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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

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Summary

The federal tax code permits a tax deduction for medical and dental expenses you pay for yourself and certain other people once the amount of the expenses reaches a threshold. Think of the threshold like a yearly deductible in a health insurance policy. You have to pay the amount each year before the benefit starts. Once you reach the threshold, acceptable medical expenses decrease your income for tax purposes. The result is that you pay less tax.

Medical expenses which are paid by other people or which are reimbursed by insurance or an employer are not included as medical expenses for purposes of the medical expense deduction.  

The Threshold

No medical or dental expense deductions are allowed unless:

  • The expenses are considered to be medical expenses by the IRS AND
  • The amount of the expenses in a given year are at least equal to ten percent (10%) of your Adjusted Gross Income AND
  • The total of all of your itemized deductions exceeds the amount you can claim as a standard deduction. 
    • For 2019, the standard deduction is
    • $12,200 for individuals; $13,850 for individuals age 65 or up
    • $24,400 for married couples filing jointly.plus$1,300 for each spouse age 65 or older
    • Potential itemized deductions include: 
      • State and local income taxes, or sales tax
      • Real estate and personal property taxes
      • Home mortgage and investment interest
      • Charitable contributions
      • Casualty and theft losses, and
      • Job expenses

Once you exceed the threshhold, you can deduct amounts above the threshhold (not the expenses below the threshold.) 

Definition Of Medical Expenses

The IRS has a long list of expenses it considers to be Medical Expenses. It is worthwhile taking a few minutes to look our article What Expenses Are Medical Expenses For Income Tax Purposes And What Are Not? because there are likely to be expenses you may not think of as an expense for tax purposes. For example:

  • Travel expense to and from a doctor is considered to be a Medical Expense. 
  • Health insurance premiums are deductible if paid for with after-tax dollars. This includes payments for COBRA, and Medicare Parts B and D.
  • Medical care does not have to be provided in the United States. 
  • Drugs from outside the U.S. must be legally approved for import to be considered a medical expense for tax purposes.

A Few Facts About Medical Deductions

  • The key to determining deductibility is whether the expense was related to a specific ailment, and not directed at improving general health or well-being. If the expense is related to general health or well-being, it will not be deductible.
  • Determining whether care is deductible depends on the nature of the services. It does not generally depend on the medical title or qualifications of the person providing the service.
  • An insurance company's determination of whether an expense is reimbursable does not determine whether the expense is tax-deductible. Even if an expense is not reimbursable by an insurer, the expense may still be deductible.
  • Reimbursed expenses are not deductible. If an insurance company partially reimburses you for an expense, the amount you can deduct is limited to the expense you paid minus the amount you were reimbursed.  For example, if the cost of medical care was $2,000 and your insurer reimbursed you $1,500, you can only deduct the difference ($500).
  • Donations made to non-profit groups do not qualify as medical care expenses. They may qualify as charitable donations which are deductible if a threshold is met.  For more about charitable contributions, click here.
  • To be a deductible medical expense, the expense must be reasonable. What's reasonable depends on the situation.To be deductible, a medical expense must be paid with after-tax, out-of-pocket dollars.
  • Medical expenses are normally deductible in the year paid or charged to a credit card.

How To Maximize A Medical Expense Deduction

If you have large enough medical bills one year to meet the threshold, maximize your deduction by paying every medical expense you can during that year for yourself and the people on the IRS list.

If you find that you are coming close to the end of the year, and the medical expenses you paid for do not add up to the minimum required, consider postponing payments until the following year when they may help.

Paperwork

If you include medical expenses in your itemized tax deductions, make sure to save your medical bills and payment statements as proof.  If you have a smart phone, one way to keep track of receipts is to download an app: Expensify. (You take a picture of the receipt with your phone's camera). The app is free.

NOTE:

  • Non-Resident Alien: A medical care deduction is not available for a non-resident alien individual working within the United States.
  • The information in this article is about federal tax. As a general matter, the federal situation is followed on a state level. However, it is worth checking in your state. For example, the threshold in your state may be lower than the federal threshold.  For information concerning the laws in your state or local area, contact your accountant, a tax service or your state revenue agency. Contact information for state revenue agencies can be found at: www.shgresources.com/agencies/revenue/. offsite link

For more information,, see:

The information in this article is not intended to be tax or legal advice. Consult your accountant or lawyer for tax or legal advice.

Research by:

Dexter D.J. Samida, Esq.
Sullivan and Cromwell
New York, NY

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Whose Medical Expenses Can I Include?

In general, deductible medical expenditures are expenses you pay for medical care and dental care for yourself, your spouse, or any other dependent.

A SPOUSE FOR PURPOSES OF DEDUCTING MEDICAL EXPENSES

Spouse includes:

  • person to whom you are legally married other than same sex couples. The Internal Revenue Code does not recognize same sex marriage. 
  • a common law spouse if your state considers you legally married. A common law spouse is a person with whom you co-habit, and you hold out as being your spouse, with whom you did not have a marriage licensed by a government authority. In some jurisdictions, the arrangement must also have gone on for a minimum period of time.

When The Person Must Be A Spouse: Expenses you pay on behalf of your spouse are only deductible if the person is your spouse at the time the expenses are incurred or when they are paid.

Example: In late 2010 Larry is injured in a farming accident and incurs medical expenses. In early 2011, he meets, falls in love with, and marries Katrina. After their marriage is finalized, Katrina pays Larry's medical expenses. Katrina can use these expenses when calculating her medical expense deduction, even if she files her tax return separately from Larry. (Tax deductions are only available in the year the medical expenses are paid. See Does It Matter When I Received The Care Or Purchased The Drug, Or When I Paid I Paid For It?)

Legal Separation: If you are legally separated under a decree of separate maintenance, you are not considered married for purposes of deducting medical or dental expenses paid for the person. 

DEFINITION OF A DEPENDENT FOR PURPOSES OF THE MEDICAL EXPENSE DEDUCTION

A dependent is a  "qualifying child" or a "qualifying relative" (as you will see, a "qualifying relative" does not have to be an actual relative.)

If a person is a child or relative as described in the tax code, there are additional requirements to meet in order to be a qualifying dependent for IRS tax purposes. A dependent for tax purposes must be a U.S. citizen or national or a resident of the United States, Canada, or Mexico, except for an adopted child. For an adopted child, you must be a U.S. citizen or national and the child needs to have been a member of your household during the taxable year.

A "qualifying child" must:

  • Be your son, daughter, stepchild, foster child, brother, sister, stepbrother, stepsister, or a descendant of any of them. For example, your granddaughter or nephew could qualify.
  • At the end of the taxable year, the person also must be:
    • Under age 19.
    • Under age 24 and a full-time student.
    • Or permanently and totally disabled.
  • Have lived with you for more than half of the taxable year and must not have provided over half of his or her own support during the year. The "support" test for a "qualifying child" focuses on the amount of support the child provides for himself or herself (or the amount of support that you and others provide for the child). Example: Krystol and Scott, a married couple, have a daughter named Natasha. At the end of the taxable year, Natasha is 22 and is a full-time student enrolled in art school. She lives with her parents for nine months of the year. She spends the other three months working on an Alaskan fishing boat where she earns 40% of the income she needs to support herself for the year. Natasha is a "qualifying child" since she (a) is under 24 and a full-time student; (b) lives with her parents for more than half the year; and (c) provides less than half of her own support.

Children of Divorced or Separated Parents and Dependents under Mutual Support Agreements: There are special rules for children of divorced or separated parents and for dependents who are supported under a multiple support agreement. To learn more, see IRS Publication 502, Medical and Dental Expenses (Including the Health Coverage Tax Credit). You can get a copy at: www.irs.gov/pub/irs-pdf/p502.pdf offsite link.

A "qualifying relative" includes:

  • A child or a descendant of a child.
  • A brother, sister, stepbrother, or stepsister.
  • The father or mother, or an ancestor of either.
  • A stepfather or stepmother.
  • A son or daughter of a brother or sister of the taxpayer.
  • A brother or sister of the father or mother of the taxpayer.
  • A son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, or sister-in-law.

If your dependent does not fall within one of the above categories, he or she might still be considered a "qualifying relative" if:

  • The person lives with you during the taxable year as a part of your household and this relationship did not violate local law. Thus, the term "relative" is misleading as the dependent need not be related to you.
  • You provided half of his or her support during the taxable year. The support test for a "qualifying relative" focuses on the amount of support you alone provide him or her.

Same-Sex Domestic Partner: The IRS has indicated that a same-sex domestic partner can qualify as a dependent. See, for example, Private Letter Ruling 200108010 [http://ftp.irs.gov/pub/irs-schema/plr_200108010.pdf offsite link]. This letter ruling, however, is not binding on the IRS except with respect to the taxpayer that requested the ruling.

Research by:
Dexter D.J. Samida, Esq.
Sullivan and Cromwell
New York, NY

 

 


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What Is Deductible As A Medical Expense And What Is Not?

The definition of medical expenses for tax purposes is the same whether used with respect to determining if you satisfied the hurdles you need to cross before any deductions are allowed, or to determine whether medical expenses are deductible.

The following alphabetical list of items includes expenses that are considered to be deductible medical expenses, and those that are not. Most of these examples represent the IRS's view on deductibility of the expenses. The IRS's views are accorded significant deference in court ashould be followed unless you have other advice from a tax professional.  For additional information about this subject, see IRS Publication 502 which can be obtained at www.IRS.gov. offsite link Type into the search box: Publication 502.

Abortion: Costs of an abortion are deductible if the abortion is legal in the state in which it is performed.

Acupuncture: Is deductible.

Alcoholism: If medically advised, inpatient treatment for alcoholism is deductible,including the cost of meals and lodging. Similarly, transportation to and from Alcoholics Anonymous meetings is also deductible, if your attendance is recommended by a physician. Donations made to Alcoholics Anonymous or other non-profit groups may be deductible for tax purposes as charitable contributions.

Animals: Deductible medical expenses include the the cost of buying and training the animal, and costs such as food and veterinary expenses if the animal used in the following circumstances:

  • To assist with mental impairments such as depression, panic disorder, and post-traumatic stress disorder.
  • To be used by a visually impaired or hearing-impaired person.
  • To assist people with other physical disabilities.
  • Deductible amounts include the cost of buying the animal, training and care such as food and veterinary expenses.

Unfortunately, no deduction is available for pet ownership that results in general health benefits, such as owning a cat in order to lower blood pressure.

NOTE: If you rent your home and the building has a no-dog or no-pet rule: Under the Americans With Disabilities Act, it is arguable that a person with a life changing condition be allowed to have a dog for emotional support despite the no-dog rule.

Ambulance Service: Is deductible

Artificial Limbs: are deductible

Artificial Teeth: are deductible

Assisted Living Facility: The costs are deductible if:

  • You or your dependent needs help with at least two activities of daily living or you or your dependent are cognitively (mentally) impaired, and
  • A doctor or other licensed medical practitioner certifies that the care is needed for at least 90 days. A doctor or nurse needs to outline a specific plan of care for the patient.

Automobile Insurance Premiums: are not deductible as a medical expense. This includes the part of the premium that goes toward medical payment coverage. See "Insurance", below.

Autoette: See "Wheelchair", below.

Baby Sitting and Child Care:

  • The costs of a babysitter to care for your children so that you can get medical or dental treatment cannot be deducted as a medical expense.
  • Similarly, the cost would not be deductible if the purpose of the babysitter was to enable the caregiver spouse an opportunity to rest, even if the rest was recommended by a medical doctor.
  • A portion may be deductible if the child-care provider also renders nursing services.

Bandages: are deductible 

Birth Control Pills: Deductible only when prescribed by a doctor.

Braille Books and Magazines: The cost that exceeds the cost of regular non-Braille editions is deductible.

Breast Pumps: In a private ruling, the IRS says that breast pumps are not a medical expense despite the many health benefits associated with breast-feeding.

Breast Reconstruction Surgery: The amounts you pay for breast reconstruction surgery following a mastectomy are deductible. For other surgery that could be considered cosmetic, see "Cosmetic Surgery", below.

Capital Expenses: See "Home Improvements", below.

Chiropractor: Deductible

Christian Science Practitioner Fees: Deductible

Coinsurance and Co-Payments: See Insurance, below.

Contact Lenses: In addition to the cost of the lenses, you can include the cost of contact lens insurance and maintenance supplies (such as saline solution or enzyme cleaner).

Controlled Substances (Such As Medical Marijuana or Cocaine): You cannot deduct amounts you pay for controlled substances (such as marijuana) in violation of federal law -- even if use of the substance is legal in your state and prescribed by a doctor.

Cosmetic Surgery: In general, you cannot deduct money for cosmetic surgery. Cosmetic surgery for these purposes is defined as "any procedure which is directed at improving the patient's appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease." Cosmetic surgery is only deductible if "the surgery or procedure is necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease." Also see: "Breast Reconstruction Surgery", above.

CT-Scans: Computerized tomography scans ("CAT Scans") are deductible when obtained for medical reasons.

Crutches: Deductible

Deductibles (Insurance): See "Insurance" below.

Dental Care: Deductible medical expense. Deductible dental care includes fees for x-rays, fillings, extractions and dentures. It des not include cosmetic treatments such as teeth whitening.

Dental Insurance premiums for dental insurance are considered Medical Expense for tax purposes.

Diagnostic Services and Treatments: The cost of devices used to diagnose and treat illness and disease is deductible. Example: Brittany has diabetes. She uses a blood sugar test kit to monitor her blood sugar level. The cost of the blood sugar test kit is deductible.

Disability Insurance Premiums: Deductible. Before you take the deduction, consider whether it is worthwhile. If you don't deduct the premiums, you receive the disability income tax free. Receiving the benefits income tax free should you become disabled is generally far more valuable than any savings you'd realize by deducting the premiums.

Dogs: See "Animals", above.

Drugs: See "Medications", below.

Drug Addiction: You can deduct the amounts you pay for treatment at a therapeutic center, including meals and lodging at the center during your treatment.

Emotional Support Animal: The cost of an emotional support animal may sometimes be deducted. The owner must show that s/he is using the animal primarly for medical care to alleviate a mental disability or illness.

Equipment (For Home)

  • You can deduct the cost of installing and operating equipment if the purpose is to ease specific medical problems. The cost of the equipment is not deductible, however, if it is installed for the promotion of general health and comfort.
  • Home Exercise Equipment is only deductible if ordered by a doctor to treat a medical condition.

Eyeglasses

  • The following eyeglass expenses are deductible as medical expense:
    • Prescription eyeglasses, including contact lenses.
    • The cost of clip-ons if they are required for medical reasons.
    • Fees paid for eye examinations.
  • Not deductible: Non-prescription eyeglasses

Eye Surgery: Amounts paid to treat defective vision-such as laser eye surgery-are deductible.

Fertility Enhancement

  • You can include the cost of in vitro fertilization (including temporary storage of eggs or sperm) and/or surgery to overcome an inability to have children.
  • We do not have information on whether you can include the cost of banking eggs or sperm before radiation or chemotherapy is not a Medical Expense for tax purposes.

Flexible Spending Accounts

  • Pretax paycheck deductions can be made for:
    • Doctors.
    • Medically necessary treatments.
    • Prescription drugs.
    • Over-the-counter medicines even though a medical care deduction would not be available.
  • You cannot include amounts for which you are fully reimbursed by your flexible spending account, if your contributions to the account are taken from your pre-tax earnings.

Founder's Fee: See "Lifetime Care-Advanced Payments" below.

Funeral, Burial, and Cremation expenses: These expenses cannot be included as medical expenses, although they may be deductible for purposes of estate taxes.

Future Medical Care: You cannot include amounts for medical care to be provided beyond the end of the year. For an exception, see "Lifetime Care-Advanced Payments", below.

Gender Reassignment Surgery: Amounts paid for gender reassignment surgery are not deductible.

Gym Equipment: Gym equipment can only be included in medical expense if prescribed by a physician for a specific medical condition. Gym equipment cannot be included if only purchased for your general health.

Gym Membership: Gym memberships can qualify as medical expense in certain circumstances. For example, the expense is a medical expense if you use the gym to treat a disease which has been diagnosed by a doctor AND you would not have spent the money for a gym membership were it not for the illness.  Membership fees do not qualify as medical expense if you use the gym to improve general health and well-being.

Hand Controls: Hand controls and other special equipment installed in a car for the use of a person with a disability is a deductible medical expense.

Health Aide: See "Long Term Care Expenses" and "Nursing Care", below.

Health Club Dues or Expenses: Can only be included as medical expense if part of a prescribed physical therapy program. A recommendation by your physician for your general health is not good enough. NOTE: Many managed care plans reimburse you if you regularly attend a health club with cardio facilities. Check your health plan.

Health Insurance Premiums

  • Premiums you pay for insurance that covers the cost of medical care are medical expenses for tax purposes.
  • If your insurance covers more than one kind of payment, you may deduct the amount charged for medical care if it is reasonable and is separately stated.
  • If you have health insurance through your employer, you may not include any insurance premiums paid by an employer-sponsored health insurance plan unless the premiums are included in the Form W-2 (box 1) that you receive from your employer.
  • If you have a health reimbursement arrangement, medical expenses that are reimbursed by the arrangement cannot be included as medical expenses because they are paid solely by the employer.
  • If you have an individual policy and also qualify for an employer-provided plan, no deduction is allowed, even if you don't use the employer plan.
  • If you are self-employed, it is more advantageous for you to deduct health insurance premiums as an adjustment to income, than as a miscellaneous deduction.

Health Institute (Mental or Physical): Medical expenses include treatment expense to alleviate a mental or physical illness provided in a health institute such as a medical school, when prescribed by a physician.

Health Maintenance Organization (HMO)You can deduct amounts paid to an HMO that entitle you, your spouse, or your dependent to receive medical care from the HMO. These payments are treated as medical insurance premiums. See "Insurance Premiums", below.

Health Savings AccountsYou cannot include as a deductible medical expense any payment or distribution for medical expenses paid from a health savings account.

Hearing Aid: The cost of ahearing aid and its batteries are deductible.

Home Health Aide: The aide's services need to be divided into nursing services and other services.

  • Amounts paid for nursing services are deductible. This includes:
    • Personal-care services if the patient is chronically ill or cognitively impaired. 
    • Related expenses such as meals and employment taxes. (To calculate the deductible amount, divide the food expense among household members to find the cost of the aide's food. Then divide beween time spent on nursing services and time spent on non-nursing services).
  • Amounts paid for a home health aide's time (if any) not relating to nursing services, or for the care of a chronically ill or cognitively impaired person, are not deductible medical expenses.

The aide does not need to be a nurse or a licensed health care provider as long as the services are the kind that would generally be performed by a nurse. This includes services connected with caring for the patient's condition, such as:

  • Giving medication or changing dressings, as well as bathing and grooming the patient.
  • Assistance needed because of the patient's disabilities (including protection from threats to health and safety due to severe cognitive impairment).

NOTE: If a patient is certified by a health care professional as being unable to do at least 2 of the 6 activities of daily living (eating, toileting, transferring, bathing, dressing and continence), and the medical professional approves the care program for the patient, the entire cost of maintenance and personal care services qualifies as a medical expense. Certifying professionals can be a doctor, registered nurse or a licensed social worker.

Home Improvements: If you make a change in your home to accommodate your medical condition or that of your spouse or a resident dependent, ("medically necessary home improvements"), you can deduct the difference between the cost of the change and the increase in the value of your home as a result of the change. You can also deduct:

  • Operating and maintenance expenditures.
  • Appraisal costs to determine the change in the value of your home. [Unable to verify.]

An example of the amount you can deduct with a home improvement: If you install a ramp to permit wheelchair access to your home, and the inclusion of the ramp does not increase the value of your home, you can deduct the entire cost of the ramp. On the other hand, if you install a movable chair to lift you from the first to the second floor that cost $10,000, and it increases the value of your home by $3,000, you can deduct only the difference between $10,000 and $3,000 or $7,000.

In order for improvements to your home to be deductible, they must fit each of the following criteria:

  • Of a medical nature
  • On the advice of a certified physician
  • Used primarily by the patient
  • Built at a reasonable expense.

NOTE: These expenses are deductible only while the condition exists. For example, if someone who suffers allergies is cured by means of immune therapy, the extra cost of running and maintaining an air-filtration system is no longer deductible.

Examples of deductible home improvement expenses are the costs of:

  • Constructing entrance or exit ramps.
  • Widening hallways and interior or exterior doorways for wheelchair access.
  • Adding handrails or grab bars, both in or out of a bathroom.
  • Lowering or making other modifications to kitchen cabinets and equipment.
  • Altering the location of or otherwise modifying electrical outlets and fixtures.
  • Installing porch lifts and elevators.
  • Modifying fire alarms, smoke detectors and other warning systems.
  • Modifying stairs.
  • Modifying hardware on doors.
  • Grading ground to provide access to the residence.

Hospice Expenses: Are includable medical expenses

Hospital Bed: Is deductible if purchased for home use for someone for whom the bed is medically necessary.

Hospital Expenses: 

  • You can include hospital expenses-including amounts for meals and lodging-if a principal reason for your stay is to receive medical care. 
  • Emergency room expenses are deductible.
  • Non-medical personal charges such as TV rentals and telephones are not deductible.

Hospital Policies that pay a guaranteed amount each week for a stated number of weeks if you are hospitalized for sickness or injury premiums are not deductible as medical expense.

Insulin: The cost of the method of ingesting insulin such as syringes, needles and pumps is deductible.

Insurance: See Health Insurance or Dental Insurance above.

Interest: on loans to pay medical or personal expenses is not a deductible medical expense.

Laboratory Tests: Out-of-pocket expenses for laboratory tests which are part of your medical care for which you are not reimbursed, are deductible.

Laser eye surgery (for Vision Correction): Is a medical expense.

Life Insurance Premiums are not deductible medical expenses.

Long-Term Care Insurance Premiums:

  • Self-employed people: Can deduct a percentage of these costs without having to satisfy the 7.5% minimum described.
  • Everyone Else: The premiums that you pay for "qualified" long-term care insurance are deductible up to the amounts per person  set by  the IRS which can vary from y year to year. 

A qualified long-term care contract must meet certain IRS guidelines for the premiums to be deductible, including the following:

  1. The policy must be guaranteed renewable.

  2. The policy cannot have a cash surrender value or any other money that can be paid, assigned, pledged, or borrowed.

  3. The policy must not provide that refunds (other than refunds due to the death of the insured or cancellation of the contracts) and dividends may be used only to reduce future premiums or increase future benefits.

  4. Generally, the policy must not pay or reimburse expenses that would be reimbursed under Medicare.

Loss of Earnings Policies premiums: not deductible.

Loss of life, limb, sight, etc., premiums: not deductible.

Medical Insurance Coverage: The part of your automobile insurance policy that provides coverage for all persons injured in or by your car is not deductible.

Medicare -- see below.

Life Insurance Premiums: Are not deductible medical expenses.

Lifetime Care-Advance Payments

If you pay a monthly or lump-sum fee under an agreement with a retirement home, the portion that is allocable to medical care is deductible. The agreement must require the fee in return for a promise of lifetime care. The retirement home should provide you with information indicating what portion of the fee is allocable to medical care. This information should be based on their past experience or the experience of a comparable facility.

Similar fees paid for care for disabled dependents are deductible if:

  • The payments are for lifetime care
  • Treatment and training of the dependent
  • Are not refundable, and
  • Are a condition of acceptance of the dependent into the program.

Lodging

  • In-hospital lodging is a medical expense to the extent it is not reimbursed or paid for.
  • Lodging obtained while traveling to obtain medical care is a medical expense (see "Transportation", below).
  • You may be able to include some of the cost of lodging while away from home if the lodging is primarily for and essential to medical care. You may also be able to include some of the cost of lodging for a person traveling with you if that person is required for the trip. (For example, a minor may need a guardian to travel with him.)

Long-Term Care Expenses

Qualified long-term care services are deductible. To qualify, the services must be:

  • Necessary,
  • Diagnostic, preventative, therapeutic, curing, treating, mitigating, rehabilitative services, or maintenance and personal care services; and
  • Required by a chronically ill individual; and
  • Provided pursuant to a plan of care prescribed by a licensed health care practitioner.

An individual is "chronically ill", if a licensed health practitioner has certified that within the past 12 months either:

  1. The individual is unable to perform two or more activities of daily living without substantial assistance from another person for at least 90 days. These activities include eating, toileting, transferring, bathing, dressing, and continence.

  2. The individual requires substantial supervision to protect them from harm due to severe mental impairment.

NOTE: If there is an up-front cost for entering a continuing-care facility, a significant part may be deductible as a medical expense. The deductible amount is based on the facility's operating costs that qualifies as a medical expense.

Marijuana: is not deductible as a medical expense for people who use it for health reasons, even in those states which permit use of marijuana for medical purposes.

Mattresses: Are medical expenses when prescribed for the relief of a physical disease or illness.

Meals

  • Meals provided in a hospital or similar institution you are at primarily for obtaining medical care are deductible.
  • Meals you have delivered to a hospital are not deductible.
  • The cost of meals while traveling to obtain health care is not deductible. See "Transportation", below.
  • For the deductibility of special foods, see "Special Diets", below.

Medical Conferences: If you attend medical conferences related to the chronic illness of yourself, your spouse, or your dependent, you can deduct the costs of admission and transportation. The majority of the time at the conference must be spent attending sessions on medical information. The cost of meals and lodging are not considered medical expenses.

Medical Equipment for Use in the Home: See Equipment, above.

Medical Information Plan: You can include in medical expenses, amounts paid to a plan that keeps your medical information so that it can be retrieved from a computer data bank for your medical care.

Medical Savings Accounts: You cannot include amounts you contribute to an Archer MSA, or expenses you pay for with a tax-free distribution from your Archer MSA.

Medical Services: Medical services are deductible medical expenses if they are legal where performed and if they are provided by physicians, surgeons, specialists, or other medical practitioners, such as acupuncturists, psychiatrists, psychologists, dentists, ophthalmologists, optometrists, chiropractors, chiropodists, anesthesiologists, gynecologists, neurologists, obstetricians, dermatologists, pediatricians, podiatrists, osteopaths, and Christian Science practitioners.

Medicare

  • Part A: If you pay premiums for Medicare Part A, they are deductible. However, if you are covered through the payment of payroll taxes those taxes are not deductible.
  • Part B: Even though they may be taken directly out of your Social Security check, premiums paid for Medicare Part B are deductible.
  • Part D: Premiums are deductible.

Medications: The cost of medication is deductible if a prescription is required to buy the medication.

Insulin: is deductible even though you may not require a prescription to purchase it.

Over-the-counter drugs, vitamins and other medical remedies are generally not deductible, even if prescribed by a physician. See "Nutritional Supplements", below.

Drugs from other countries:

  • In general, you cannot include the cost of a prescribed drug brought in (or ordered and shipped) from another country, unless the FDA agrees that the particular drug can be legally imported by individuals. Approval is on a case-by-case basis. Your doctor can request approval by calling the FDA at 301.827.4570. Ask for a Drug Information Specialist. He or she will direct your doctor to the project manager or review division for the particular situation.
  • You can include the cost of a prescribed drug you purchase and consume in another country if the drug is legal both in the other country and in the U.S.

Example: Maryann is traveling in Spain. She falls ill and is prescribed Drug X to treat her illness. She purchases and consumes Drug X. If Drug X is legal in both Spain and the United States, the cost is potentially deductible.

MRIs: Are medical expenses when obtained for medical reasons.

Nursing Home Expenses: Nursing Home expenses, including the costs of lodging and food, are deductible if medical care is the primary reason for being admitted.

Nursing Services (also see Home Health Aide, above)

  • To qualify as medical expense, nursing services do not need to be performed by a nurse as long as the services are of a kind generally performed by a nurse. For example, a home health aide who administers medicines and helps you bathe is providing nursing services, although he or she is not a nurse.
  • The services can be provided in your home or another care facility.
  • If the person also provides personal and household services, you must specify how much they were paid for nursing services, and how much they were paid for household services. The amount paid for household services, such as house cleaning or shopping, does not count as a medical expense.
  • You are allowed to deduct the cost of the nurse's food, and costs for additional household expenses incurred because of the nurse. For example, extra rent or utilities would be potentially deductible if you require a larger apartment in order to provide space for the nurse.

Nutritional Supplements:

Nutritional supplements, vitamins, herbal supplements and natural medicines are generally considered to maintain your ordinary good health, and are not considered medical expenses for tax purposes.

Nutritional supplements can be included as medical expenses if they are recommended by a medical practitioner as treatment for a specific medical condition diagnosed by a physician and not intended to meet normal nutritional requirements. For example, one Revenue Ruling discussed the possibility of a deduction for the cost of whiskey taken to relieve angina pain. If consumed solely for relief of the ailment, not a part of the nutritional needs of the patient, and recommended in writing by a doctor, the cost could be deductible.

Office Visits: In addition to the charges from the medical practitioner, medical expenses include the cost of transportation to and from. See "Transportation", below.

Operations: Are deductible unless done for elective cosmetic surgery. See Cosmetic Surgery, above.

Organ Donor:See "Transplants", below.

Oxygen: Is a medical expense if used for health purposes

PET Scans: When obtained for medical reasons.

Physician's Services: Are medical expenses

Physical Therapy: You can include as medical expense amounts you pay for therapy you receive as medical treatment.

Prepaid Insurance Premiums: Premiums you pay before age 65 for insurance for medical care for yourself, your spouse or your dependents after you reach age 65 are medical care expenses in the year paid if they are:

  • Payable in equal yearly installments or more often; and
  • Payable for at least 10 years, or until you reach age 65, but not for less than 5 years.

Prescription Drugs See "Medicines", above.

Prescription Drug Plans or Insurance: Premiums you pay for these plans are deductible.

Preventive Health Care Treatments: Are medical expenses, including check-ups and flu vaccinations.

Prosthetic Devices: Are medical expenses

Psychiatric Care: Are medical expenses

Psychoanalysis: Is generally deductible. However, you cannot include amounts paid for psychoanalysis that is part of the required training to be a psychoanalyst.

Psychologist: Is a deductible medical expense.

Reimbursements: Any expenses for which the insurance company reimbursed you cannot be deducted. If you itemized the reimbursed expenses as a deduction on a previous year's return, and receive the reimbursement this year, you must report the reimbursement as income.

Service Dog: Veterinary costs for a service dog are deductible medical expenses. So are the amounts paid to purchase and train the dog plus food and grooming.

Special Diets:  Special diets are potentially deductible if they are medically necessary. The deduction is limited to the amount that the cost of the special food exceeds the cost of comparable food. Diet foods and beverages can not be included as they are considered substitutes for food normally consumed. To be deductible:

  • The food must not merely satisfy normal nutritional needs.
  • It must alleviate or treat an illness and
  • The need for the food must be verified by a doctor.

If you wish to claim a deduction for special food, you should carefully document the increased expenses you incur. 

  • Example: Jenna has specific food allergies that cause medical problems. These allergies are alleviated only by an organic food diet. Jenna is allowed to deduct the cost of the diet that exceeds the cost of comparable nonorganic food.
  • Example: Alyssa's doctor has told her that it is medically necessary for her to consume a salt-free diet. She is allowed to deduct the additional charges imposed by a restaurant to prepare her food salt-free. She cannot, however, deduct the cost of renting a kitchen in order to prepare salt-free meals.

Smoking cessation programs or aids: Stop-smoking program expenses are deductible. Amounts paid for drugs that aid in stopping smoking, but do not require a prescription, are not deductible.

Special Education: You can claim amounts paid for tutoring paid to a teacher specially trained and qualified to work with children who have learning disabilities caused by mental or physical impairments. Additionally, you can receive a deduction for a special school if a doctor recommends the school and the primary purpose for attendance is overcoming the learning disabilities. See "Tuition", below.

Sterilization: Vasectomies and tubal ligation are deductible medical expenses.

Teeth (False or Artificial): Are deductible medical expenses, but not the cost of preventive or regular dental care.

Telephone: You can deduct as medical expenses the cost and repair of special telephone equipment for people who are hearing-impaired.

Television: You can include the cost of devices that display the audio part of television programs as subtitles, if you are hearing impaired. Alternatively, you could deduct the increased cost of a specially-equipped television over the same model of regular television.

Therapy: The cost of therapy relating to mental health is deductible, whether it is with a psychiatrist, psychologist or social worker. Therapy such as marriage counseling is not included as a medical expense. For "Physical Therapy", see above.

Transportation in the Area to Obtain Medical Care:

  • Transportation expenses to obtain medical care are deductible. In addition to the costs of getting to your doctor's appointment or treatments, you can deduct the cost of transportation to pick up prescriptions at the pharmacy, to pick up your eyeglasses, or to go to a special treatment center across the country.
  • You can claim the cost of parking and tolls. If you use your own car, during 2017 you can include mileage at the rate of 17 cents per mile.

Travel (Outside of Where You Live)

If the trip is primarily for, and essential to, receiving medical services:

  • Ambulance services. Ambulance services, like all other medical expenses, are limited to those which are reasonable.

  • Actual out-of-pocket auto expenses, such as gas and oil or 17 cents a mile during 2017. You cannot count the cost of depreciation, insurance or general maintenance.

  • Bus, taxi, train, or plane fares.

  • Lodging: The cost of lodging is deductible if it is for essential medical care in a licensed medical care facility. The accommodations must be reasonable (for example, at a Holiday Inn, not a Ritz-Carlton), and there cannot be a significant element of personal pleasure associated with the trip. Lodging expenses are limited to $50 per night per person.
  • Meals: Meals are not a deductible travel expense unless they are provided by the medical care facility as part of the medical care.
  • Parking fees and tolls.
  • Travel costs of any person necessary to travel with the patient, including a parent of a minor. A second parent is unlikely to be considered "necessary" to the procurement of the medical services, and thus it's unlikely it would be deductible (unless the trip falls within the next sentence.) The costs incurred to visit a mentally ill dependent could be deducted if the visits were considered part of the dependent's medical treatment.
  • A trip for general improvement of morale or general improvement of health, even if made on the advice of a doctor, cannot be deducted.
  • Travel for a second or third opinion: There does not appear to be a ruling or precedent. It is believed that if the travel is reasonable, it is includible.
  • Travel outside the United States: Even if the treatment you are seeking is not available in the U.S., the cost of going outside the country for treatment is not deductible.

Transportation for qualified long-term care services is not included in this list.

Transplants: You can deduct any expenses related to care received because you are an organ donor or a possible organ donor, including transportation.

Treatments Outside the United States: Expenses for medical operations or treatments that are illegal in the United States are not deductible medical expenses, even if they are legal in the place where performed.

Tuition

  • For a special school, if the school has special facilities and medical care is received, is a medical expense.
  • If the purpose of attending school is to learn or update your skills to be able to return to work after disability due to your health condition, the expenses may be deductible as a Miscellaneous Expense.
  • Charges for a school health plan are includible if the charges are separately stated or provided by the school.

Vaccinations: Are deductible medical expenses

Vitamins: See Nutritional Supplements, above

Water: Water, other than tap water, may be deductible if prescribed by your physician as a medical necessity.

Weight Loss Programs: Deductible only if it is a treatment a doctor recommends in writing to help a specific ailment, such as high blood pressure or obesity. Without a specific ailment, the treatment would be considered for the benefit of your general health and well-being and thus not deductible.

Wheelchairs, Together with the Cost of Operating and Maintenance: Medical expense provided the wheelchair is used mainly for the relief of an illness or disability and not just to provide transportation to and from work.

Wigs: Are a medical expense if purchased upon the advice of a physician for the mental health of a patient who has lost all of his or her hair from cancer or other disease. An expert tax preparer suggests you ask your doctor to write "wig prosthesis" on the prescription form or his letterhead.

X-Rays Are medical expenses when obtained for medical reasons.

Research by:
Dexter D.J. Samida, Esq.
Sullivan and Cromwell
New York, NY

How Much Can I Deduct?

You can only deduct those medical and dental expenses which, added together for the tax year for which you are filing, the required threshhold of your Adjusted Gross Income.

If your adjusted gross income is recalculated -- because of an audit or amended return, for example -- you will need to recalculate the amount of deduction available. If your income goes up, the deduction goes down.

Example: Richard, age 67, initially calculated his Adjusted Gross Income at $50,000 and had medical expenses of $15,000 related to a soccer injury. His medical expenses exceeded 7.5% of his AGI by $11,250 and therefore were potentially deductible. After an IRS audit, his Adjusted Gross Income was recomputed and now totals $65,000. Because his medical expenses are a smaller percentage of $65,000 than of $50,000, the expenses now exceed 7.5% of his AGI by a smaller amount. The amount he is potentially able to deduct is reduced to $10,250 ($15,000 -- 7.5% of $65,000).

A General Overview Of What Expenses Are Considered To Be Medical Expenses For Tax Purposes

In  general, deductions are available for payments made for "medical care." Medical care includes payments for:

  • The diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body. The deduction is basically for everything that would be covered by health insurance - and more. The deduction does not include expenses for maintaining good health.
  • Transportation for and essential to the types of care listed above.
  • Qualified long-term care services.
  • Insurance premiums for medical care and qualified long-term care.



Frequently Asked Questions

WHAT IF I GET REIMBURSED FOR A MEDICAL EXPENSE? CAN I STILL DEDUCT IT?

No. You are only allowed to deduct expenses that are not covered by your insurance company.

You cannot include:

  • Expenses paid for or reimbursed by an insurance plan.
  • Expenses paid for or reimbursed by an employer.
  • Expenses paid for by anyone else.

This is the case whether payments were made directly to the supplier of the medical care or to you.

Example: Your doctor visit is $150. Of the $150, you pay a $25 co-pay. The insurance company pays the doctor the remaining $125. Only the $25 co-pay is potentially deductible.

Be sure to file all potential insurance claims. Your deduction could be denied if you fail to make a claim when you were eligible for reimbursement.

WHAT IF I RECEIVE MONEY FROM A COURT AWARD OR FROM A SOURCE OTHER THAN A HEALTH INSURANCE POLICY?

  • If you expect compensation for your illness from a court reward, you should make sure your attorney considers how to structure the award. If part of the award is designated for future medical expenses, you cannot claim a deduction for expenses for that illness until they exceed the portion of the award designated for medical expenses.
  • If you receive compensation from other sources such as an accident insurance plan, the general rule is they reduce deductibility to the extent the money is compensation for medical expenses, but do not reduce your medical expenses if the payments are compensation for the disability itself.

WHAT IF I RECEIVE COMPENSATION FOR A MEDICAL EXPENSE DEDUCTED IN A PREVIOUS YEAR?

  • Compensation for medical expenses previously deducted must be included in gross income. If you receive a lump-sum payment, it is considered first allocated to any expenses previously deducted.
  • At least one court has concluded that lump sum awards cannot be allocated to future medical expensesThe IRS has taken the opposite view.

DOES IT MATTER WHEN I RECEIVED THE CARE OR PURCHASED THE DRUG, OR ONLY WHEN I PAID FOR IT?

You can only include medical and dental expenses that you paid for during the tax year. It does not matter when the services were provided. The only thing that matters is when they were paid for.

  • If you pay by check, the day you mail or deliver the check generally is the date of payment.
  • If you use a "pay-by-phone" or "online" account to pay, the date reported on the statement of the financial institution showing when payment was made is the date of payment.
  • If you use a credit card or borrowed money, the date you made the charge is the date of payment. It does not matter when you actually pay the credit card bill or your debt.

WHAT IF I DID NOT CLAIM A MEDICAL EXPENSE IN A YEAR I COULD HAVE?

You can file Form 1040X, Amended U.S. Individual Tax Return for that year. An amended return must be filed within three years from the date the return was filed or within two years from the date the tax was paid.

WHAT IF MY SPOUSE AND I FILE SEPARATE TAX RETURNS?

The answer depends on whether or not you live in a community property state.

  • If you and your spouse live in a non-community property state: Each of you can only include the medical expenses that you each actually paid. Any expenses paid out of a joint checking account are considered to have been paid equally by each of you, unless you can show otherwise.
  • If you and your spouse live in a community property state: Any medical expenses paid out of community funds are divided equally. If the expenses are paid from separate funds, only the spouse who paid the medical expenses can include them.

WHERE DO I TAKE A MEDICAL DEDUCTION?

Medical expense deductions are reported on Form 1040, Schedule A, Itemized Deductions.

 Research by:

Dexter D.J. Samida, Esq.
Sullivan and Cromwell
New York, NY