The Pub. 502 Medical and Dental Expense Deduction

Internal Revenue Service Publication 502 provides guidance on deducting costs for medical and dental care. This itemized deduction, claimed on Schedule A (Form 1040), offers tax relief for individuals with significant healthcare costs. The deduction is for unreimbursed medical expenses that exceed 7.5% of a taxpayer’s adjusted gross income (AGI). Publication 502 defines what qualifies as a medical expense, whose expenses can be included, and how to calculate the final amount.

Determining Whose Expenses Qualify

A taxpayer can include medical expenses they pay for themselves, their spouse, and their dependents. The rules for a spouse and dependents have specific timing and relationship requirements.

Your Spouse

You can include medical expenses you paid for your spouse. To qualify, you must have been married either when your spouse received the medical services or when you paid for them. If you pay medical expenses for a deceased spouse in the year of their death or afterward, you can include them on your tax return for the year you paid them.

Your Dependents

You can include medical expenses you paid for a dependent, which can be a qualifying child or a qualifying relative. These classifications involve specific tests related to relationship, age, residency, and financial support, which are detailed in IRS Publication 501.

A special rule allows you to include medical expenses for a person who would have been your dependent except that they earned more than the gross income limit, filed a joint return, or could be claimed as a dependent by another taxpayer. This provision applies if you provided more than half of their total support for the year.

Identifying Deductible Medical Expenses

Deductible medical expenses include the costs of diagnosing, curing, mitigating, treating, or preventing disease. The payments must be for treatments that affect a body part or function and are intended to alleviate or prevent a physical or mental illness. Expenses that are only for general health, such as vitamins, are not deductible.

Fees to Medical Professionals

Payments for services from a wide range of healthcare practitioners are includible. This includes fees paid to physicians, surgeons, dentists, specialists, chiropractors, osteopaths, and podiatrists. Mental health services are also covered, allowing for the deduction of payments to psychiatrists, psychologists, and other licensed therapists. Payments to an acupuncturist for a specific medical condition and fees for Christian Science practitioners are also deductible.

Hospital and Institutional Care

The costs of inpatient care at a hospital are deductible, including room, board, and nursing services. If the main reason for being in a hospital, nursing home, or similar institution is to receive medical care, the entire cost of meals and lodging is included. This also applies to inpatient treatment at a center for alcohol or drug addiction. If an individual is in a nursing home for personal reasons, only the portion of the cost for direct medical care is deductible.

Prescription Medications and Equipment

The cost of prescription drugs, insulin, and over-the-counter medicines are deductible. You can also include the cost of equipment, supplies, and diagnostic devices needed for medical purposes. Examples of deductible items include:

• Hearing aids and batteries
• Artificial limbs
• Eyeglasses and contact lenses
• Crutches and wheelchairs
• Blood sugar test kits
• The cost and maintenance of service animals, such as a guide dog

Transportation Essential to Medical Care

You can include amounts paid for transportation that is primarily for and essential to medical care. This includes fares for taxis, buses, trains, or ambulances. It also covers out-of-pocket expenses for your car, such as gas and oil. You can use the actual costs or a standard medical mileage rate. For 2024 and 2025, the rate is 21 cents per mile.

The cost of lodging while away from home for medical care can also be deductible if the lodging is at a licensed hospital or a similar medical care facility. The amount is limited to $50 per night for each person, including for a person traveling with the individual seeking care.

Common Non-Deductible Expenses

Publication 502 lists several expenses that are not deductible. Cosmetic surgery is not deductible unless it is necessary to improve a deformity from a congenital abnormality, an injury, or a disfiguring disease. Expenses for general health, such as nutritional supplements or health club dues, are also disallowed unless recommended by a doctor to treat a specific diagnosed medical condition. Other non-deductible items include toiletries and funeral expenses.

Calculating Your Medical Expense Deduction

Calculating your deduction is a multi-step process based on your AGI. The deduction is only for the portion of expenses that exceeds a set threshold.

First, total all your qualifying medical expenses for the year. This total should only include costs not paid for by other sources. You cannot include expenses reimbursed by insurance or paid using funds from a Health Savings Account (HSA), Flexible Spending Arrangement (FSA), or Health Reimbursement Arrangement (HRA).

Next, determine your AGI for the tax year from your Form 1040 and multiply it by 7.5%. This result is your threshold, and only expenses exceeding this amount are deductible.

The final step is to subtract the 7.5% AGI threshold from your total unreimbursed medical expenses. The result is your medical expense deduction. If your total expenses are less than the threshold, you do not have a deduction for that year.

Required Documentation and Reporting

Claiming the medical expense deduction requires diligent record-keeping. The IRS requires you to maintain proof of your expenses in case your return is selected for an audit. You do not need to submit these records with your return, but you must have them available if requested.

You should keep comprehensive records, including:

• Receipts and invoices from all medical providers
• Explanation of Benefits (EOB) statements from your insurance company
• A logbook showing dates, mileage, and the purpose of any medical-related travel
• Copies of prescriptions

The medical expense deduction is an itemized deduction, which means you must file Schedule A (Form 1040) with your tax return. This requires you to forgo the standard deduction. You should only itemize if your total itemized deductions—including medical expenses, state and local taxes, and mortgage interest—exceed the standard deduction amount for your filing status.