You can deduct unreimbursed medical expenses on Schedule A (Form 1040), but only the amount that exceeds 7.5% of your adjusted gross income. For most people, that threshold is hard to clear. But in years with major medical costs, knowing the rules and planning strategically can generate real savings.
How Is the Medical Expense Deduction Calculated?
The deductible amount equals your total qualified medical expenses minus 7.5% of your AGI. Only the excess clears the threshold.
Example: Your AGI is $80,000. Your threshold is $6,000 (7.5% x $80,000). You paid $9,500 in unreimbursed qualified expenses. Your deductible amount is $3,500.
If your total itemized deductions (medical expenses above the floor, mortgage interest, state and local taxes up to the $40,000 SALT cap, charitable contributions) exceed the 2026 standard deduction of $15,750 for single filers or $31,500 for married filing jointly, itemizing makes sense.
What Medical Expenses Qualify?
Qualified expenses under IRC Section 213 include:
- Doctor, dentist, and hospital fees
- Prescription medications (not over-the-counter drugs, except insulin)
- Health insurance premiums paid with after-tax dollars (not employer-provided or pre-tax through a cafeteria plan)
- Long-term care services and qualified long-term care insurance premiums, subject to age-based annual limits per IRS Publication 502
- Vision care, eyeglasses, and laser eye surgery
- Hearing aids and batteries
- Mental health treatment and psychotherapy
- Ambulance fees and emergency transport
- Home modifications for a disability such as ramps or widened doorways, limited to the cost above any increase in the home's fair market value
- Medical mileage driven to and from care (verify the current per-mile rate in IRS guidance for 2026)
The core test is whether the expense is primarily for the diagnosis, cure, treatment, or prevention of disease or an ailment affecting a body structure or function.
What Does Not Qualify?
These commonly questioned expenses are not deductible:
- Cosmetic surgery (unless medically necessary to correct a deformity from disease, accident, or congenital abnormality)
- Teeth whitening and most cosmetic dental work
- Gym memberships and health club dues
- Vitamins and nutritional supplements (unless prescribed for a specific medical condition)
- Over-the-counter medications other than insulin
- Maternity clothing
- Diet foods and general weight loss programs (unless prescribed for treating a specific disease)
- Funeral or burial costs
Do HSA or FSA Reimbursements Affect the Deduction?
Yes. Expenses paid or reimbursed by a Health Savings Account (HSA) or Flexible Spending Account (FSA) are already tax-advantaged at the point of contribution. Deducting them again on Schedule A is not allowed. Only out-of-pocket amounts paid personally from after-tax dollars count toward the Schedule A deduction.
Strategies to Maximize the Medical Expense Deduction
Bundle expenses into a single tax year
If your annual medical expenses are consistently close to but below the 7.5% AGI threshold, consider pulling planned procedures into the same tax year. Elective dental work, new glasses, hearing aid fittings, or scheduled surgeries can be timed to push your total above the floor. Bundling in alternate years, sometimes called "bunching," also pairs well with swapping between itemizing and the standard deduction year over year.
Document every qualified expense throughout the year
Many taxpayers lose the deduction not because their costs are too low but because they fail to capture them. Keep receipts, insurance Explanation of Benefits forms, and payment confirmations for every qualified expense. Co-pays, prescription pickups, medical mileage, and after-tax insurance premiums are easy to forget. A simple folder or spreadsheet updated monthly ensures nothing is missed at tax time.
Have questions about medical deductions or whether itemizing makes sense for your situation? Our individual tax team can review your situation and help you decide. Contact TS CPA for a free consultation. We respond within the same day.