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Insurance and costs · October 17, 2026

FSA use it or lose it: chiropractic visits and your HSA before December 31

Health FSA money can be lost at the end of the plan year, while HSA money rolls over. Here is what the IRS rules say, and how chiropractic fees fit in.

A hand dropping a coin into a piggy bank

If you have a health flexible spending arrangement (FSA) through work, the end of the plan year matters: money you don’t use can be lost. A health savings account (HSA) works differently. Here is what the IRS says about both, and how chiropractic visits fit in.

The FSA rule: use it or lose it

The IRS says FSAs are generally “use-it-or-lose-it” plans: money left in the account at the end of the plan year can’t generally be carried over. Employers can soften that in one of two ways, but not both:

  • A grace period of up to 2½ months after the plan year ends, to spend what is left.
  • A carryover of part of the balance into the next year. For plans in 2026, the most that can carry over is $680. Anything above the carryover amount is lost.

Your plan decides which one, if any, you get. Check your plan’s deadline: for many people it is December 31, but it depends on the plan year.

Do chiropractic visits count?

IRS Publication 502 lists fees paid to a chiropractor for medical care as a medical expense, and HSA rules use the same definition of medical care. Health FSA plans can set their own rules, so confirm with your plan administrator before you count on it.

The HSA rule: it rolls over

Money left in an HSA at the end of the year generally carries over to the next year. For 2026, the contribution limit is $4,400 with self-only high-deductible coverage and $8,750 with family coverage. There is no year-end rush with an HSA, but it can still pay for qualified visits.

The 2026 FSA limit

For 2026, employees can put up to $3,400 into a health FSA through salary reduction. The IRS updates these amounts each year, so check your plan when you choose your amount for next year.

A year-end checklist

  1. Check your FSA balance and your plan’s last day to use it.
  2. Ask whether your plan has a grace period or a carryover, and how much.
  3. Confirm your plan accepts chiropractic visits.
  4. Ask the practice whether it takes FSA or HSA cards, and for an itemized receipt.
  5. Don’t count the same expense twice: amounts paid from an HSA or reimbursed by an FSA can’t also be deducted on your tax return.

Need a chiropractor before the deadline? Find one by city or state, and see our guides to insurance and costs.

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Related guides

What does a chiropractor cost?What you pay, and how to ask for a good faith estimate.Does insurance cover chiropractic?Medicare, Medicaid, the VA, Marketplace plans and HSAs.Open enrollment and chiropracticFive things to check before you pick a plan.

Sources

  1. IRS Publication 969 – HSAs and other tax-favored health plans
  2. IRS – Rev. Proc. 2025-32, section 4.15 (2026 health FSA limits), Internal Revenue Bulletin 2025-45
  3. IRS Publication 502 – Medical and dental expenses

Published October 17, 2026 by the ChiroScience editorial team, with sources fetched in October 2026. General information, not medical, legal or insurance advice. Check with your plan before you enroll. More from the blog

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