Medical bills are deductible only if you itemize deductions and your total medical expenses exceed a threshold set by the IRS

You cannot deduct medical bills unless you itemize deductions on your tax return instead of taking the standard deduction. Most people take the standard deduction because it is larger. If you do itemize, medical expenses are deductible only if they exceed 7.5% of your adjusted gross income (AGI) in the tax year you paid them. For example, if your AGI is $60,000, you can deduct medical expenses only above $4,500. You deduct the amount over that threshold, not the full bill.

The IRS defines deductible medical expenses narrowly. They must be for diagnosis, cure, mitigation, treatment, or prevention of disease, or for treatment affecting any part or function of the body. Cosmetic procedures are not deductible unless they are medically necessary—for instance, reconstructive surgery after an accident or injury. The expense must be paid in the tax year you claim it, regardless of when the service was provided.

Key Takeaways

  • Medical expenses are deductible only if you itemize deductions and your total medical costs exceed 7.5% of your adjusted gross income for that tax year.
  • Deductible expenses include doctor visits, hospital care, prescription drugs, dental work, vision care, and medical equipment, but not cosmetic procedures or general wellness items.
  • You can deduct expenses you paid out of pocket, but not amounts your insurance covered or that you were reimbursed for.
  • If your medical expenses are close to the threshold, you may want to bunch expenses into a single tax year to cross it and make itemizing worthwhile.

What counts as a deductible medical expense

The IRS maintains a list of deductible medical expenses. They include doctor and dentist visits, hospital stays, surgery, prescription medications, insulin, medical devices (crutches, wheelchairs, hearing aids), eyeglasses and contact lenses, and psychiatric care. Physical therapy, chiropractic care, and acupuncture are deductible if performed by a licensed practitioner. You can deduct the cost of a guide dog or service animal trained to information you with a disability, including food and care for that animal.

Transportation to and from medical appointments is deductible. You can deduct either the actual cost of gas and parking or use the standard mileage rate set by the IRS each year (check the current rate on IRS.gov). Lodging is deductible if you travel out of town for medical treatment, but only the lodging—not meals. Long-term care insurance premiums are deductible, but only up to an age-based limit that changes each year.

Expenses that are not deductible include cosmetic surgery (unless medically necessary), general health items like vitamins or toothpaste, gym memberships or fitness programs, weight loss programs, and over-the-counter medications except insulin. Maternity clothes, baby formula, and diaper services are not deductible. If you pay for a procedure that is partly cosmetic and partly medical, you can deduct only the medical portion if you can document the split.

How to calculate what you can deduct

Start by adding up all medical expenses you paid out of pocket in the tax year. Do not include amounts your insurance paid or reimbursed you for. Then calculate 7.5% of your adjusted gross income (AGI). Your AGI appears on your tax return and is your total income minus certain deductions like contributions to a traditional IRA or student loan interest.

Subtract the 7.5% threshold from your total medical expenses. The remainder is what you can deduct. For example: if your AGI is $80,000, the threshold is $6,000. If you paid $9,500 in medical expenses, you can deduct $3,500 ($9,500 minus $6,000). You claim this deduction on Schedule A when you itemize.

Before you itemize, compare the total of all your itemized deductions (medical, state and local taxes, mortgage interest, charitable donations) to the standard deduction for your filing status. If the standard deduction is higher, you will pay less tax by taking it, even if you have significant medical expenses. The standard deduction changes each year and depends on whether you file as single, married filing jointly, head of household, or another status.

When to bunch medical expenses into one year

If your medical expenses are close to the 7.5% threshold but not quite there, you may be able to deduct them by timing when you pay. This strategy is called "bunching." For instance, if you know you will need dental work or elective surgery, you could pay for it in the same calendar year as other medical expenses to push your total above the threshold. You must actually pay the bill in that year—charging it to a credit card counts as payment even if you pay the card bill later.

Bunching works best if you have a choice about when to pay. You might schedule a dental cleaning or vision exam in December instead of January to add it to the current year's total. If you are near the threshold in two consecutive years, you could pay for two years of expenses in one year, deduct them, and take the standard deduction the following year.

This strategy requires planning. Talk to a tax professional before you schedule elective procedures specifically to bunch expenses, because the tax savings depend on your full financial picture and may not be worth the medical hassle of timing procedures.

Medical expenses for dependents and spouses

You can deduct medical expenses you paid for your spouse and your dependents, even if they do not live with you. The dependent must meet IRS rules for claiming them on your return—generally, they must be a relative, a citizen or resident alien, and have income below a certain threshold. You can deduct medical expenses you paid for a dependent in the year you paid them, regardless of which year you claimed them as a dependent.

If you are divorced or separated, you can deduct medical expenses you paid for a child only if you have the right to claim the child as a dependent under your divorce agreement. If you and your ex-spouse share custody and alternate claiming the child, only the parent who claims the child that year can deduct medical expenses paid for that child.

What records to keep

Keep receipts and invoices for all medical expenses you claim. The IRS does not require you to attach them to your return, but you must have them if the IRS asks. Your records should show the date of service, the provider's name, what service or item was provided, and the amount you paid. If you paid out of pocket and were later reimbursed by insurance or an employer, keep the reimbursement documentation too—you cannot deduct the amount you were reimbursed for.

For mileage, keep a log showing the date, destination, and miles driven for each trip to a medical appointment. For insurance premiums, keep the statements showing what you paid. If you deduct a portion of home care or modifications to your home for medical reasons, keep receipts and documentation of what percentage is medical versus general home improvement.

Frequently Asked Questions

Can I deduct health insurance premiums?

It depends on your situation. If you are self-employed, you can deduct health insurance premiums as a business expense, not as a medical expense. If you are an employee, premiums withheld from your paycheck are already pre-tax and cannot be deducted again. If you pay premiums out of pocket for a spouse or dependent, they count toward the 7.5% threshold only if you itemize deductions.

What if I paid medical bills in one year but was reimbursed in a different year?

You deduct the expense in the year you paid it. If you are reimbursed later, you must report the reimbursement as income in the year you receive it, unless you deducted the expense in a prior year—in which case you may owe tax on the reimbursement. Keep documentation of when you paid and when you were reimbursed.

Can I deduct fertility treatment or adoption-related medical expenses?

Fertility treatment, including in vitro fertilization and related procedures, counts as a deductible medical expense if it is performed by a licensed provider. Adoption expenses are not deductible as medical expenses, but some may be deductible as adoption tax credits or exclusions under different tax rules. Consult a tax professional about adoption costs.

Do I have to itemize to deduct medical expenses?

Yes. Medical expenses are only deductible if you itemize deductions on Schedule A. If you take the standard deduction, you cannot deduct medical expenses. Compare your total itemized deductions to the standard deduction for your filing status to see which is larger.

Can I deduct medical expenses paid with a health savings account or flexible spending account?

No. Money you contribute to an HSA or FSA is already tax-free, so you cannot deduct the medical expenses you pay with those funds. You can deduct only out-of-pocket expenses that you paid with after-tax money.