Can You Use Your HSA or FSA for a Custom Night Guard? Yes — Here's Exactly How

If you have a Health Savings Account or Flexible Spending Account, you already know the general idea: pre-tax dollars, qualifying medical expenses. What a lot of people don't realize is that custom night guards for bruxism fall squarely into that category.

That's not a loophole. The IRS classifies dental night guards as a qualified medical expense when used to treat a medical condition like bruxism or TMJ. If you're paying for your night guard out of pocket instead of through your HSA or FSA, you're leaving money on the table.

Here's everything you need to know.

Are Night Guards HSA and FSA Eligible?

Yes. Custom night guards used to treat bruxism (teeth grinding) or temporomandibular joint disorder are HSA and FSA eligible expenses. They're classified as medical devices. Boil-and-bite sports guards purchased for athletic use are generally not eligible.

The key is medical purpose. A guard designed to protect your teeth from grinding damage is a medical device. A mouthguard you bought for Tuesday night hockey is not.

How to Pay With Your HSA or FSA Card at Cheeky

The simplest option: use your HSA or FSA card like a regular debit card at checkout on getcheeky.com. Most plans process it without any additional documentation required.

If your card is declined, here's what to do:

• Pay with a regular card and submit for reimbursement through your plan's portal

• Include your Cheeky order receipt as documentation

• If your plan requires a letter of medical necessity, ask your dentist for a brief note confirming a bruxism diagnosis. Most dentists will provide this in minutes.

What If My Plan Requires a Letter of Medical Necessity?

Some HSA and FSA administrators require documentation that a purchase is medically necessary, especially for products from online providers. A letter of medical necessity is just a simple note from a licensed healthcare provider confirming that a night guard is appropriate for your situation.

Your dentist can write this. It doesn't need to be elaborate; typically one or two sentences confirming a bruxism or TMJ diagnosis and recommending a custom occlusal guard. Most dentists are happy to provide it when asked.

Can You Get Reimbursed Through Dental Insurance?

This is a different question from HSA and FSA eligibility, and the answer is murkier. Dental insurance coverage for night guards varies significantly by plan. Some plans cover them partially under major services. Others don't cover them at all. When they do cover them, they typically require:

• A documented diagnosis of bruxism, TMD, or TMJ from a licensed dentist

• Submission using the correct CDT insurance code

• Waiting periods or limits on replacement frequency

The Right Dental Insurance Codes for Night Guards

In 2019 the American Dental Association updated its Current Dental Terminology to include three specific codes for night guards:

D9944: Hard appliance, full arch. A hard acrylic guard covering all teeth on one row. This is the most common code for custom hard night guards.

D9945: Soft appliance, full arch. Any soft guard covering a full row of teeth.

D9946: Hard appliance, partial arch. A hard guard that doesn't cover all teeth. Less common with custom online guards.

For Cheeky's hybrid dual-layer guard, use D9944. It's classified as a hard appliance based on the outer layer and covers the full arch. When submitting a claim, make sure your dentist is listed as the prescribing provider. The ICD-10 diagnosis code for bruxism is K08.81; for TMJ disorders it's K07.6.

Is It Worth Filing an Insurance Claim?

Depends on your plan. If your dental insurance covers night guards at even 50%, that's meaningful money back. The simpler and faster path for most people is to just use the HSA or FSA and skip the insurance claim entirely. You're using money already set aside for exactly this kind of expense, with no waiting period or pre-authorization in most cases.

Whether it's your HSA card, your FSA, or a dental insurance claim, a custom night guard is an investment your teeth will benefit from for years. Don't let the payment process talk you out of it.

Cheeky accepts HSA and FSA cards at checkout. Start your order at getcheeky.com