Frequently Asked Questions

What is an FSA (Flexible Spending Account)?

An FSA lets you set aside money from your paycheck before taxes to pay for certain health and dependent care expenses. This reduces your taxable income and helps you save around 30% on qualified costs.

What FSAs Typically Cover (not limited to):

Healthcare FSA:

• Doctor’s visits

• Prescription medications

• Dental care (e.g., cleanings, braces)

• Vision care (e.g., glasses, contacts)

• Medical equipment (e.g., crutches, blood pressure monitors)

• Bandaids, Tylenol, Motrin, Condoms

Dependent Care FSA:

• Childcare expenses (e.g., daycare, babysitters)

• Care for a dependent adult (e.g., disabled spouse, parent, or child while you work)

Important to Know:

• FSAs are usually “use it or lose it”—funds must be spent within the plan year or a short grace period.

• Some plans allow a small rollover (typically up to $640 in 2024) to the next year.

Want to dive deeper? Check out our blog for more detailed explanations.

What is an HSA (Health Savings Account)?

An HSA is a special savings account that lets you set aside pre-tax money for healthcare expenses. The money goes in tax-free, grows tax-free, and can be used tax-free—as long as it’s spent on qualified medical expenses.

Key Features:

• Must have a High-Deductible Health Plan (HDHP): Only available if you’re enrolled in a qualified HDHP. (Most plans today are HDHPs.)

• Money rolls over year to year: Unlike an FSA, unused funds don’t expire—they stay in your account and can grow over time.

• Portable account: Your HSA stays with you even if you change jobs or insurance plans.

What HSAs Typically Cover:

• Doctor’s visits and hospital care

• Prescription medications

• Dental care (e.g., cleanings, fillings, braces)

• Vision care (e.g., eye exams, glasses, contacts)

• Mental health services

• Medical equipment (e.g., wheelchairs, crutches)

• Some over-the-counter items (e.g., bandages, thermometers, condoms)

Why It’s a Powerful Tool:

An HSA isn’t just a savings account—it’s a triple tax-advantaged investment vehicle that can be used for both current and future healthcare costs. Unused funds can grow tax-free, making it one of the best long-term savings tools available.

Want to learn how to turn your HSA into the most powerful investment account you own?

Check out our blog for deeper insights.

Flexup Wellness PLLC is a telehealth company that partners with experienced nurse practitioners to provide fast, personalized health evaluations—all online.

What We Do:

• Assess your health to determine eligibility for a Letter of Medical Necessity

• Help expand what your HSA or FSA can cover—beyond traditional care

• Support a more holistic, integrative approach to your wellness

Why It Matters:

With a Letter of Medical Necessity, you may be able to use pre-tax dollars for expenses like:

• Fitness and personal training

• Supplements and organic groceries

• Ergonomic or therapeutic equipment

• Mental wellness tools

• And more

How It Works:

• Complete a quick, secure online health evaluation

• You become a patient of Flexup Wellness

• A licensed provider customizes a Letter of Medical Necessity based on your unique health needs

Your care. Your savings. Backed by licensed professionals.

Take control of your wellness—on your terms.

Tax Overview: Massachusetts + Federal

When you earn money in Massachusetts, your income is subject to:

1. Federal Income Tax

• Taxed progressively in brackets (10% to 37%)

• Most middle-class earners pay between 12% and 24%

2. Massachusetts State Income Tax

• Flat 5% rate on most income

3. FICA Taxes (Social Security & Medicare)

• 7.65% total:

  • 6.2% for Social Security (on income up to $168,600 in 2024)

  • 1.45% for Medicare (no income cap)

So in total, if you’re a W-2 employee in Massachusetts, your effective tax burden on each additional dollar is often:

• Federal: ~12–24%

• State: 5%

• FICA: 7.65%

• Total: ~24% to 36%, depending on your tax bracket

How Pre-Tax Spending Saves You ~30%

Using pre-tax money (like from an HSA or FSA) means you’re spending before taxes are applied—which skips:

• Federal income tax

• State income tax

• FICA taxes

For Example:

Let’s say you want to buy $1,000 worth of wellness-related expenses like supplements, fitness, or ergonomic equipment.

If you use post-tax money, (how you probably are now), you’d have to earn about $1,430 just to end up with $1,000 after:

• ~24% Federal

• 5% State

• 7.65% FICA

But if you use pre-tax money, you spend the full $1,000—no taxes taken out.

The government and state are not taking your money before you get to spend it.

Savings: ~$430 or 30%

That’s why using your FSA or HSA can save you around 30% on health-related costs. And that’s exactly what Flexup Wellness helps people do—with Letters of Medical Necessity that turn typically non-eligible expenses into tax-free ones.

What is a Letter of Medical Necessity (LMN)?

A Letter of Medical Necessity is a note from a licensed healthcare provider that explains why a specific product or service is medically required for your health. It allows non-traditional expenses—not normally covered by the IRS—to become HSA or FSA eligible.

Why It Matters:

• The IRS only allows certain expenses—unless they’re deemed medically necessary.

• With an LMN, you can unlock pre-tax coverage for wellness expenses like:
  

  • Gym memberships

  • Nutritional supplements

  • Organic groceries

  • Therapeutic equipment

  • And much more

How Flexup Wellness Helps:

• Quick and simple online health evaluation

• Licensed providers review your needs

• Customized, IRS-compliant Letter of Medical Necessity issued

• Average savings = ~30% using pre-tax HSA/FSA funds

Important to Know:

• You’ll become an official patient under our care

• All medical records are confidential, private, and secure

• Your LMN can be used to submit eligible wellness expenses for tax-free reimbursement

Want to see what’s possible with a Letter of Medical Necessity?

Check out our blog for examples and ideas.

Absolutely. Your privacy and security are a top priority.

Here’s How We Protect You:

• Our licensed practitioners follow HIPAA laws, just like any other healthcare provider

• All health evaluations are completed through a secure, HIPAA-compliant platform

• We use a protected electronic medical record (EMR) system to store your health information safely

• Your personal information (email, phone number, etc.) is never shared

Your trust matters. So does your privacy. We’re here to protect both.

The IRS provides official guidance on what’s eligible for HSA and FSA reimbursement through:

• Publication 502: Medical and Dental Expenses

• This document outlines:

  • Which expenses are automatically eligible

  • Which ones may be eligible with a Letter of Medical Necessity (LMN)

Where to Find the Full List

• Visit IRS publication 502 for a complete and searchable list

• It includes both commonly accepted and conditionally approved expenses

Important Note

• Employer-sponsored plans may add their own restrictions

• Always check with your FSA/HSA plan administrator or employer for specifics on what your plan allows

If you need assistance in obtaining a Letter of Medical Necessity, Flexup Wellness offers services to help facilitate this process.

Below is a searchable list for quick reference:

Health equity.com

IRS pdf

Many treatments aren’t eligible under IRS guidelines—unless a licensed healthcare provider issues a Letter of Medical Necessity specifically recommending them. Here are some examples:

• Organic groceries

• Gym memberships

• Personal training sessions

• Massage therapy

• Chiropractic care packages

• Nutritional supplements

• Probiotics

• Home gym and exercise equipment

• Red light therapy

• Sauna therapy

• Therapeutic mattresses or pillows

• Ergonomic desks or chairs

• Mental health or meditation apps

• Online fitness programs

• Meal delivery services

• Cognitive training apps

• Fitness classes

• Cold plunge or contrast therapy tools

• Grounding mats or grounding sheets

• Swimming pool (for therapeutic use)...yes really!

Check our blogs for more details and possibilities...

IRS info Here

How Eligibility Works at Flexup Wellness

• Letters of Medical Necessity (LMNs) are issued only after a licensed nurse practitioner reviews your health survey and conducts a brief telehealth visit

• There is no guarantee of eligibility, but the majority of patients do qualify

Our Guarantees to You:

• 100% Money-Back Guarantee if you're not eligible for an LMN

• If your FSA/HSA administrator requests revisions, we’ll update the letter at no extra cost to meet their requirements

• Even if you're not eligible, you'll still receive 15% off a Fullscript supplement account—our way of saying thank you

At Flexup Wellness, we believe in fair, honest care—with no financial risk to you.

Yes, another licensed medical professional—such as your PCP—can technically provide a Letter of Medical Necessity.

However, There Are Common Challenges:

• Many providers are unfamiliar with IRS tax requirements and what must be included for HSA/FSA eligibility

• Letters must contain specific legal language to be accepted by benefit administrators

• Writing these letters often involves unpaid administrative time, which may make some providers hesitant to complete the request

Flexup Wellness specializes in this process, making it faster, compliant, and hassle-free for both patients and practitioners.

Our practitioners are currently licensed to serve patients in Massachusetts. We plan to expand to additional states soon, so stay tuned!

Yes! Along with your 15% discount on over 20,000 supplements and holistic products through your Fullscript account, you’ll also get access to these exclusive perks:

• 90-day free trial of The Way meditation app instead of their offer of 30 days.

• 50% off Mindset Health apps ($199), including:
  

  • Nerva (for gut support)

  • Claria (for mood and stress)

  • Finito (to help quit smoking)

More perks are on the way, and you’ll receive all the access links in your follow-up email—no obligations, just value.