end deadline works, what may and may not be eligible, and how to make the process simple if you see me in Maryland. I am not a tax advisor, so please use this as a starting point and confirm the details with your plan administrator.

What an FSA and an HSA are

A health flexible spending account is an employer-sponsored account that lets you set aside part of your paycheck before taxes to pay for qualified medical expenses. For plan years beginning in 2026, the IRS limits employee salary reduction contributions to a health FSA at $3,400, according to IRS Revenue Procedure 2025-32. Because the account belongs to your employer’s plan, the money generally has to be used within the plan year.

A health savings account is a personal account that you can open if you are covered by a qualifying high-deductible health plan. For 2026, the IRS contribution limit is $4,400 for self-only coverage and $8,750 for family coverage, according to IRS Revenue Procedure 2025-19, and people age 55 or older can contribute an extra $1,000. IRS Publication 969 explains that the money in an HSA stays in your account and carries over from year to year, so there is no use-it-or-lose-it rule.

The December 31 deadline and the two exceptions

Most health FSAs run on a calendar year, which means unused money is generally forfeited after December 31. The IRS allows employers to soften this rule in one of two ways, and a plan can offer one or the other but not both, as described in IRS Notice 2013-71 and in Publication 969.

• Carryover: If your plan allows it, you can carry unused money into the next plan year. For plan years beginning in 2026, the maximum carryover amount is $680, according to Revenue Procedure 2025-32, and your employer may set a lower amount.
• Grace period: Some plans instead give you up to two and a half extra months after the plan year ends, often until March 15, to spend the remaining money.

Some plans offer neither option. Many plans also give you a little extra time after the deadline to submit receipts for expenses you already had, so it is worth reading your plan summary or calling your plan administrator to learn your exact dates.

What may be eligible, and what is not

IRS Publication 502 defines medical care expenses as costs for the alleviation or mitigation of a disease or for services that affect a structure or function of the body. In practical terms, a visit with a licensed practitioner for a specific medical condition may be an eligible expense. Expenses that are merely beneficial to general health are not eligible, and that includes general wellness visits and items bought simply to feel better overall.

Supplements follow the same idea. Publication 502 explains that nutritional supplements, vitamins, and herbal products are generally not eligible, unless a medical practitioner recommends them for a specific medical condition. In that case, your plan may ask for a letter of medical necessity or other documentation.

In 2024, the IRS also warned consumers about companies that market general wellness and nutrition products as eligible for FSA and HSA funds, in its news release IR-2024-65. The IRS explained that relabeling general wellness spending does not make it a medical expense, and that a note from a doctor is not enough if the expense is not tied to a specific medical condition. I share this so that you can use your account confidently and avoid surprises later.

Why itemized receipts matter

Plan administrators usually ask for proof that an expense qualifies. A good itemized receipt shows the patient name, the date of service, the provider’s name and credentials, a description of the service, and the amount paid. Card swipes alone are often not enough, so save every receipt even if your card was approved at the time of payment.

How payment works at my office

To make paying for your visit simple, HSA and FSA cards are accepted at Move Forward Natural Health, and every patient receives an itemized receipt to submit to their plan. Naturopathic visits are self-pay, and whether your plan reimburses a visit depends on your plan and on the reason for your visit, so we recommend that you check with your plan administrator before you book. You can read more about using HSA and FSA funds on our HSA and FSA payment page.

Visits anywhere in Maryland

You do not need to live near Odenton to see me before the year ends. I offer in-office visits in Odenton and telehealth visits for anyone located in Maryland. If you are looking for a naturopathic doctor in Maryland, a functional medicine doctor in Maryland, or a holistic and integrative doctor in Maryland, those pages explain how I work and how licensing works in our state.

A simple year-end checklist

• Log in to your FSA or HSA account and check your remaining balance.
• Find out whether your FSA plan offers a carryover, a grace period, or neither.
• Ask your plan administrator whether the visit or item you have in mind is eligible.
• Schedule visits early in December, because calendars fill up quickly before the holidays.
• Keep every itemized receipt and any letter of medical necessity in one place.

Frequently asked questions

Sources

This article is for educational purposes only and is not medical, tax, or financial advice. It does not replace an individual evaluation. Eligibility for HSA and FSA funds depends on your plan, so please check with your plan administrator. Talk with your healthcare provider before making changes to your diet, exercise, supplements, or medications, especially if you are pregnant, nursing, or managing a health condition.