Medical expenses: what counts, and the floor you have to clear

Medical and dental costs are deductible only above a share of your income, and only if you itemize. That combination is why most households get nothing, and why a single expensive year sometimes gets a lot.

The two gates

The first gate is the floor. Schedule A lets through whatever your medical and dental bills come to above 7.5% of adjusted gross income, and nothing below it, so the first slice of every year's spending does nothing for you.

The second gate is itemizing at all. Itemized deductions only help once their total beats the standard deduction, and for most households it does not — standard versus itemized is where that comparison lives. Put the two gates together and you get the practical rule: this deduction works in a year with unusually large bills and unusually low income, and it does very little in an ordinary year.

What counts as a medical expense

The category is defined by what the spending is for. What it costs to diagnose an illness, cure it, treat it, ease it or head it off all counts, and so does spending directed at how some part of the body functions. That takes in what you pay lawful practitioners — physicians, surgeons, dentists and the rest — together with the equipment, supplies and diagnostic devices those purposes call for. The outer limit is drawn by purpose too: the money has to go principally on easing or heading off an illness or a disability, of body or of mind. What merely does you good in a general way, a bottle of vitamins or a restorative week away, falls outside.

Dental work shows how that plays out, and it is what most readers came here to check. What you spend to head off dental disease or to relieve it counts, so a hygienist's cleaning, sealants and fluoride treatments are in on the preventive side, and X-rays, fillings, braces, extractions and dentures are in on the treatment side. Teeth whitening does not count, because it is not treating anything.

What does not count

Health club dues, maternity clothes, nonprescription medicines and nutritional supplements are all outside, as is cosmetic surgery, by which is meant work aimed at appearance that does nothing much for how the body functions and neither prevents nor treats any illness. Two edges are worth knowing. Cosmetic surgery does count where what it corrects is a deformity traceable to a congenital abnormality, to a personal injury from an accident or some other trauma, or to a disease that disfigured the patient. And a controlled substance illegal under federal law stays outside even in a state that has legalized it.

Travel and lodging for care

Getting to the care counts, where the journey is essential to it and made mainly for it, and that includes driving your own car at the medical mileage rate, which for 2025 is 21 cents per mile.

Lodging away from home is the part with conditions attached, and three out of the four is not the rule. All four have to hold. The stay has to be essential to the medical care and taken mainly for it. A doctor has to be delivering that care in a licensed hospital, or somewhere related to one or equivalent to one. The room cannot be lavish or extravagant, judged against the circumstances. And the trip cannot carry any real measure of vacation, recreation or personal pleasure. Only then does the cap apply, at $50 per person per night. Someone traveling with the patient is covered on the same terms, so a parent staying with a sick child doubles that nightly amount between them. Meals away from home are not included, and neither is a journey made to get a change of scene or to feel generally better, even at a doctor's suggestion.

Premiums

Premiums you pay for policies covering medical care are medical expenses. The trap is what comes next: a premium you are already claiming elsewhere, whether as a credit or as some other deduction, cannot be counted here as well — which is exactly where a household with marketplace coverage and a premium tax credit stands. Read your 1095-A before you total anything, and marketplace insurance for 2026 for what changed on that side. Long-term care services and qualifying long-term care insurance can also count, in limited amounts, and Publication 502 carries the detail.

Whose expenses you can include

Your own, your spouse's, and your dependents'. Their dependency has to hold at one of two moments — when the care happened, or when you settled the bill — so an invoice arriving long after the treatment still works.

Then the exception that matters most in practice. Three things that would otherwise disqualify a person are set aside for this purpose alone: gross income of $5,200 or more, a joint return filed for the year, and your own claimability as somebody else's dependent. Any one of those can stop the person being your dependent while still leaving their medical bills on your Schedule A. The usual case is an elderly parent with just enough retirement income to fail the income test and nowhere near enough to meet a care home's fees, and caring for an aging parent works through the rest of it.

Two routes that skip the floor

If you are self-employed, you may be able to deduct health insurance premiums without itemizing and without the floor, working from the Form 1040 instructions and their Self-Employed Health Insurance Deduction Worksheet or, where that worksheet is not available to you, from Form 7206. And a health savings account pays medical costs with money that was never taxed, which beats a deduction most households never reach. One rule joins the two: an expense already reimbursed from such an account cannot also be deducted on Schedule A.