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    Flexible Spending Accounts and Celiac Disease by Dwight Senne

    Scott Adams

    This article appeared in the Autumn 2004 edition of Celiac.coms Scott-Free Newsletter. It originally appeared in the book A Personal Touch On...™ Celiac Disease. ©A Personal Touch Publishing, LLC.

    Celiac.com 10/27/2004 - For at least the last 15 years I have gone to several doctors with a host of various gastrointestinal disorders. The most common diagnosis I received was Irritable Bowel Syndrome. Finally, in May of 2003, I found a doctor who was thorough enough to check for Celiac Disease. I have been on the gluten-free diet ever since and feel wonderful!

    When first diagnosed with Celiac Disease, I suppose I was like most people—overwhelmed by the magnitude of the lifestyle change associated with the gluten-free diet. Once reality set in and I began to accept and deal with this new diet, I experienced another overwhelming feeling—the high cost of gluten-free foods! While I was not on a tight budget, the idea of spending four times as much for a loaf of bread that was only half the size was daunting to say the least. I immediately began searching for ways to diminish this extra expense.

    My research took me to the Internet, where I discovered that according to several IRS rulings (Revenue Ruling 55-261; Revenue Ruling 76-80, 67 TC 481; Cohen 38 TC 37; Van Kalb TC MEMO 1978 366; Flemming TC MEMO 1980 583), the cost difference between gluten containing food products and specialty gluten-free alternatives is tax deductible for Celiac patients. However, it didnt turn out to be that simple.

    Further research revealed that only the portion which exceeds a 7.5% threshold of adjusted gross income for all medical expenses combined would be deductible. In English, that meant that if I had an income of $50,000, I would only be able to deduct my extra expense of gluten-free foods (and any other legally deductible medical expense) that exceeded $3,750 (7.5% of $50,000)! Well, gluten-free foods are not that expensive!

    Knowing I would never reach that deductibility threshold, my search continued. Suddenly, a rare epiphany befell me. Since the IRS had ruled specialty foods that are medically necessary to treat a condition are deductible, it may follow that these same expenses may be reimbursable through my employers Flexible Spending Account program.

    Basically, the Flexible Spending Account is a plan that allows you, the employee, to set up a separate savings account, usually administered by a third party. You decide at the beginning of the year how much to contribute to this account. The contributions are deducted from your payroll before tax (meaning you are not charged income tax on the portion of your income you put into the account). As you have out of pocket medical expenses, you file a claim from the Flexible Spending Account administrator for reimbursement of those expenses. Once the account is emptied, no further reimbursements are possible for that year. One caveat with these plans is that they are "use it or lose it," which means that if you do not have sufficient medical expenses equal to the amount contributed you will forfeit any unclaimed balance. Your human resources department should be able to tell you if your company offers a Flexible Spending Account.
    In my case, I first called the human resources department at my place of employment to find out if indeed my rationale was valid. The response was "I dont know, but I doubt it"! Never one to take no for an answer (especially when preceded by "I dont know"!), I pressed on. A phone call to the Flexible Spending Account administration company yielded the answer I had hoped for—YES!

    Fortunately, I happened to connect with a customer service representative who was extremely thorough and diligent. She had to put me on hold several times, but she finally found not only the answer I was looking for, but also the proper procedure for filing a claim. She sent me a worksheet that I now use to file any claim for gluten-free foods. The sheet has a place to list the food item, cost of the gluten-free variety, cost of the gluten-containing variety, and the price difference. I made several copies of the worksheet, so now whenever I file a claim, I just fill out a new sheet. The receipts for the food items I am requesting reimbursement for must be included each time with the worksheet. With my first claim, I also had to provide a letter from my doctor clearly stating I was diagnosed with celiac disease and that I must be on a gluten-free diet. They keep this letter on file, so I do not have to send it each time.

    Generally speaking, any medical expense the IRS considers deductible (on Schedule A of your 1040 form) is reimbursable, however, employers are not obligated to follow those guidelines. They are not able to add other expenses that are not deductible, but they can delete certain ones (like gluten-free foods) if they choose. So it behooves you to check with your Flexible Spending Account administrator to find out what your plan covers and the proper procedure for reimbursement. It may be necessary to ask to speak to a supervisor, since not every customer service representative will be as helpful as the one I had. You may wish to cite the IRS rulings I listed earlier to convince them to accept this as a reimbursable item. This can also be helpful to convince them to reimburse gluten-free food items if they do not currently do so.

    While it is still your money that is paying for the entire cost of gluten-free food, using the Flexible Spending Account to switch that money to the tax free variety can add up to significant savings. Depending on the amount of gluten-free food you are buying, and your tax bracket, it can easily be over $100 per year in tax savings!

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    Guest maggie

    Posted

    Thank you! I have money in my FSA and was hoping that this could work. This is a wonderful website!

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    Guest Marilyn Perkins

    Posted

    Excellent! I should have known this 25 years ago! Today it is of little value as I'm below tax paying income and retired. A great benefit to those out there purchasing gluten free foods. It adds up more when it has to be yeast free. Thanks for the information. I will be sure to pass it on.

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    Any advice for Australians? I don't think we get tax deductions here for gluten free food. Does anyone know any different?

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    Excellent! I never knew about this deduction! I spend at least $600 extra on gluten-free food per year!

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    Guest defallstead

    Posted

    So in the end, do you feel like it is worth it to do all that work to save 3-7% on the difference of each item ($1-3)? How much do you submit a year for gluten-free foods? The main reason I ask is that I have considered it myself but didn't feel like the amount would be worth my time. Thank you so much for all the information you put out there - you do a great job, and I send everyone I know with celiac questions to your site.

    As a registered tax preparer with Type 2 diabetes and having a wife diagnosed last year with celiac this is great news. She has a flexible spending account through her job, and yes, when feeding a family of four with one diagnosed with chronic Lyme, one with Diabetes and one with celiac and one whose body aches and pains have yet to be diagnosed...every penny counts.

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    Guest cecil grass

    Posted

    Great article, thanks for sharing!

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    Any info that is more recent?

    I used to spend $45/week on food. Now I'm spending more than twice that amount. Is this typical, am I being ripped off, or do I just not know how to put gluten free meals together? Is there anyway we can band together to get the prices of these items down? I used to love to cook and love to eat. All I ever craved was bread, pasta, pastry... all gluten. Now, I'm injured, and I'm celiac... I just eat to survive. I never ate PBJ. Now it's at least 3x/week on rice cakes. boring.

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    Any info that is more recent?

    I used to spend $45/week on food. Now I'm spending more than twice that amount. Is this typical, am I being ripped off, or do I just not know how to put gluten free meals together? Is there anyway we can band together to get the prices of these items down? I used to love to cook and love to eat. All I ever craved was bread, pasta, pastry... all gluten. Now, I'm injured, and I'm celiac... I just eat to survive. I never ate PBJ. Now it's at least 3x/week on rice cakes. boring.

    I used to cook and bake wheat-based food all the time, too, and was devastated and depressed when I was first diagnosed. It gets better, though as you get used to the new way of eating. Now brown rice is the basis for most of our family meals. It's much healthier, even if a person doesn't have to be gluten-free, and it's much less expensive than regular bread and pasta. Even so, I spend WAY more than that on food at the grocery store. My favorite cookbooks are both small books by Hilda Cherry Hills. The magazine Living Without also has some really wonderful recipes for meals, snacks, desserts, etc. Enjoy!

     

    Updated tax information would be helpful.

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    Guest Diane Aragon

    Posted

    I was just diagnosed with celiac disease and have had no symptoms except osteoporosis and depression. I am 68 years old. Had a blood test and endoscopy because my daughter has celiac disease and has many symptoms.

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    I agree the FSA or HSA plans MAY reimburse your gluten free items. Be wary, however...as mine "did" then "didn't" and now are threatening to not do it in the future due to "too much trouble"...so here's my 2 cents worth:

    First, I was a LOVER of all things grain, never had a white product, ate all the "healthy" stuff and had been sick for years with an incorrect digestive problem/s. On numerous meds and even had "diagnostic surgery" - all paid for under my HSA of course. Then the discovery of celiac disease. Wow. No more meds, follow the plan and wonderful health. Years of unknown cause of anemia - SOLVED. Stomach issues - SOLVED. Then the sticker shock - wow. $5 for "so-so" tasting bread (0r more)...flour at $5 a lb ? Yikes. So, I call the plan and YES they will cover the difference between "regular" and "gluten free." Whew that was easy. Not so fast there. EACH and every time I submit a gluten free product I must also submit the comparison of the other item. Not so easy if you don't buy it regularly (hubby still eats the other stuff) - ok, but now they want it DATED ? They make it so impossible to submit. My plan now says a photo will be fine. Really? And all that expense to document has not eaten up the difference in foods. So, next year, NO allowances for these foods into my plan. Just not worth the hassle. I truly feel absolutely sympathetic to the families and children who must strictly adhere to this plan. Food costs and lack of food choices in a small town will sometimes cause me to go off the food plan, but I always pay for that choice. We need so much more support - everywhere. Thanks to the many companies that are getting more products out there, but please help us out with cost factors ! Thanks for listening. Just my more than 2 cents worth.

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