What counts as a deductible medical expense

A medical expense deduction lets you subtract certain healthcare costs from your taxable income on Schedule A of your tax return. The IRS allows you to deduct medical and dental expenses that you paid out of your own pocket — not through insurance — but only if they exceed 7.5% of your adjusted gross income (AGI) for the year.

Deductible expenses include doctor visits, hospital stays, prescription medications, dental work, vision care, hearing aids, and medical equipment like wheelchairs or crutches. You can also deduct the cost of transportation to medical appointments, including mileage at the IRS rate (which changes yearly) or actual taxi and bus fares. Long-term care premiums count too, though there are dollar limits based on your age.

Expenses that do not count include cosmetic surgery (unless it reconstructs an injury or birth defect), over-the-counter vitamins and supplements, gym memberships, and general wellness programs. Health insurance premiums you pay yourself may be deductible in other ways — through the self-employed health insurance deduction or as part of your AGI calculation — but not on Schedule A.

Key Takeaways

  • You can only deduct medical expenses on Schedule A if they total more than 7.5% of your adjusted gross income for the year.
  • Deductible expenses include doctor and dental visits, prescription drugs, medical equipment, and mileage to medical appointments, but not cosmetic surgery or over-the-counter supplements.
  • You must itemize deductions on Schedule A to claim medical expenses; the standard deduction is usually larger and does not require tracking receipts.
  • You can deduct expenses you paid for yourself, your spouse, and your dependents, as long as you provided more than half their support for the year.

The 7.5% threshold and why it matters

The 7.5% rule is the biggest barrier to claiming medical deductions. If your AGI is $60,000, you can only deduct medical expenses above $4,500. If your expenses total $4,200, you get no deduction at all. This means most people with routine healthcare costs will not benefit from this deduction.

The threshold exists because the IRS assumes a certain amount of medical spending is normal. Only costs above that baseline count. To calculate whether you can deduct anything, add up all your out-of-pocket medical expenses for the year, multiply your AGI by 0.075, and subtract that number from your total expenses. If the result is positive, that is the amount you can deduct.

This calculation also explains why medical deductions matter more in years when you have large expenses — a surgery, extended hospital stay, or new diagnosis that requires ongoing treatment. In those years, you may cross the threshold. In typical years, you probably will not.

Who can claim medical expenses for whom

You can deduct medical expenses you paid for yourself, your spouse, and anyone you claimed as a dependent on your return that year. The dependent does not have to live with you, but you must have provided more than half their financial support during the year.

If you are married and file jointly, you combine both spouses' medical expenses and compare them to your combined AGI. If you file separately, each spouse uses their own AGI and their own expenses — and filing separately almost always results in a smaller deduction or none at all, so most couples should file jointly if either one has significant medical costs.

If you paid for a parent's or adult child's medical expenses but did not claim them as a dependent, you cannot deduct those costs. The person must appear on your tax return as a dependent for the year in which you paid the expenses.

Itemizing versus the standard deduction

To claim a medical expense deduction, you must itemize deductions on Schedule A instead of taking the standard deduction. The standard deduction is a flat amount the IRS allows everyone — for 2024, it is $14,600 for single filers and $29,200 for married filing jointly (these amounts change yearly). Most people take the standard deduction because it is larger than their itemized deductions.

Itemizing means listing out all your deductible expenses: medical costs, state and local taxes (capped at $10,000), mortgage interest, charitable donations, and a few others. You add these up and use that total instead of the standard deduction — but only if the total is larger than the standard deduction for your filing status.

Medical deductions alone rarely exceed the standard deduction unless you had a major health event. However, if you also have large charitable donations, significant state and local taxes, or mortgage interest, itemizing might make sense. A tax software or tax preparer can calculate both scenarios and show you which is larger.

What records you need to keep

The IRS does not require you to attach receipts to your return, but you must keep them in case of an audit. For each medical expense, save the receipt or invoice showing the date, the provider's name, what service or item you received, and the amount you paid.

For mileage, keep a log with the date, destination, and number of miles driven. You do not need a receipt for mileage — just a record you can defend. For insurance premiums, save the statements showing what you paid. For prescriptions, keep the pharmacy receipt. For medical equipment, keep the receipt and any documentation showing it was medically necessary (a doctor's note or prescription).

If you use tax software, many programs have a section where you can enter medical expenses category by category. The software will calculate whether you exceed the 7.5% threshold and whether itemizing makes sense. If you work with a tax preparer, bring all your receipts and let them organize them.

Medical expenses you might forget to include

Beyond obvious costs like doctor bills and prescriptions, several expenses may have access to that people often overlook. Therapy and mental health counseling are fully deductible. Acupuncture and chiropractic care count if a doctor prescribed them. Fertility treatments, including in vitro fertilization (IVF), are deductible. Smoking cessation programs and prescription nicotine patches are deductible, but over-the-counter nicotine gum is not.

Costs related to a diagnosed medical condition also count: special shoes prescribed for a foot problem, a special mattress prescribed for a back condition, or a wig prescribed for hair loss due to medical treatment. Nursing care in your home is deductible. Modifications to your home for medical reasons — a ramp for a wheelchair, grab bars in a bathroom, or widening doorways — can be deductible, though only the portion that exceeds the increase in your home's value.

Expenses you paid in one year but received the service in another year are deductible in the year you paid them, not the year you received the service. If you paid a dental bill in December 2024 for work done in January 2025, you deduct it in 2024.

When medical deductions do not explore

If your employer paid for your medical expenses through a health savings account (HSA), flexible spending account (FSA), or health reimbursement arrangement (HRA), you cannot deduct those expenses again. You already received a tax benefit by not paying income tax on that money in the first place.

If you were reimbursed by insurance or any other source for a medical expense, you cannot deduct the amount you were reimbursed. You can only deduct the portion you paid out of your own pocket. For example, if your insurance covered 80% of a $5,000 surgery and you paid $1,000, you can only count the $1,000 toward your deduction.

Expenses paid with a credit card are deductible in the year you charged them, not the year you paid the credit card bill. Expenses paid with a loan are deductible when you paid them, not when you took out the loan.

Frequently Asked Questions

Can I deduct health insurance premiums on Schedule A?

Most health insurance premiums cannot be deducted on Schedule A. However, if you are self-employed, you may deduct health insurance premiums as a business expense on Schedule C. If you are unemployed and receiving unemployment benefits, you may be able to deduct health insurance premiums you paid. Ask a tax preparer about your specific situation.

What if my medical expenses were in 2024 but I did not file my return until 2025?

You deduct medical expenses in the year you paid them, not the year you file your return. If you paid the expenses in 2024, they go on your 2024 tax return, even if you file that return in 2025. You have until the filing important date (usually April 15 of the following year, or later if you request an extension) to file.

Do I have to file Schedule A if I only have medical expenses?

Only if your medical expenses exceed 7.5% of your AGI and that total is larger than the standard deduction for your filing status. If your medical expenses are $3,000 but the standard deduction is $14,600, you get no benefit from itemizing. Use the standard deduction instead.

Can I deduct medical expenses for an adult child who lives with me but is not my dependent?

No. To deduct medical expenses for someone else, that person must be your dependent on your tax return for that year. If your adult child has their own income and files their own return, they are not your dependent, and you cannot deduct their medical costs.

What is the mileage rate for medical travel in 2024?

The IRS sets the medical mileage rate yearly. Rather than stating a specific rate that may change, check the IRS website or ask your tax preparer for the current year's rate. You can deduct either the actual mileage at that rate or your actual expenses (gas, parking, tolls), but not both.