The medical expense deduction is one of the oldest lines on the tax code and one of the least used, because it is built with a floor under it. Nothing counts until your costs pass 7.5% of adjusted gross income, and even then the deduction only matters if the total of everything you itemize beats your standard deduction.
That makes it a bad-year deduction. In a normal year it does nothing. In the year of a hospitalization, a long stretch of after-tax premiums, or a nursing home, it can be one of the largest lines on a return. Everything below was verified against IRS publications and revenue procedures on September 6, 2026, with each figure labeled by tax year.
The 7.5% Floor, With Real Numbers
IRS Publication 502 for 2025 states it directly: generally, you can deduct on Schedule A only the amount of your medical and dental expenses that is more than 7.5% of your AGI. The 2025 Instructions for Schedule A carry the identical rule, and IRS Tax Topic 502, last updated May 20, 2026, says the same. The threshold was made permanent in law and applies to tax year 2025 and tax year 2026 alike.
Work an example for tax year 2025. Take a married couple filing jointly with AGI of $80,000.
| Step | Amount |
|---|---|
| Adjusted gross income | $80,000 |
| 7.5% floor (line 3 of Schedule A) | $6,000 |
| After-tax insurance premiums paid | $8,400 |
| Hospital, dental and prescription costs | $5,600 |
| Total medical expenses (line 1) | $14,000 |
| Deductible medical expense (line 4) | $8,000 |
That $8,000 goes on Schedule A, line 4, and then joins state and local taxes, mortgage interest and charitable gifts. For tax year 2025 that couple needs the whole itemized column to beat $31,500 before any of it saves a dollar, and for tax year 2026 the bar is $32,200 under Revenue Procedure 2025-32. Reverse the same couple’s costs to $5,000 of medical expenses and the deduction is zero, because $5,000 never reaches the $6,000 floor.
The floor moves with income, which is the part people miss. Lower AGI, lower floor. A year with a business loss or a big above-the-line deduction is also a year the medical deduction gets easier.
What Counts Under Section 213(d)
Publication 502 defines medical expenses as the costs of diagnosis, cure, mitigation, treatment, or prevention of disease and for the purpose of affecting any part or function of the body, including equipment, supplies and diagnostic devices needed for those purposes. It then draws the line: expenses must be primarily to alleviate or prevent a physical or mental disability or illness, and they do not include expenses that are merely beneficial to general health.
| Qualifies | Does not qualify |
|---|---|
| Doctors, dentists, surgeons, psychiatrists, psychologists, osteopaths, chiropractors | Health club, gym or spa dues, and clubs organized for pleasure or recreation |
| Inpatient hospital care, including meals and lodging | Cosmetic surgery, including face lifts, hair transplants, electrolysis and liposuction |
| Prescription drugs and insulin | Nonprescription drugs, with insulin the only exception |
| Eyeglasses, contact lenses, hearing aids, wheelchairs, crutches | Toothbrushes, toothpaste and other ordinary personal items |
| After-tax insurance premiums, including Medicare Part B and Part D | Premiums paid pre-tax through an employer cafeteria plan or reimbursed by an HRA |
| Qualified long-term care services and premiums within the age caps | Household help, even when a doctor recommends it |
| Medical transportation, at 21 cents a mile for 2025 plus parking and tolls | Commuting to work, even if your condition requires unusual transportation |
| A wig bought on a physician’s advice after hair loss from disease | Teeth whitening, diaper service, dancing and swimming lessons |
| Special education tuition when overcoming a learning disability is the primary reason | Nutritional supplements and vitamins, unless a practitioner prescribes them for a diagnosed condition |
| Guide dogs and other service animals, including food and vet care | Veterinary fees generally, funeral expenses, surrogacy expenses |
| Weight-loss treatment for a disease diagnosed by a physician, such as obesity | Weight loss for appearance or general well-being, and diet food or beverages |
Two boundaries do a lot of work in that table. Cosmetic surgery flips to deductible when it is necessary to improve a deformity arising from a congenital abnormality, an accident or trauma, or a disfiguring disease. Weight-loss and nutritional-supplement costs flip when a physician has diagnosed a specific condition rather than treating general health.
Publication 502 also caps qualified long-term care insurance premiums by age. For tax year 2025 the Schedule A instructions and Publication 502 both list $480 at age 40 or under, $900 for 41 to 50, $1,800 for 51 to 60, $4,810 for 61 to 70, and $6,020 at 71 or older, and Revenue Procedure 2024-40 sets the same figures. Revenue Procedure 2025-32 lifts them to $500, $930, $1,860, $4,960 and $6,200 for tax year 2026. More detail in is long-term care insurance tax deductible, and the dental side is in are dental expenses tax deductible.
Whose Expenses You Can Include
Publication 502 says you can generally include expenses you paid for yourself and for someone who was your spouse or your dependent either when the services were provided or when you paid for them. The timing choice is generous on purpose. A spouse’s pre-marriage treatment that you paid for after the wedding still counts.
For dependents, the person must have been a qualifying child or a qualifying relative, and a U.S. citizen or national or a resident of the United States, Canada or Mexico. Then comes the rule that quietly opens the door for adult children and aging parents. You can include expenses you paid for an individual who would have been your dependent except that the person had gross income of $5,200 or more in 2025, filed a joint return for 2025, or that you yourself could be claimed as someone else’s dependent.
Two special cases are worth knowing.
A person you support with siblings. Under a multiple support agreement, if you are the one treated as providing more than half of a qualifying relative’s support, you can include the medical expenses you paid for that person. Publication 502’s own example: four siblings each provide a quarter of a parent’s support, one pays all the medical bills and is repaid three-quarters by the others, and that sibling can include only the one-quarter they actually bore. If instead the siblings split the nonmedical support and one sibling separately pays all the medical bills, that sibling can include the full unreimbursed amount.
Children of divorced or separated parents. For the medical deduction only, a child can be treated as the dependent of both parents, and each parent can include the medical expenses they pay, provided custody, support and separation conditions are met. This is one of the rare places where both households get a piece.
The Timing Rule: Year Paid, Not Year Billed
Publication 502 says you can include only the medical and dental expenses you paid this year, and generally not payments for care you will receive in a future year. Three practical translations:
- Credit card. Include the expense in the year the charge is made, not when you pay the balance. Charging a December surgery keeps it in the earlier tax year even if you pay the card off over the following spring.
- Check. The day you mail or deliver the check is the date of payment. For an online or pay-by-phone account, the date on the financial institution’s statement controls.
- Prepayment. Paying ahead for care substantially beyond year end generally does not count, with narrow exceptions for lifetime care contracts and qualified long-term care insurance.
If a payment plan is spreading a bill across two tax years, that timing decides which return each dollar belongs to. Structuring the plan is covered in medical bill payment plans.
You also have to net out reimbursements. Publication 502 says you can include only amounts for which you received no insurance or other reimbursement, and that includes payments from Medicare. If a policy reimburses only some of your bills, you still reduce your total medical expenses by everything you received from it.
Schedule A Mechanics
The reporting is four lines and rarely takes long.
- Line 1. Total medical and dental expenses paid during the year, net of reimbursements, and net of any premiums covered by the premium tax credit.
- Line 2. Your AGI from Form 1040, line 11.
- Line 3. Multiply line 2 by 7.5%.
- Line 4. Subtract line 3 from line 1. If line 3 is more than line 1, enter zero.
Two lines that never touch Schedule A. Premiums already excluded from wages under a Section 125 cafeteria plan are not deductible again, which is the single most common error and is covered in is health insurance tax deductible. And the Form 7206 instructions say not to include the self-employed health insurance deduction amount when figuring your Schedule A medical deduction, though any premiums that deduction could not absorb can be added back to Schedule A.
Impairment-related work expenses are a separate and better path for people with disabilities. Publication 502 says those are a business deduction and are not subject to the 7.5% limit at all, reported on Schedule C, E or F for the self-employed or through Form 2106 for employees.
The Bottom Line
Two hurdles, in order: 7.5% of AGI, then the standard deduction. For tax year 2026, Revenue Procedure 2025-32 and IR-2025-103 put that second hurdle at $16,100 single, $24,150 head of household and $32,200 married filing jointly, with an extra $1,650 per condition for being 65 or older or blind, or $2,050 if unmarried and not a surviving spouse. The comparable 2025 figures are $15,750, $23,625 and $31,500, with $1,600 or $2,000 for age and blindness. The IRS had not published tax year 2027 inflation adjustments as of September 6, 2026.
If you are close to the line, bunching helps. Elective procedures, a year of dental work, and prepaid-in-December bills all land in whichever tax year you actually pay them, so concentrating them into one year can carry an entire itemized column over the top.
Before you count on the deduction, though, work on the number itself. A charity care approval or a negotiated discount is worth more than a deduction on the same bill, because it removes the cost rather than shaving a fraction of it. Start with hospital charity care and prescription assistance programs. This page explains the rules, not your return. For your own numbers, work from the IRS instructions for your tax year or use a preparer.