Most health expenses are not tax deductible, but some are if you itemize

The IRS lets you deduct medical and dental expenses, but only if two things are true: you itemize deductions on your tax return instead of taking the standard deduction, and your total medical expenses exceed 7.5% of your adjusted gross income (AGI) for the year. For most people, the standard deduction is larger, so itemizing does not help. Even if you do itemize, you can only deduct the amount that exceeds that 7.5% threshold.

This means if your AGI is $60,000, you can only deduct medical expenses above $4,500. If your total medical costs for the year were $5,000, you could deduct only $500. The threshold is high enough that most households never reach it unless they face a major illness, surgery, or ongoing treatment.

Key Takeaways

  • You can only deduct medical expenses if you itemize deductions and your total medical costs exceed 7.5% of your adjusted gross income.
  • Deductible expenses include doctor visits, dental work, prescription medications, medical equipment, and some travel costs to receive treatment.
  • Health insurance premiums are generally not deductible on your personal tax return, though self-employed people can deduct them as a business expense.
  • Over-the-counter medications and cosmetic procedures do not count as deductible medical expenses.
  • You must keep receipts and records for every expense you claim, and the IRS may request documentation.

What counts as a deductible medical expense

The IRS has a specific list of what qualifies. Deductible expenses include visits to doctors, dentists, optometrists, and mental health providers; prescription medications and insulin; medical equipment like crutches, wheelchairs, or hearing aids; hospital stays and surgery; physical therapy and rehabilitation; and lab tests and X-rays. Dental work including cleanings, fillings, root canals, and orthodontia all count.

You can also deduct some costs related to treatment: mileage to and from medical appointments (at a rate set by the IRS each year), lodging if you travel out of state for medical care, and certain home modifications made for medical reasons, such as installing a wheelchair ramp or grab bars. Nursing care and in-home health aides are deductible if they provide medical care rather than general household help.

Cosmetic procedures do not count unless they are medically necessary. Teeth whitening, most plastic surgery, and gym memberships are not deductible. Over-the-counter medications like aspirin or cold medicine are not deductible, though prescription versions of the same drugs are.

Health insurance premiums and what you cannot deduct

Premiums you pay for health insurance through your employer are usually taken out before taxes, so you do not deduct them again. If you buy insurance on your own through the marketplace, those premiums are not deductible on your personal return unless you are self-employed. Self-employed people can deduct health insurance premiums as a business expense, which is different from itemizing medical deductions.

Long-term care insurance premiums are partially deductible, but the amount depends on your age and changes each year. The IRS publishes the limits annually. Supplemental insurance like accident or disability coverage is not deductible.

Expenses that do not count include cosmetic surgery, teeth whitening, vitamins and supplements (unless prescribed by a doctor for a specific condition), weight loss programs, and most fertility treatments. Childcare, even if needed because you are receiving medical treatment, does not count.

How to track and report medical expenses

Keep every receipt, invoice, and explanation of benefits (EOB) from your insurance company. The IRS does not require you to attach receipts to your return, but you must have them if the agency asks. Organize expenses by category and by month so you can calculate your total accurately.

When you file, you will need your total medical expenses for the year. If you use tax software, it will walk you through the itemization process and calculate whether itemizing saves you money compared to the standard deduction. If you work with a tax preparer, give them a complete list of expenses with supporting documents.

If you received reimbursement from an insurance company or employer health plan for any expense, you cannot deduct that same expense. Only deduct the amount you actually paid out of pocket after insurance paid its share.

When itemizing makes sense for medical expenses

Itemizing is worth considering if you have high medical costs in a single year, such as a major surgery, extended hospital stay, or ongoing treatment like dialysis or chemotherapy. It also makes sense if you have other deductible expenses beyond medical costs—such as mortgage interest, property taxes, or charitable donations—that together exceed the standard deduction.

For 2024, the standard deduction is $14,600 for single filers and $29,200 for married couples filing jointly. If your medical expenses plus other itemizable expenses add up to more than these amounts, itemizing will lower your taxable income. A tax preparer can run the numbers both ways to show you which approach saves more.

If your medical expenses are close to the threshold but do not quite exceed it, you might consider timing large expenses across two tax years if possible. For example, if you are planning elective surgery, scheduling it in a year when you already have other medical costs might push you over the 7.5% threshold.

Frequently Asked Questions

Can I deduct health insurance premiums I pay myself?

Not on your personal tax return if you buy insurance through the marketplace or directly from an insurer. If you are self-employed, you can deduct premiums as a business expense. If you are unemployed and receiving unemployment benefits, you may be able to deduct premiums paid during that time.

What if my employer reimburses me for medical expenses?

You cannot deduct expenses your employer paid for or reimbursed. Only deduct the amount you paid out of pocket. If your employer offers a health savings account (HSA) or flexible spending account (FSA), contributions and withdrawals for medical expenses are already tax-free, so you do not deduct them separately.

Do I have to itemize to use an HSA or FSA?

No. HSAs and FSAs are separate from itemization. Money you contribute to these accounts is not taxed, and withdrawals for medical expenses are not taxed. You can use an HSA or FSA whether you itemize or take the standard deduction.

Can I deduct dental work and vision care?

Yes. Dental visits, cleanings, fillings, root canals, and orthodontia are all deductible. Vision care including eye exams, glasses, and contact lenses counts. Hearing aids and related care are also deductible.

What mileage rate do I use for medical travel?

The IRS sets a standard mileage rate for medical travel each year. For 2024, it is 21 cents per mile. Keep a log of dates, destinations, and miles driven. You can deduct either the mileage or actual expenses like gas and parking, but not both.