Medical expenses are deductible only if they exceed a threshold, and only if you itemize

You can deduct medical and dental expenses on your federal tax return, but only under two conditions: your total medical costs for the year must exceed 7.5% of your adjusted gross income (AGI), and you must itemize deductions instead of taking the standard deduction. If your medical bills don't clear that 7.5% threshold, you get no deduction at all. If they do, you can only deduct the amount above the threshold.

For example, if your AGI is $60,000, the threshold is $4,500. If you spent $5,200 on medical care, you can deduct $700 (the $5,200 minus $4,500). If you spent $4,200, you cannot deduct anything. This is why medical deductions matter most to people with either very high medical costs or lower incomes, where 7.5% is a smaller number.

The standard deduction for 2024 is $14,600 for single filers and $29,200 for married couples filing jointly. Itemizing only makes sense if your medical deduction plus other itemized deductions (mortgage interest, state taxes, charitable donations) exceeds these amounts. Many people with moderate medical bills will find the standard deduction is still larger.

Key Takeaways

  • Medical expenses are deductible only if they total more than 7.5% of your adjusted gross income, and you can only deduct the amount above that threshold.
  • You must itemize deductions on your tax return to claim medical expenses; the standard deduction is larger for most filers and does not require itemizing.
  • Deductible expenses include insurance premiums you pay yourself, out-of-pocket costs, dental work, vision care, and travel to medical appointments, but not cosmetic procedures or over-the-counter drugs.
  • Insurance premiums paid through your employer's payroll are already pre-tax and cannot be deducted again; only premiums you pay out of pocket count.
  • You report medical deductions on Schedule A (Form 1040) if you choose to itemize instead of taking the standard deduction.

What counts as a deductible medical expense

The IRS allows you to deduct costs you pay directly for diagnosis, cure, mitigation, treatment, or prevention of disease. This includes doctor visits, hospital stays, surgery, prescription medications, and mental health treatment. Dental work—fillings, root canals, crowns, orthodontia—is deductible. Vision care, including eye exams, glasses, and contact lenses, counts. Hearing aids and the cost of fitting them are deductible.

You can also deduct medical equipment and supplies: crutches, wheelchairs, blood pressure monitors, glucose meters, and insulin. If a medical condition requires you to modify your home—installing a ramp, widening doorways, adding a bathroom—those capital improvements can be deductible, though the calculation is complex and depends on whether the improvement adds value to your home.

Travel to receive medical care is deductible. You can deduct mileage at the IRS rate (currently 21 cents per mile for medical travel, though this changes yearly), parking, tolls, and public transportation. If you need someone to drive you because of your condition, their mileage counts too. Lodging while traveling for medical treatment is deductible if the trip is primarily for medical reasons.

Insurance premiums you pay out of your own pocket are deductible: health insurance, dental insurance, vision insurance, and long-term care insurance premiums. If you are self-employed, you can deduct health insurance premiums even without itemizing, but that is a separate calculation and does not count toward the 7.5% threshold for itemized medical deductions.

What does not count as deductible

Cosmetic procedures are not deductible unless they are medically necessary to treat an injury or disease. Teeth whitening, Botox, facelifts, and hair transplants for baldness do not count. Over-the-counter medications and supplements—vitamins, pain relievers, cold medicine, antacids—are not deductible, even if you use them regularly for a chronic condition. The IRS treats these as general health maintenance, not medical treatment.

Health club memberships and exercise equipment are not deductible, even if your doctor recommends exercise. Maternity clothes, although related to pregnancy, are not deductible because they are not medical in nature. Cosmetic dentistry—teeth whitening or veneers purely for appearance—does not count, though orthodontia to correct a bite problem does.

Insurance premiums deducted from your paycheck through your employer's plan are already pre-tax and cannot be deducted again on your return. The same applies to premiums paid through a Health Savings Account (HSA) or Flexible Spending Account (FSA)—those contributions are already tax-free, so you cannot deduct them a second time.

How the 7.5% threshold works in practice

The threshold is calculated on your adjusted gross income, which is your total income minus certain deductions (like contributions to a traditional IRA or student loan interest). You find your AGI on line 11 of Form 1040. Multiply that number by 0.075 to find your threshold.

If your AGI is $40,000, your threshold is $3,000. If you spent $4,500 on medical care during the year, you can deduct $1,500 ($4,500 minus $3,000). If you spent $2,800, you cannot deduct anything because it does not exceed the threshold. The IRS does not round or give partial credit; you must clear the full threshold to deduct anything at all.

This threshold applies to all medical expenses combined in a single tax year. You cannot carry over unused medical expenses from one year to the next. If you have a year with very high medical costs, it may make sense to bunch other deductible expenses (like charitable donations) into that same year to maximize your itemized deduction.

When itemizing makes sense versus taking the standard deduction

Itemizing is only worth doing if your total itemized deductions exceed the standard deduction. For 2024, the standard deduction is $14,600 for single filers, $29,200 for married filing jointly, and $21,900 for head of household. If your medical deduction plus mortgage interest, state and local taxes (capped at $10,000), charitable donations, and other itemized deductions add up to more than these amounts, you itemize. Otherwise, you take the standard deduction.

Many people with medical bills still cannot itemize because their medical costs, even after clearing the 7.5% threshold, do not push their total itemized deductions above the standard deduction. For example, a single filer with $60,000 income, $5,200 in medical bills, and no other deductible expenses would have a medical deduction of only $700 (the amount above the $4,500 threshold). That is far below the $14,600 standard deduction, so they would take the standard deduction instead and get no tax benefit from the medical bills.

If you are close to the standard deduction threshold, you might benefit from timing large medical procedures or donations to cluster them in a single year. Some people alternate between itemizing and taking the standard deduction in different years depending on their medical costs that year.

How to report medical deductions on your tax return

If you decide to itemize, you report medical expenses on Schedule A (Form 1040), which is the itemized deductions form. Line 1 of Schedule A is for medical and dental expenses. You enter your total medical expenses for the year, then subtract 7.5% of your AGI (which you calculate on the form itself). The result is your deductible medical expense amount.

You do not need to attach receipts to your return, but you must keep them for your records in case the IRS asks. The IRS can request documentation for up to three years after you file (or longer if there is suspected fraud). Keep receipts, invoices, insurance statements, and mileage logs organized by category.

If you use tax software, it will walk you through Schedule A and calculate the 7.5% threshold automatically. If you file by hand or with a tax professional, make sure they know about all your medical expenses—including those paid in December for care received earlier in the year, and those paid in January for care received in December of the prior year. The deduction is based on the year you paid, not the year you received the care.

Medical expenses paid through HSAs and FSAs

If you contribute to a Health Savings Account (HSA) or Flexible Spending Account (FSA), those contributions are already taken out of your paycheck before taxes. You cannot deduct those contributions again on your tax return. However, if you pay medical expenses out of pocket beyond what your HSA or FSA covers, those out-of-pocket costs can count toward your medical deduction if you itemize.

HSA contributions are particularly valuable because they are triple tax-advantaged: the money goes in pre-tax, grows tax-free, and comes out tax-free when used for medical expenses. This means you should use your HSA first for medical costs, then deduct any remaining out-of-pocket expenses if you itemize. FSA funds work the same way for tax purposes, though FSAs have a "use it or lose it" rule that HSAs do not.

Frequently Asked Questions

Can I deduct health insurance premiums I pay myself?

Yes, if you pay premiums out of your own pocket for health, dental, or vision insurance, those premiums are deductible medical expenses. However, premiums deducted from your paycheck through your employer are already pre-tax and cannot be deducted again. Self-employed people can deduct health insurance premiums even without itemizing, but that is a separate deduction and does not count toward the 7.5% threshold.

What if my medical expenses are below the 7.5% threshold?

You cannot deduct any amount. The IRS requires your total medical expenses to exceed 7.5% of your adjusted gross income before you can deduct anything at all. If you are close to the threshold, you might consider timing elective procedures or other deductible expenses to a year when your medical costs are higher, so you can clear the threshold and itemize.

Can I deduct over-the-counter medications?

No. Over-the-counter drugs, vitamins, and supplements are not deductible, even if you take them regularly for a chronic condition. The IRS treats these as general health maintenance. Prescription medications are deductible, but you must have a prescription from a doctor.

Do I have to keep receipts for medical deductions?

You do not attach receipts to your return, but you must keep them for your records. The IRS can request documentation if they audit your return, and you will need proof of what you spent. Keep receipts, invoices, insurance statements, and mileage logs organized by year and category.

Can I deduct cosmetic surgery?

Cosmetic procedures are not deductible unless they treat an injury or disease. Cosmetic dentistry like teeth whitening or veneers for appearance only does not count. However, orthodontia to correct a bite problem, or reconstructive surgery after an accident or illness, would be deductible.