You can deduct medical expenses, but only if they exceed 7.5% of your adjusted gross income

The medical expense deduction exists on your federal tax return, but it comes with a high threshold. You can only deduct the amount of medical expenses that exceeds 7.5% of your adjusted gross income (AGI) for the year. If your AGI is $60,000, for example, you would need medical expenses over $4,500 before you could deduct any of them. Most people do not reach this threshold, which is why the deduction is used by fewer than 1 in 20 tax filers.

The deduction also requires you to itemize deductions on your tax return instead of taking the standard deduction. The standard deduction for 2024 is $14,600 for single filers and $29,200 for married couples filing jointly. Unless your total itemized deductions (medical expenses plus charitable donations, state and local taxes, and mortgage interest) exceed the standard deduction for your filing status, you will not benefit from deducting medical expenses at all.

Key Takeaways

  • You can only deduct medical expenses that exceed 7.5% of your adjusted gross income, and only if you itemize deductions instead of taking the standard deduction.
  • Deductible medical expenses include insurance premiums, doctor and dentist visits, prescription medications, medical equipment, and travel to receive medical care.
  • Cosmetic procedures, over-the-counter medications you buy without a prescription, and health club memberships are not deductible.
  • You report medical expenses on Schedule A (Form 1040) if you itemize, and you must keep receipts and documentation for at least three years.

What counts as a deductible medical expense

The IRS allows you to deduct a wide range of medical and dental costs. These include premiums for health insurance (including Medicare premiums if you are retired), copays and coinsurance, prescription medications, eyeglasses and contact lenses, hearing aids and batteries, crutches and wheelchairs, and costs for surgery or hospital stays. You can also deduct the cost of visits to doctors, dentists, therapists, and other licensed medical professionals.

Less obvious expenses also count. If you travel to receive medical care, you can deduct mileage at the IRS rate (21 cents per mile for 2024) or actual fuel costs, plus parking and tolls. If you stay overnight for treatment, lodging is deductible. You can deduct the cost of prescription birth control, fertility treatments, and weight-loss programs prescribed by a doctor. Nursing home care, home health aides, and modifications to your home for medical reasons (like installing a wheelchair ramp or grab bars) are all deductible.

What does not count as a deductible medical expense

Cosmetic procedures are not deductible unless they are medically necessary to correct a deformity caused by injury or disease. Teeth whitening, facelifts, and hair transplants for baldness do not count. Over-the-counter medications you buy without a prescription—such as aspirin, cold medicine, or antacids—are not deductible, even if a doctor recommends them. Prescription versions of the same medications are deductible.

Health club memberships and gym fees are not deductible, even if your doctor recommends exercise. Vitamins and supplements are not deductible unless prescribed by a doctor for a specific medical condition. Toothpaste, mouthwash, and other hygiene products do not count. Maternity clothes are not deductible because they are not medical expenses. If you have a question about whether a specific expense qualifies, the IRS Publication 502 lists hundreds of examples.

How to calculate and report your deduction

Start by adding up all your deductible medical expenses for the year. Then calculate 7.5% of your adjusted gross income. Subtract that percentage from your total expenses. The remainder is what you can deduct. For example, if your AGI is $50,000 and your medical expenses total $6,000, you calculate 7.5% of $50,000, which is $3,750. You can deduct $6,000 minus $3,750, or $2,250.

You report this deduction on Schedule A (Form 1040), which is the form you use when you itemize deductions. You enter your total medical expenses on line 1, then subtract 7.5% of your AGI on line 2, and enter the result on line 3. You then add this amount to your other itemized deductions (charitable donations, state and local taxes, mortgage interest, and so on) and compare the total to the standard deduction for your filing status. If your itemized deductions are higher, you itemize; if not, you take the standard deduction instead.

Keeping records and documentation

The IRS requires you to keep receipts, invoices, and statements for all medical expenses you deduct. You should also keep records showing that you paid the expenses and that they were for medical care. If you claim mileage, keep a log showing the date, destination, and purpose of each trip. For insurance premiums, keep your policy statements and payment records. For prescriptions, keep the pharmacy receipt showing the medication name and the amount paid.

You do not send these documents with your tax return, but you must have them available if the IRS asks. The IRS can audit your return for up to three years after you file, so keep your records for at least that long. If you use tax software or work with a tax preparer, they will ask you for this documentation before they file your return.

When medical expenses might exceed the threshold

The 7.5% threshold is high enough that most people do not reach it in a single year. However, some situations make it more likely. If you have a chronic condition that requires ongoing treatment, multiple family members with medical needs, a major surgery or hospitalization, or you are retired and paying Medicare premiums, your expenses may add up quickly. If you are self-employed, you can deduct health insurance premiums on a different part of your return (Form 1040, line 17) regardless of the 7.5% threshold, so those do not count toward the Schedule A deduction.

Some people use a strategy called "bunching" medical expenses. If you know you will have a large medical expense in the coming year (like elective surgery), you might delay other medical procedures, dental work, or vision care until that same year to push your total over the threshold. This only works if you itemize deductions, and only if your total itemized deductions still exceed the standard deduction after you add the medical expenses.

Frequently Asked Questions

Can I deduct health insurance premiums I pay myself?

If you are self-employed, you can deduct health insurance premiums directly on Form 1040, and this deduction is not subject to the 7.5% threshold. If you are an employee, premiums you pay through your employer's plan are usually deducted before taxes are calculated, so you do not deduct them again. If you pay premiums out of pocket for a policy you buy yourself, those premiums count toward the 7.5% threshold on Schedule A.

What if my employer reimburses me for medical expenses?

You cannot deduct medical expenses that your employer reimburses through a health reimbursement arrangement (HRA) or flexible spending account (FSA). You can only deduct expenses you paid out of your own pocket. If your employer reimburses you, reduce your total medical expenses by the reimbursement amount before you calculate the deduction.

Can I deduct medical expenses for my adult child?

You can deduct medical expenses you paid for your spouse and dependents, including adult children if they meet the IRS definition of a dependent. You cannot deduct expenses for an adult child who is not your dependent, even if you paid for their care. The dependent must have lived with you for the entire year and met income and citizenship requirements.

Do I need to itemize to deduct any 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 at all. The only exception is self-employed health insurance premiums, which are deducted on Form 1040 itself, not on Schedule A.

What happens if I have medical debt that was forgiven?

If a hospital or doctor forgives medical debt you owed, that forgiven amount may be considered taxable income. However, there are exceptions for certain situations. Consult a tax professional or IRS Publication 525 for guidance on your specific case, as the rules depend on the circumstances of the forgiveness.