You can only deduct medical expenses that exceed 7.5% of your adjusted gross income

The medical expense deduction is available only if your total medical costs for the year are higher than 7.5% of your adjusted gross income (AGI). If they are not, you cannot deduct any medical expenses. This threshold applies to all taxpayers — there is no exception based on income level or filing status.

The IRS calls this the "floor". If your AGI is $60,000, the floor is $4,500. You can only deduct the amount above that. If your medical expenses total $5,200, you deduct $700. If they total $4,200, you deduct nothing.

This rule has been in place since 2013 and applies to the 2024 tax year and beyond. The percentage does not change year to year, though your AGI does, which means your deductible amount shifts with your income.

Key Takeaways

  • You must itemize deductions on Schedule A to claim medical expenses; the standard deduction is usually larger and blocks you from using this deduction at all.
  • Only expenses above 7.5% of your AGI count, so a $60,000 income means you need more than $4,500 in medical costs to deduct anything.
  • Deductible expenses include insurance premiums you paid yourself, prescription drugs, dental work, vision care, and mileage to medical appointments at the IRS rate.
  • Cosmetic procedures, over-the-counter medications, and gym memberships do not count, even if a doctor recommends them.
  • You must keep receipts, invoices, and insurance statements for every expense you claim, because the IRS requests documentation during audits.

When itemizing makes sense instead of taking the standard deduction

Most taxpayers take the standard deduction because it is larger than the total of all itemized deductions combined. For 2024, the standard deduction is $14,600 for single filers and $29,200 for married filing jointly. If your medical expenses plus other itemized deductions (mortgage interest, property taxes, charitable donations) do not exceed these amounts, you cannot use the medical deduction.

You itemize only when the sum of all deductible items — medical, state and local taxes up to $10,000, mortgage interest, charitable gifts — exceeds the standard deduction for your filing status. A person with $8,000 in medical expenses and $4,000 in charitable donations might itemize if single (total $12,000 is close to $14,600 but still below). A married couple with $12,000 in medical expenses and $8,000 in property taxes would itemize because $20,000 exceeds $29,200.

If you do not itemize, the medical deduction does not exist for you that year, regardless of how high your medical costs are.

What counts as a deductible medical expense

The IRS publishes a list of deductible medical expenses in Publication 502. The main categories are insurance premiums you paid out of pocket, prescription medications, dental and vision care, hospital and doctor visits, mental health treatment, and transportation to medical appointments.

Insurance premiums count only if you paid them yourself — not if your employer paid them or deducted them from your paycheck before taxes. If you are self-employed and paid health insurance premiums, you may be able to deduct them separately as a business expense, which is often better than itemizing. Premiums for long-term care insurance are deductible up to an age-based limit set by the IRS each year.

Prescription drugs and insulin count. Over-the-counter medications like ibuprofen, cold medicine, and antacids do not, unless you have a prescription for them. Dental work including cleanings, fillings, root canals, and orthodontia counts. Eyeglasses, contact lenses, and laser eye surgery count. Mental health counseling and therapy count. Hearing aids and batteries count.

Mileage to and from medical appointments is deductible at the IRS standard mileage rate for medical travel, which is 21 cents per mile for 2024. Keep a log of the date, destination, and miles driven. Parking and tolls also count. Lodging near a hospital for treatment counts, but only the lodging — not meals.

What does not count as a deductible medical expense

Cosmetic procedures do not count unless they are medically necessary to correct an injury or birth defect. Teeth whitening, facelifts, and hair removal for appearance do not may have access to. Gym memberships and fitness equipment do not count, even if a doctor recommends exercise. Vitamins and supplements do not count unless prescribed by a doctor for a specific medical condition.

Over-the-counter medications without a prescription do not count. Toothpaste and toothbrushes do not count. Maternity clothes do not count. Cosmetics and toiletries do not count. Wigs count only if you need them because of a medical condition like alopecia or chemotherapy, not for appearance.

Procedures that are purely elective — like cosmetic dentistry that improves appearance but not function — do not count. If you are unsure whether a specific expense qualifies, Publication 502 has a detailed list, or you can ask a tax professional.

How to calculate and document your deduction

Start by adding up every medical expense you paid in the calendar year. Include insurance premiums, copays, deductibles you met, prescription costs, dental bills, vision care, therapy, and mileage. Organize them by category — insurance, prescriptions, dental, vision, other — so you can spot errors and make the list easier to follow if audited.

Calculate 7.5% of your AGI. Your AGI appears on your tax return (Form 1040, line 11 for 2024). Subtract that amount from your total medical expenses. The result is your deductible amount. If the result is zero or negative, you have no deduction.

If you itemize, enter this amount on Schedule A, line 1. You will need to file Schedule A with your Form 1040 instead of claiming the standard deduction. Keep all receipts, invoices, insurance statements, and mileage logs for at least three years. The IRS can audit back three years, and in some cases longer if there is a substantial error.

If you paid medical expenses for a dependent — a child, parent, or other relative you claim on your return — those expenses count toward your deduction if you paid them directly. Expenses paid by the dependent themselves do not count, even if you claim them as a dependent.

Medical expenses paid through insurance and reimbursement accounts

If your insurance covered part of a medical bill, you deduct only the amount you paid out of pocket, not the amount insurance paid. If you paid $500 for a procedure and insurance reimbursed $300, you deduct $200.

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), money you withdraw from these accounts to pay medical expenses cannot also be deducted on your tax return. You are using pre-tax money to pay the expense, so you do not deduct it again. However, any medical expenses you paid out of pocket beyond what your HSA or FSA covered can be deducted if they meet the threshold.

If you received a reimbursement from your employer for medical expenses in a separate arrangement, that reimbursement reduces the amount you can deduct. If your employer reimbursed you $1,000 and you paid $2,000 in medical expenses, you deduct only the $1,000 you paid yourself.

State and local tax limits do not affect medical deductions

The $10,000 cap on state and local tax deductions (SALT) does not explore to medical expenses. You can deduct medical expenses separately from SALT, and the medical deduction has no cap. However, you still must exceed 7.5% of your AGI to deduct any medical expenses at all, and you still must itemize instead of taking the standard deduction.

If you live in a state with a state income tax, you may also be able to deduct medical expenses on your state return. State rules vary — some states follow the federal 7.5% threshold, others use a different percentage, and some do not allow the deduction at all. Check your state's tax guidance or speak with a tax professional about your state's rules.

Frequently Asked Questions

Can I deduct medical expenses for my adult child if I claim them as a dependent?

Yes, if you paid the medical expenses directly. The expenses must be for someone you claim as a dependent on your return. If your adult child paid their own medical bills, you cannot deduct them, even if you claim them as a dependent.

What if I paid medical expenses in one year but the insurance reimbursement came in the next year?

Deduct the expense in the year you paid it. If you receive a reimbursement in a later year, you must report that as income in the year you receive it, unless you deducted the expense in a prior year — in which case you may need to amend that return. Keep records of when you paid and when you were reimbursed.

Does my spouse's medical expenses count if we file jointly?

Yes. When you file jointly, you combine both spouses' medical expenses and compare the total to 7.5% of your combined AGI. This often makes it easier to exceed the threshold than if you filed separately.

Can I deduct the cost of a medical alert system or home modifications for accessibility?

A medical alert system counts if it is prescribed by a doctor for a specific medical condition. Home modifications like ramps, grab bars, or widened doorways for a disability count, but only the cost that exceeds the increase in your home's value. Consult Publication 502 or a tax professional for the exact calculation.

What if my medical expenses are very high because of a major surgery or illness?

The 7.5% threshold still applies. However, a year with unusually high medical costs may be the year you finally exceed the threshold and can itemize. If you have a choice about when to pay certain elective procedures, paying them in the same year as other major medical expenses can help you reach the threshold.