Taxpayers who itemize deductions on their federal return may deduct qualifying medical and dental expenses on Schedule A, but only the portion of those expenses that exceeds 7.5% of their adjusted gross income (AGI). Because this deduction requires itemizing, it only provides a tax benefit when total itemized deductions surpass the applicable standard deduction for the filing year.
This is general information, not tax advice — consult a qualified tax professional about your specific situation.
The 7.5%-of-AGI Threshold Explained
The IRS does not allow a dollar-for-dollar deduction of every medical expense paid during the year. Instead, taxpayers subtract a floor equal to 7.5% of their AGI. Only the medical expenses paid above that floor are deductible.
The threshold has been 7.5% of AGI since the Tax Cuts and Jobs Act made it permanent for all taxpayers beginning in tax year 2017. Earlier law briefly set the floor at 10% for most filers; that higher rate no longer applies.
Worked Example
| Item | Amount |
|---|---|
| Adjusted gross income (AGI) | $65,000 |
| 7.5% floor (0.075 x $65,000) | $4,875 |
| Total qualifying medical expenses paid | $8,200 |
| Deductible amount ($8,200 - $4,875) | $3,325 |
In this example, only $3,325 would be entered on Schedule A as the medical expense deduction — not the full $8,200 paid.
If qualifying expenses had totaled $4,500 instead, the deductible amount would be $0 ($4,500 - $4,875 = -$375), because the expenses did not clear the floor.
This Is an Itemized Deduction — When Does It Actually Help?
Medical expenses belong on Schedule A, which means a taxpayer must forgo the standard deduction to claim them. For 2025, the standard deduction is $15,000 for single filers and $30,000 for married filing jointly (amounts are adjusted annually for inflation).
If all of a taxpayer's itemized deductions combined — including the deductible portion of medical expenses, state and local taxes (capped at $10,000), mortgage interest, and charitable contributions — are less than the standard deduction, itemizing produces a smaller tax benefit. Understanding the comparison between these two paths is fundamental before pursuing the medical expense deduction; see Standard Deduction vs. Itemizing: What to Know for 2026 for a deeper comparison.
What Qualifies as a Deductible Medical Expense?
The IRS defines deductible medical care broadly in IRS Publication 502 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." Qualifying categories include:
Professional Services and Treatments
- Fees paid to licensed physicians, surgeons, dentists, chiropractors, psychiatrists, psychologists, and other recognized medical practitioners
- Hospital and nursing-home costs (including the portion allocable to medical care in a qualified long-term care facility)
- Qualifying long-term care services, subject to limits based on the taxpayer's age (the IRS publishes annual dollar caps)
- Inpatient alcohol or drug treatment programs
- Acupuncture, as well as participation in medically supervised weight-loss programs prescribed for a specific disease (not general health improvement)
Prescription Drugs and Medical Equipment
- Prescription medicines and insulin (insulin is specifically deductible even without a prescription)
- Prescription eyeglasses, contact lenses, and hearing aids
- Wheelchairs, crutches, and other durable medical equipment
- Costs of special equipment installed in a home for a person with a disability, to the extent the improvement exceeds the increase in the home's fair market value
Insurance Premiums
Medical insurance premiums a taxpayer pays with after-tax dollars are deductible. This includes COBRA continuation coverage, Medicare premiums (Parts B and D, as well as supplemental Medigap premiums), and long-term care insurance premiums up to the annual age-based limits. Premiums paid with pre-tax dollars — for example, through an employer's cafeteria plan — are not deductible because the taxpayer received a tax benefit already.
Transportation and Lodging
Reasonable transportation costs to receive medical care are deductible. Taxpayers may deduct:
- Actual out-of-pocket vehicle costs (parking, tolls, and actual gas and oil) or the IRS standard medical mileage rate (check the IRS website for the current year's rate, as it is adjusted periodically)
- Bus, taxi, train, and ambulance fares
- Lodging costs while away from home, primarily for medical care at a licensed medical facility, up to $50 per night per person (limited to $100 per night if a parent must travel with a child patient)
Meals while traveling for medical care are not deductible.
Capital Improvements for Medical Necessity
The cost of permanent improvements to a home may be deductible to the extent the improvement does not increase the property's value and was medically necessary. Examples include installing wheelchair ramps, widening doorways for a wheelchair, constructing entrance or exit ramps, lowering kitchen cabinets, or adding hand rails in bathrooms. Any amount of the improvement cost exceeding the resulting increase in home value may qualify.
What Does NOT Qualify
Understanding the boundaries of this deduction is as important as knowing what qualifies.
| Non-Qualifying Item | Reason |
|---|---|
| Cosmetic surgery and procedures | Elective; does not treat disease or correct deformity from accident/disease |
| Gym memberships and fitness programs | General health, not treatment of a specific disease |
| Vitamins and dietary supplements | Not prescribed for a diagnosed condition |
| Non-prescription (OTC) drugs (other than insulin) | Excluded by statute; prescription required |
| Teeth whitening | Cosmetic |
| Maternity clothes | Not medical care |
| Swimming lessons | General health |
| Funeral or burial expenses | Not medical care |
| Expenses reimbursed by insurance | No net out-of-pocket cost |
| Expenses paid from HSA or FSA pre-tax dollars | Double-dipping is not permitted |
The prohibition on double-dipping is significant. If a taxpayer uses a Health Savings Account (HSA) or a Flexible Spending Account (FSA) to pay a medical bill, those dollars were never included in taxable income. Claiming the same expense as an itemized deduction would effectively grant two tax benefits for one expense, which the IRS does not permit. Only amounts paid with after-tax dollars can be included in the Schedule A calculation.
Whose Medical Expenses Can Be Included?
Taxpayers may include qualifying medical expenses paid for:
- Themselves
- A spouse — expenses paid for a spouse are deductible regardless of whether a joint or separate return is filed, provided the couple was married either at the time services were rendered or at the time payment was made
- Dependents — a person who qualifies as the taxpayer's dependent under the rules for qualifying child or qualifying relative at either the time the medical services were provided or the time the taxpayer paid the expenses
A special rule applies when parents are divorced or separated. A parent who cannot claim a child as a dependent may still be able to deduct medical expenses paid for that child if specific conditions are met. Publication 502 covers this scenario in detail.
Taxpayers who pay medical bills for someone they could have claimed as a dependent but for the gross-income test or the joint-return test may also include those amounts. Consult IRS Publication 502 for the precise conditions.
Year of Payment, Not Year of Service
Medical expenses are deductible in the tax year they are actually paid, regardless of when services were rendered. If a bill for a December procedure is paid in January of the following year, the deduction belongs to the January tax year.
This rule creates planning considerations for taxpayers who anticipate a year with high itemizable expenses. Bunching large medical payments into a single year — rather than spreading them across two years — can increase the likelihood of clearing the 7.5%-of-AGI threshold and exceeding the standard deduction. Taxpayers should consult a qualified tax professional before making payment timing decisions with tax consequences in mind.
How to Claim the Deduction
Qualified medical expenses are reported on Schedule A (Form 1040), Line 1. Taxpayers enter total qualifying expenses on Line 1, the AGI-based floor on Line 3 (calculated from Form 1040 Line 11), and the deductible excess on Line 4. Schedule A then feeds into Form 1040 as the total itemized deduction.
Substantiation matters. The IRS can ask for documentation supporting claimed medical expenses. Taxpayers should retain:
- Receipts and Explanation of Benefits (EOB) statements from insurers
- Records showing out-of-pocket costs not reimbursed
- Written statements from physicians when a capital improvement or special program is claimed as medically necessary
- Mileage logs if the vehicle mileage rate is used
For more on expenses that often go unclaimed, see Commonly Missed Tax Deductions. For the broader category of Schedule A itemized deductions, the TaxPros Rated newsroom covers additional topics year-round.
Frequently Asked Questions
Can medical expenses be deducted on a federal tax return?
Qualifying medical and dental expenses are deductible on Schedule A of Form 1040, but only the portion that exceeds 7.5% of the taxpayer's adjusted gross income (AGI) is actually deductible. Additionally, because Schedule A requires itemizing, the deduction only provides a benefit if total itemized deductions exceed the standard deduction for that filing year. This is general information, not tax advice — consult a qualified tax professional about your specific situation.
What is the 7.5% AGI threshold and how does it work?
The IRS requires that taxpayers subtract a floor equal to 7.5% of their AGI before claiming any medical expense deduction. Only the dollar amount of qualifying medical expenses paid during the year that exceeds that floor may be deducted on Schedule A. For example, a taxpayer with a $60,000 AGI has a $4,500 floor (0.075 x $60,000); if they paid $7,000 in qualifying expenses, only $2,500 would be deductible. This is general information, not tax advice — consult a qualified tax professional about your specific situation.
Are insurance premiums deductible as medical expenses?
Medical insurance premiums paid with after-tax dollars — including COBRA premiums, Medicare Parts B and D premiums, and Medigap supplemental premiums — generally qualify as deductible medical expenses. Premiums paid through an employer's pre-tax cafeteria plan are not deductible because they were excluded from income. Long-term care insurance premiums are deductible up to annual age-based dollar limits set by the IRS. This is general information, not tax advice — consult a qualified tax professional about your specific situation.
Can expenses paid from an HSA or FSA be deducted?
No. Amounts paid from a Health Savings Account (HSA) or Flexible Spending Account (FSA) used pre-tax dollars, so they may not also be claimed as an itemized medical expense deduction. Claiming the same expense twice would constitute double-dipping. Only out-of-pocket medical costs paid with after-tax money are eligible for the Schedule A deduction. This is general information, not tax advice — consult a qualified tax professional about your specific situation.
Are over-the-counter medications deductible?
Generally, non-prescription (over-the-counter) medications are not deductible as medical expenses. Insulin is a statutory exception — it is deductible even without a prescription. Prescription drugs obtained with a valid prescription from a licensed physician do qualify. This is general information, not tax advice — consult a qualified tax professional about your specific situation.
Can a taxpayer deduct medical expenses paid for a parent or other family member?
Qualifying medical expenses paid for a taxpayer's spouse or dependents may be included. In some circumstances, expenses paid for a person who would have qualified as a dependent but for the gross-income or joint-return test may also be eligible. The rules around who qualifies are fact-specific; IRS Publication 502 and Topic No. 502 set out the detailed conditions. This is general information, not tax advice — consult a qualified tax professional about your specific situation.
This is general information, not tax advice — consult a qualified tax professional about your specific situation.