You can deduct medical bills on your federal tax return, but only if they exceed a threshold and you itemize instead of taking the standard deduction

The IRS allows you to deduct unreimbursed medical and dental expenses, but the rules are strict. Your total medical expenses must exceed 7.5% of your adjusted gross income (AGI) in the tax year you're claiming them. Only the amount above that threshold counts as a deduction. For example, if your AGI is $60,000, you can only deduct medical expenses over $4,500. You also must choose to itemize deductions on your tax return rather than take the standard deduction—and itemizing only makes sense if your total itemized deductions exceed the standard deduction amount for your filing status.

This deduction applies to expenses you paid out of your own pocket and were not reimbursed by insurance, an employer, or another source. It covers a wide range of costs: doctor visits, hospital stays, prescription medications, dental work, vision care, mental health treatment, and certain medical equipment or home modifications your doctor says you need for treatment.

Key Takeaways

  • Medical expenses must exceed 7.5% of your adjusted gross income before any of them can be deducted, and only the amount above that threshold counts.
  • You must itemize deductions on your tax return for medical expenses to matter, which only saves money if your total itemized deductions beat the standard deduction for your filing status.
  • Only unreimbursed expenses count—money you paid yourself after insurance, employer plans, or other sources covered their share does not may have access to.
  • Expenses must be for diagnosis, treatment, or prevention of disease or for treatment that affects a body function; cosmetic procedures and general wellness do not may have access to.
  • You can deduct expenses you paid in the tax year, even if the medical service happened in a different year.

What counts as a deductible medical expense

The IRS has a long list of medical costs you can deduct. Obvious ones include doctor and dentist visits, hospital stays, surgery, prescription drugs, and mental health counseling. Less obvious ones include the cost of eyeglasses and contact lenses, hearing aids and batteries, crutches and wheelchairs, and guide dogs for the blind. You can also deduct the cost of a home modification your doctor prescribes—such as a ramp, grab bars, or a stair lift—if it's medically necessary and doesn't add value to your home beyond its medical purpose.

Travel to receive medical care counts too. You can deduct mileage to and from doctor appointments, hospital visits, or treatment centers at the IRS mileage rate (which changes yearly). If you need someone to drive you because of your condition, their mileage also counts. Parking and tolls are deductible. If you fly or take a train for treatment, the full cost of transportation is deductible, and a companion's ticket is deductible if your condition requires someone to travel with you.

Insurance premiums you pay yourself are deductible, including health insurance, dental insurance, and vision insurance. Long-term care insurance premiums are also deductible, though there are age-based limits on how much you can claim. However, premiums paid through a pre-tax employer plan (like a cafeteria plan) are already excluded from your income, so you cannot deduct them again.

What does not may have access to as a deductible medical expense

Cosmetic procedures are not deductible unless they're reconstructive—meaning they repair damage from injury, disease, or surgery. A facelift or teeth whitening for appearance alone does not count. General health and wellness expenses do not may have access to either: gym memberships, vitamins, weight loss programs (even if medically recommended), and over-the-counter medications do not meet the IRS standard. Marijuana, even if prescribed by a doctor in a state where it's legal, is not deductible under federal tax law.

Expenses for someone else's care are not deductible unless that person is your dependent. You cannot deduct medical bills for an adult child, a parent, or a sibling unless they meet the IRS definition of a dependent, which includes a gross income test and a relationship or residency test. Childcare and babysitting are not medical expenses, even if you need them while attending medical appointments.

How to calculate whether itemizing makes sense for you

Before you spend time gathering medical receipts, check whether itemizing will actually lower your taxes. The standard deduction for 2024 is $14,600 for single filers, $29,200 for married filing jointly, and $21,900 for head of household. If your total itemized deductions (medical expenses plus mortgage interest, state and local taxes, charitable donations, and other deductible items) do not exceed your standard deduction, itemizing saves you nothing.

Start by calculating your adjusted gross income (AGI). This is your total income minus certain deductions like contributions to a traditional IRA or student loan interest. You can find your AGI on your previous year's tax return or calculate it using IRS worksheets. Multiply your AGI by 0.075 (7.5%). This is your threshold. Add up all your unreimbursed medical expenses for the year. Subtract the threshold from that total. If the result is positive and your total itemized deductions exceed the standard deduction, you have a deduction to claim.

Many people find that medical expenses only become deductible in years when they have unusually high costs—a major surgery, extended hospitalization, or new chronic condition treatment. In other years, the standard deduction is the better choice. You might also consider timing: if you're close to the threshold, paying medical bills before or after December 31 can shift expenses into the year where they're more likely to help.

How to document and claim medical deductions

Keep receipts and invoices for every medical expense you plan to deduct. The IRS does not require you to attach receipts to your tax return, but you must keep them for at least three years in case of an audit. Your records should show the date of service, the provider's name, what was provided or treated, and the amount you paid out of pocket. Insurance explanations of benefits (EOBs) are helpful because they show what the provider charged, what insurance paid, and what you owe.

When you file your tax return, you will report itemized deductions on Schedule A (Form 1040). Medical and dental expenses go on line 1. You subtract the 7.5% threshold yourself on the form—the IRS does not do this calculation for you. The remaining amount (if any) is added to your other itemized deductions. If the total exceeds your standard deduction, you itemize. If it does not, you take the standard deduction instead and ignore the medical expenses.

If you use tax software, it will walk you through this calculation. If you file by hand or with a tax professional, make sure they know about all your medical expenses so they can determine whether itemizing benefits you.

State tax deductions for medical expenses

Some states allow medical expense deductions on state income tax returns, and the rules vary. A few states follow the federal 7.5% threshold. Others use a different threshold or allow deductions without a threshold at all. A handful of states do not have income tax.

Check your state's tax agency website or ask a tax professional about your state's rules, because a deduction that does not help federally might still lower your state taxes. State rules can differ significantly from federal rules, so it's worth investigating even if you decide not to itemize on your federal return.

Medical expenses paid in prior or future years

You deduct medical expenses in the year you paid them, not the year the service was provided. If you had surgery in December 2023 but paid the bill in January 2024, the deduction goes on your 2024 return. This matters if you're deciding whether to pay a bill before or after December 31. In some cases, bunching medical expenses into one calendar year (by paying bills early or delaying payment) can push you over the 7.5% threshold when you might not reach it if expenses are spread across two years.

If you paid medical bills through a payment plan or credit card, the deduction is in the year you charged or paid, not when the provider received the money. If you used a health savings account (HSA) or flexible spending account (FSA) to pay medical expenses, those amounts are already excluded from your taxable income, so you cannot deduct them again on Schedule A.

Frequently Asked Questions

Can I deduct medical expenses for my adult child?

Only if your adult child is your dependent for tax purposes. This requires that they live with you for the entire year (with limited exceptions), that you provide more than half their financial support, and that their gross income is below a certain threshold (currently $4,700). If these conditions are met, their medical expenses count toward your deduction. If not, they cannot deduct their own expenses unless they file their own return and meet the threshold themselves.

What if my insurance company denied a claim—can I deduct that expense?

Yes. You deduct what you actually paid out of pocket. If insurance denied the claim and you paid the full bill yourself, the entire amount counts. If insurance partially covered it and you paid your share, only your share is deductible. The fact that insurance denied it does not change the calculation—only what you personally paid matters.

Can I deduct the cost of a gym membership if my doctor recommended it?

No. General fitness and wellness expenses do not may have access to, even with a doctor's recommendation. However, if you need physical therapy or rehabilitation as treatment for an injury or illness, that cost is deductible. The distinction is between treatment for a diagnosed condition and general health maintenance.

Do I have to file Schedule A to deduct medical expenses?

Yes. Medical expenses are only deductible if you itemize deductions on Schedule A. If you take the standard deduction instead, you cannot deduct medical expenses. This is why many people find that medical deductions do not help them—their standard deduction is already larger than their total itemized deductions would be.

What if I paid medical bills with a health savings account—do I still deduct them?

No. Money you withdraw from an HSA to pay medical expenses is already tax-free, so you cannot deduct it again. The same applies to flexible spending accounts (FSAs). You deduct only the medical expenses you paid with your own after-tax money.