Medical Expense Deduction Guide 2026 (and 2025)

What Is the Medical Expense Deduction?

The medical expense deduction is an itemized deduction under IRC §213 that lets you subtract unreimbursed medical and dental expenses from your income - but only the portion that exceeds 7.5% of your adjusted gross income (AGI). It is claimed on Schedule A (Form 1040), so you can only use it if you choose to itemize rather than take the standard deduction.

The structure has two gates. First is the 7.5% AGI floor: a fixed slice of every taxpayer's medical spending is simply not deductible, scaled to income. Second is the itemizing gate: your total itemized deductions (medical above the floor, plus state and local taxes, mortgage interest, and charitable contributions) must beat your standard deduction, or the medical deduction produces no benefit at all. Both gates have to be cleared before a single dollar of medical cost reduces your tax.

Because of those two gates, the medical deduction is unavailable to the substantial majority of filers in any given year. The roughly nine in ten taxpayers who take the standard deduction never reach Schedule A. The deduction becomes meaningful in three recurring situations: a catastrophic medical year (major surgery, a long hospitalization, a difficult pregnancy), a retiree with large long-term care or nursing-home costs, and a homeowner who already itemizes because of a mortgage and high SALT and can stack medical on top.

The deduction was not changed by the One Big Beautiful Bill Act (OBBBA, P.L. 119-21). The 7.5% floor, the definition of medical care, and the long-term care premium caps all continue under their existing rules for 2025 and 2026. To run your own numbers, use the Medical Expense Deduction Calculator.

How the 7.5% of AGI Floor Works

IRC §213(a) allows a deduction for medical expenses "to the extent that such expenses exceed 7.5 percent of adjusted gross income." In plain terms: multiply your AGI by 7.5%, and only medical expenses above that amount are deductible.

The floor is permanent at 7.5%

The 7.5% threshold has a complicated history. The Affordable Care Act raised the floor from 7.5% to 10% starting in 2013 (with a temporary delay for taxpayers age 65 or older). A series of short extensions kept 7.5% alive for various years until the Consolidated Appropriations Act, 2021 (Public Law 116-260) made 7.5% permanent for tax years beginning after December 31, 2020. The same Act struck the former IRC §213(f), which had contained the temporary 10% rule and the separate over-65 threshold. There is now a single, permanent 7.5% floor for every taxpayer regardless of age.

AGI is the benchmark - and the deduction does not reduce it

The floor is measured against AGI, and the medical deduction itself is a below-the-line itemized deduction, so it reduces taxable income but not AGI. That has a useful planning consequence: anything that lowers AGI also lowers the 7.5% floor, freeing up more medical expense to deduct. Above-the-line moves such as HSA contributions, deductible traditional IRA contributions, and the self-employed health insurance deduction under §162(l) all shrink the floor. See the AGI & MAGI Calculator to model the effect.

Married filing separately

On separate returns, each spouse deducts the medical expenses they actually paid and applies the 7.5% floor to their own AGI. If expenses were paid from a joint account, they are generally split. Note the §63(c)(6) coordination rule: if one MFS spouse itemizes, the other's standard deduction drops to zero, which can change the itemize-versus-standard math for both. See the Filing Status Guide.

What Medical Expenses Qualify

IRC §213(d) defines "medical care" broadly as amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body. IRS Publication 502 turns that definition into a long list of specific deductible items. Common qualifying expenses:

• Professional services: doctors, dentists, surgeons, chiropractors, psychiatrists, psychologists, optometrists, podiatrists, and other licensed medical practitioners.
• Facilities: hospital care, and nursing-home or assisted-living costs when medical care is the principal reason for being there (including meals and lodging at the facility).
• Prescriptions and insulin: prescription medicines and insulin. Nonprescription drugs do not qualify (insulin is the exception).
• Equipment and aids: eyeglasses, contact lenses, hearing aids and batteries, wheelchairs, crutches, artificial limbs and teeth, guide dogs and their care, and home improvements for medical reasons (to the extent cost exceeds the increase in home value).
• Treatments and programs: acupuncture, inpatient treatment for alcohol or drug addiction, smoking-cessation programs, and a weight-loss program prescribed for a specific diagnosed disease such as obesity or hypertension.
• Insurance premiums (after-tax): health and dental insurance premiums you pay with after-tax dollars, Medicare Part B and Part D premiums, and tax-qualified long-term care premiums (subject to the age caps below).
• Transportation: mileage, parking, tolls, taxi, bus, train, plane, and ambulance fares for trips primarily for and essential to medical care.
• Dependents and capital expenses: qualifying expenses paid for a spouse or dependent, and capital expenses for special equipment installed for medical reasons.

What Does Not Qualify

The IRS specifically excludes several categories. These are the most common items taxpayers mistakenly try to deduct:

• Reimbursed expenses. Anything paid back by insurance, an employer, or a settlement is not deductible. You deduct only your net out-of-pocket cost.
• HSA, FSA, and HRA spending. Expenses paid from a Health Savings Account, Flexible Spending Account, or Health Reimbursement Arrangement are already paid with pre-tax dollars. Deducting them again on Schedule A is double-dipping and will be reversed on audit.
• Pre-tax premiums. Employer health premiums withheld pre-tax through a cafeteria plan are not deductible because they were never in your taxable income.
• Nonprescription medicines. Over-the-counter drugs and supplements are not deductible (insulin is the only exception).
• Cosmetic procedures. Most cosmetic surgery and treatments that do not treat a deformity, disease, or injury are excluded.
• General health items. Toiletries, cosmetics, toothpaste, vitamins for general health, gym and health-club dues, and weight-loss programs for general appearance.
• Personal and household. Funeral and burial expenses, most non-prescribed nicotine products, and the cost of a babysitter while you attend appointments.
• Self-employed health insurance. Deducted above-the-line under IRC §162(l), not as a Schedule A medical expense. See the Self-Employed Health Insurance Deduction Guide.

Long-Term Care Insurance Premiums and the Age Caps

Premiums for tax-qualified long-term care (LTC) insurance count as deductible medical expenses, but only up to an age-banded per-person limit under IRC §213(d)(10). The cap is indexed for medical inflation each year. Premiums above the cap are simply not included; they are not lost as a carryforward, just excluded from the current year's medical total.

Key rules for LTC premiums

• Per person. A married couple can deduct up to two caps - each spouse uses the cap for their own age. A couple both 71+ could include up to $12,400 of LTC premiums for 2026.
• Tax-qualified only. The policy must be a tax-qualified LTC contract. Hybrid life-insurance or annuity policies with an LTC rider generally do not produce a deductible premium.
• Then the 7.5% floor. The capped premium is added to your other medical expenses, and the combined total is still subject to the 7.5% AGI floor.
• LTC benefits. Benefits received from a qualified LTC policy are generally tax-free up to a per-diem limit, separate from the premium deduction.

LTC premiums for the self-employed follow the same age caps but are deducted above-the-line under §162(l) instead, without the 7.5% floor.

Medical Transportation, Mileage, and Lodging

Transportation primarily for and essential to medical care is a deductible medical expense. You have two options for car costs: the standard medical mileage rate, or actual gas and oil costs. You cannot use both, and depreciation and general repairs are never included.

• On top of mileage: parking fees and tolls are deductible in addition to the mileage rate.
• Other transportation: bus, taxi, train, plane, and ambulance fares for medical care all qualify.
• Lodging: lodging while away from home primarily for medical care is deductible up to $50 per night per person - the patient plus one accompanying person ($100 total per night). Meals while traveling are not deductible.
• Companion travel: a parent traveling with a sick child, or a nurse or companion whose presence is necessary, can include their transportation and lodging.

Keep a mileage log with dates, destinations, and purpose. The medical mileage rate is far lower than the business rate (72.5¢ for 2026) because it reflects only variable operating costs, not depreciation. See the Mileage Deduction Guide for how the different rates are set.

Whose Medical Expenses You Can Include

Under IRC §213(a) you can deduct medical expenses you paid for:

• Yourself and your spouse (if married at the time the expense was incurred or paid).
• Your dependents - both qualifying children and qualifying relatives under IRC §152.
• A person who would be your dependent except that they had gross income above the dependent limit, or filed a joint return, or could be claimed on someone else's return. This is the most useful expansion: it lets you deduct medical bills you pay for a parent whose Social Security or pension income is too high for the dependency exemption, provided you meet the support test.

The year-paid rule

A medical expense is deductible in the year you pay it, not the year the care was provided, under the cash method. A December 2025 surgery billed and paid in January 2026 is a 2026 deduction. Charging the bill to a credit card counts as paid on the charge date, even if you carry the balance. This timing flexibility is the foundation of the bunching strategy discussed below.

Divorced or separated parents

A parent can deduct the medical expenses they pay for a child even if the other parent claims the child as a dependent. Medical expenses are an exception to the general rule that only the custodial/claiming parent gets child-related tax benefits - each parent deducts what they actually paid.

The Itemize-vs-Standard Gate

This is the gate that surprises most taxpayers. The medical deduction lives on Schedule A, and you only file Schedule A if you itemize. You itemize only when your total itemized deductions beat your standard deduction. So clearing the 7.5% floor is necessary but not sufficient - the deductible medical must combine with your other itemized deductions to exceed the standard deduction before it reduces your tax.

The net-benefit concept

The real value of your medical deduction is not the deductible medical amount itself - it is how much that amount pushes your total itemized above what you would otherwise deduct. If you would take the standard deduction anyway, the medical only helps to the extent total itemized exceeds the standard deduction. If you already itemize because of a large mortgage and high SALT, every dollar of deductible medical adds on top at your full marginal rate. The calculator computes this net benefit directly; the Itemize vs Standard Deduction Calculator shows the full side-by-side.

Bunching to clear both gates

Because the deduction follows the year paid, taxpayers near the line can concentrate elective and prepayable medical costs - dental work, vision correction, a planned procedure, prepaid nursing-home deposits - into a single tax year. Bunching $20,000 of medical into one year may clear both the 7.5% floor and the standard deduction in that year, while spreading the same $20,000 across two years clears neither. Pair medical bunching with a donor-advised-fund charitable contribution in the same year to push total itemized well above the standard deduction, then take the standard deduction the following year.

How to Claim It on Schedule A

The medical expense deduction is reported on Schedule A (Form 1040), lines 1 through 4:

• Line 1 - total medical and dental expenses you paid (after subtracting any reimbursements).
• Line 2 - your AGI from Form 1040 line 11.
• Line 3 - 7.5% of line 2 (the floor).
• Line 4 - line 1 minus line 3, but not less than zero. This is your deductible medical expense, which flows into the Schedule A total on Form 1040 line 12.

You must itemize to claim the deduction, which means giving up the standard deduction. Nothing is attached to the return, but keep your documentation: itemized receipts, insurance Explanation of Benefits statements (to prove the unreimbursed amount), a mileage log, pharmacy printouts, and LTC premium statements. The IRS can request substantiation for up to three years after filing.

Common reporting mistakes

• Deducting the gross bill instead of the unreimbursed net (subtract insurance payments first).
• Including HSA/FSA-paid expenses (already pre-tax).
• Putting self-employed health insurance on Schedule A instead of above-the-line under §162(l).
• Exceeding the LTC age cap without trimming to the limit.
• Forgetting that the deduction does not help unless you itemize.

Frequently Asked Questions

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