Medical expenses are deductible only if they exceed a threshold, and only if you itemize rather than take the standard deduction

You can deduct may have access to medical and dental expenses on your federal tax return, but only under specific conditions. The IRS allows the deduction only for expenses that exceed 7.5% of your adjusted gross income (AGI) in the tax year you're claiming them. You must also choose to itemize deductions on Schedule A rather than claim the standard deduction — and for most people, the standard deduction is larger, so the medical deduction rarely saves money.

The threshold changes your math entirely. If your AGI is $60,000, you can only deduct medical expenses above $4,500. If your expenses total $5,000, you deduct $500. If they total $4,200, you deduct nothing. This is why medical deductions matter most to people with very high medical costs or very low income in a particular year.

Key Takeaways

  • Medical expenses must exceed 7.5% of your adjusted gross income before any amount becomes deductible.
  • You must itemize deductions on Schedule A to claim medical expenses; the standard deduction is larger for most filers and blocks this deduction entirely.
  • may have access to expenses include insurance premiums, doctor and dentist visits, prescription drugs, medical equipment, and travel to medical appointments, but not cosmetic procedures or general wellness items.
  • If you're self-employed, you may deduct health insurance premiums separately as a business expense, which does not require itemizing and has no income threshold.

What counts as a deductible medical expense

The IRS publishes a detailed list in Publication 502. Deductible expenses include health insurance premiums (including Medicare premiums and long-term care insurance), copays and coinsurance, prescription medications, dental work, vision care, hearing aids, crutches, wheelchairs, and home modifications required for medical reasons (like a wheelchair ramp or bathroom grab bars). You can also deduct the cost of traveling to medical appointments — mileage at the IRS rate, parking, tolls, or airfare if you travel out of state for treatment.

Expenses that do not count include cosmetic procedures (unless medically necessary, like reconstructive surgery after injury), general health club memberships, vitamins and supplements (unless prescribed by a doctor for a specific condition), over-the-counter medications (except insulin), and procedures or treatments that are purely elective or for appearance. Teeth whitening, for example, is not deductible. Orthodontia is, because it corrects a medical condition.

How to calculate the deduction

Start with your adjusted gross income (AGI) — the number on line 11 of Form 1040. Multiply it by 0.075. That is your threshold. Add up all your may have access to medical expenses for the year. Subtract the threshold from the total. The result is your deductible amount, but only if it is greater than zero.

Example: AGI is $50,000. Threshold is $50,000 × 0.075 = $3,750. Your medical expenses total $6,200. Deductible amount is $6,200 − $3,750 = $2,450. You can deduct $2,450, but only if you itemize on Schedule A and only if your total itemized deductions exceed the standard deduction for your filing status.

Itemizing versus the standard deduction

The standard deduction for 2024 is $14,600 for single filers and $29,200 for married filing jointly. If your itemized deductions (medical expenses plus mortgage interest, property taxes, charitable donations, and state income taxes) total less than the standard deduction, you receive no benefit from the medical deduction. The IRS will not let you claim both.

You itemize only when it saves you money. If your medical expenses are $2,450 but you have no other deductions, you are better off taking the standard deduction of $14,600. If your medical expenses are $2,450 and you also paid $15,000 in mortgage interest and property taxes, your total itemized deductions are $17,450, which exceeds the standard deduction, so you itemize and claim the medical portion.

Self-employed health insurance deduction

If you are self-employed, you can deduct health insurance premiums (including Medicare premiums and long-term care insurance) directly on Schedule C or Schedule SE, separate from itemized deductions. This deduction has no income threshold — you do not have to exceed 7.5% of anything. You also do not have to itemize to claim it. This is one of the few tax breaks that favor self-employed people over W-2 employees.

The deduction covers premiums you pay for yourself, your spouse, and your dependents. It does not cover copays, coinsurance, or other out-of-pocket costs — only the insurance premium itself. If you have a net loss in your business for the year, you cannot deduct more in health insurance than your net profit.

Dependent care and medical savings accounts

If your employer offers a Flexible Spending Account (FSA) or Health Savings Account (HSA), you can set aside pre-tax money for medical expenses. Money you contribute to an FSA or HSA is not subject to income tax or payroll tax, which is often more valuable than the itemized deduction. You use the account to pay for the same may have access to expenses listed in Publication 502.

An FSA is "use it or lose it" — money you do not spend by the end of the year (or a short grace period) is forfeited. An HSA rolls over year to year and can be invested like a retirement account. If you have an HSA, you should use it before claiming a medical deduction, because the tax savings are usually larger. Money you spend from an HSA or FSA cannot also be deducted on your tax return.

Records you need to keep

The IRS does not require you to attach receipts to your return, but you must keep them for your records in case of an audit. For each expense, save the receipt or invoice showing the date, the provider's name, the service or item, and the amount paid. For mileage to medical appointments, keep a log with dates, destinations, and miles driven. For insurance premiums, keep the statements or 1098-T forms your school or insurer sends.

If you are audited and cannot produce receipts, the IRS will disallow the deduction. Receipts should be kept for at least three years, though the IRS can go back further if it suspects fraud. Digital copies are acceptable.

Frequently Asked Questions

Can I deduct medical expenses my insurance company reimbursed me for?

No. You can only deduct expenses you actually paid out of pocket. If your insurance company reimbursed you, subtract the reimbursement from the expense before adding it to your total. The IRS does not allow double recovery.

What if I paid medical bills for my adult child or parent?

You can deduct medical expenses you paid for anyone you could claim as a dependent, even if you did not claim them that year. You can also deduct expenses for your spouse. You cannot deduct expenses for an adult child unless they meet the dependent test (usually income under $4,700 and you provide more than half their support).

Does long-term care insurance count?

Yes, but only up to a limit. The IRS sets an annual cap on how much long-term care insurance premium you can deduct — for 2024 it varies by age, ranging from $450 to $3,200. Check Publication 502 for the exact limit for your age. Amounts above the cap do not count.

Can I deduct the cost of my gym membership if my doctor recommended it?

No. General health club memberships are not deductible even with a doctor's recommendation. However, if you install medical equipment at home (like a hot tub prescribed for a specific condition), the cost of that equipment may be deductible. The recommendation alone is not enough.

What if I had a very high medical year and then recovered?

You can only deduct expenses in the year you paid them. If you had $20,000 in medical expenses in 2024 but only $1,000 in 2025, you claim the deduction only in 2024. You cannot carry forward or back unused medical expenses to other years.