What counts as a deductible medical expense

A medical expense deduction lets you reduce your taxable income by the cost of certain health-related expenses you paid out of pocket. The IRS allows you to deduct medical and dental costs that exceed 7.5% of your adjusted gross income (AGI) for the 2024 tax year. This threshold means most people cannot use this deduction unless their medical bills were unusually high.

Deductible expenses include doctor visits, hospital stays, prescription medications, dental work, vision care, hearing aids, and medical equipment like wheelchairs or crutches. You can also deduct the cost of long-term care insurance premiums (within limits), therapy sessions, and travel to receive medical treatment. Cosmetic procedures do not count unless they are medically necessary — for example, reconstructive surgery after an accident or injury qualifies, but elective procedures do not.

Insurance premiums you pay yourself are deductible, but only if you are self-employed or your employer does not offer coverage. If your employer provides health insurance and deducts premiums from your paycheck, those amounts are already pre-tax and cannot be deducted again. Over-the-counter medications are deductible only if you have a prescription for them; vitamins and general wellness products are not.

Key Takeaways

  • You can only deduct medical expenses that exceed 7.5% of your adjusted gross income in 2024, which means most taxpayers cannot use this deduction.
  • Deductible expenses include doctor visits, hospital bills, prescription drugs, dental work, and medical equipment, but not cosmetic procedures or over-the-counter vitamins.
  • You must itemize deductions on Schedule A to claim medical expenses; the standard deduction is larger for most people, so this deduction rarely saves money.
  • Keeping receipts and records for all medical expenses throughout the year is essential, because the IRS may request proof if you are audited.
  • Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) often provide better tax savings than the medical deduction for most households.

The 7.5% threshold and why it matters

The threshold is the barrier that stops most people from using this deduction. If your AGI is $60,000, you can only deduct medical expenses above $4,500 (7.5% of $60,000). If your medical bills total $5,000, you deduct only $500. If they total $4,000, you deduct nothing.

This threshold has been 7.5% since 2013. It applies to all taxpayers equally — there is no special rate for seniors or people with chronic illness. Because the threshold is high, the deduction is most useful for people who had a major health event in a single year: a surgery, a serious illness, or a long hospital stay that pushed their medical costs well above the threshold.

The threshold is calculated using your AGI, not your gross income. Your AGI is your total income minus certain deductions like contributions to traditional IRAs or student loan interest. You can find your AGI on your prior-year tax return, or calculate it by starting with your gross income and subtracting above-the-line deductions.

Itemizing versus taking the standard deduction

To claim medical expenses, you must itemize deductions on Schedule A of your tax return instead of taking the standard deduction. The standard deduction for 2024 is $14,600 for single filers and $29,200 for married filing jointly. You can only use the medical deduction if your total itemized deductions (medical expenses plus mortgage interest, state and local taxes, charitable donations, and other may be able to access items) exceed the standard deduction.

For most households, the standard deduction is larger. A single person would need more than $14,600 in itemized deductions to benefit from itemizing at all. Even if medical expenses exceed the 7.5% threshold, they may not push your total itemized deductions above the standard deduction. This is why the medical deduction helps only a small number of taxpayers.

If you are close to the standard deduction threshold, you might benefit from bunching deductions — timing large expenses (like elective dental work or a planned surgery) in the same year as other deductible expenses to cross the itemization threshold. For example, if you expect $8,000 in medical expenses and $5,000 in charitable donations in 2025, you might schedule a procedure in 2025 to reach $13,000 in itemized deductions, then take the standard deduction in 2026.

What records you need to keep

The IRS does not require you to attach receipts to your tax return, but you must keep them in case of an audit. For each medical expense, save the receipt or invoice showing the date, the provider's name, the service or item provided, and the amount paid. If you paid by check or credit card, that record also serves as proof.

For ongoing treatment or prescriptions, keep a summary showing the total paid in the year. If you drove to medical appointments, you can deduct mileage at the IRS rate for medical travel (21 cents per mile in 2024, but check the current year's rate). Keep a log with the date, destination, and miles driven, or save your GPS or mapping app records.

If you paid for a dependent's medical expenses, you can deduct them even if you do not claim the dependent as a tax dependent, as long as you paid more than half their total support for the year. Keep records showing the relationship and your payment.

HSAs and FSAs as alternatives

A Health Savings Account (HSA) often provides better tax savings than the medical deduction. You contribute pre-tax money to an HSA (up to $4,150 for individual coverage in 2024), use it to pay medical expenses, and the money grows tax-free. Unlike the medical deduction, there is no 7.5% threshold — every dollar you spend counts. You can only open an HSA if you have a high-deductible health plan (HDHP), which your employer or the health insurance marketplace offers.

A Flexible Spending Account (FSA) works similarly: you contribute pre-tax money through your employer's payroll, and use it for medical and dependent care expenses. FSA contributions are limited to $3,300 per year in 2024. The downside is that FSA money does not roll over — you lose what you do not spend by the end of the year (though some plans allow a grace period or a small carryover).

If you have access to an HSA or FSA, these accounts almost always save more money than the medical deduction, because they avoid the 7.5% threshold entirely. Max out your HSA or FSA before considering the medical deduction.

Self-employed and business owners

If you are self-employed, you can deduct health insurance premiums (including dental and vision) as a business expense on Schedule C, separate from the medical deduction. This is often called the self-employed health insurance deduction. You can deduct premiums you paid for yourself, your spouse, and your dependents, up to your net self-employment income.

This deduction is taken above the line, meaning it reduces your AGI before you calculate the 7.5% threshold for other medical expenses. If you are self-employed and have high medical expenses, you may be able to use both the self-employed health insurance deduction and the medical expense deduction on Schedule A.

If you have employees, you cannot deduct your own health insurance premiums as a business expense if you are covered under a group health plan maintained by your business. In that case, the premiums are part of your business income and taxed as such.

State and local tax limits

Medical expenses are deductible on your federal return, but state tax treatment varies. Some states follow federal rules exactly; others have different thresholds or do not allow the deduction at all. If you live in a state with an income tax, check your state's tax guide or contact the state revenue department to learn whether medical expenses are deductible and what the rules are.

The federal SALT (state and local tax) deduction cap of $10,000 per year does not directly affect medical expenses, because medical expenses are claimed separately from SALT. However, if you are close to the standard deduction threshold and itemizing, the SALT cap may limit your total itemized deductions and affect whether itemizing is worthwhile.

Frequently Asked Questions

Can I deduct medical expenses for my adult child?

Yes, if you paid more than half their total support for the year, even if you do not claim them as a dependent. You must have receipts showing you paid the bills. If someone else claims them as a dependent, you still cannot deduct their medical expenses unless you paid over half their support.

What if my employer reimburses me for medical expenses?

You cannot deduct expenses your employer reimbursed. If your employer has a health reimbursement arrangement (HRA) or you receive reimbursement through an FSA, those amounts are excluded from your deductible expenses. Only out-of-pocket costs you paid yourself count.

Does health insurance I bought on the marketplace count?

Premiums you paid for marketplace insurance are deductible only if you are self-employed and have no access to employer coverage. If you received a premium tax credit (subsidy), you cannot deduct the portion the credit covered. You can deduct only the amount you paid out of pocket.

Can I deduct the cost of a gym membership or fitness classes?

No, unless a doctor prescribed them as treatment for a specific medical condition and you have documentation of that prescription. General fitness and wellness expenses are not deductible, even if they improve your health.

What if I had major surgery in December — can I deduct it?

Yes, deduct it in the year you paid the bill, not the year of the surgery. If you paid the surgeon in December 2024, deduct it on your 2024 return. If the bill is not due until 2025, you deduct it in 2025, even if the surgery happened in 2024.