Medical bills are deductible only if you itemize deductions and your total medical expenses exceed a threshold set by the IRS

Most people cannot deduct medical bills because the standard deduction is larger than their itemized deductions would be. But if your medical expenses are very high in a single year — and you itemize instead of taking the standard deduction — you can deduct the amount that exceeds 7.5% of your adjusted gross income (AGI). This threshold applies to the 2024 tax year and may change in future years.

The IRS defines deductible medical expenses narrowly. Cosmetic surgery, teeth whitening, and gym memberships do not may have access to. Prescription medications, insulin, and doctor visits do. The rules also cover some expenses people do not always think of as medical: travel to receive treatment, medical equipment, and certain long-term care premiums.

Key Takeaways

  • You can only deduct medical expenses if you itemize deductions on Schedule A, and only the amount above 7.5% of your adjusted gross income counts.
  • Deductible expenses include doctor visits, hospital stays, prescription medications, medical equipment, and travel to receive treatment, but not cosmetic procedures or over-the-counter wellness products.
  • If you are self-employed, you may deduct health insurance premiums as a business expense on Form 1040 instead of itemizing, which is usually more valuable.
  • Medical expenses paid by insurance, Medicare, or Medicaid do not count toward the deduction because you did not pay them yourself.
  • You must keep receipts and statements from providers to prove the expenses you claim, and the IRS may request documentation years after you file.

How the 7.5% threshold works

The threshold is a floor, not a ceiling. You subtract 7.5% of your AGI from your total medical expenses, and only the remainder is deductible. If your AGI is $60,000 and your medical expenses are $8,000, you can deduct $3,500 ($8,000 minus $4,500, which is 7.5% of $60,000). If your medical expenses are $4,000, you cannot deduct any of them because $4,000 is below the threshold.

This threshold has been 7.5% since 2013. Congress set it there and has not changed it, though proposals to raise it appear regularly. The threshold applies to all taxpayers equally — there is no separate rule for older adults or people with chronic illness.

What counts as a deductible medical expense

The IRS publishes a list in Publication 502. Deductible expenses include doctor and dentist visits, hospital stays, surgery, prescription drugs, insulin, medical equipment (crutches, wheelchairs, hearing aids), eyeglasses and contact lenses, psychiatric care, and physical therapy. You can also deduct the cost of travel to receive treatment: mileage to a doctor's office, airfare to a specialist in another state, or lodging near a hospital during treatment.

Long-term care insurance premiums are partially deductible, but the amount depends on your age. In 2024, someone age 40 or younger can deduct up to $530 in premiums; someone age 71 or older can deduct up to $3,360. These limits change yearly.

Expenses that do not count include cosmetic surgery (unless it is reconstructive surgery after an injury or illness), over-the-counter medications like aspirin or cold medicine, teeth whitening, gym memberships, vitamins, and most weight-loss programs. Marijuana is not deductible even in states where it is legal, because federal law still classifies it as a controlled substance.

Itemizing versus the standard deduction

To claim medical deductions, you must file Schedule A and itemize your deductions instead of taking the standard deduction. The standard deduction for 2024 is $14,600 for single filers and $29,200 for married couples filing jointly. If your total itemized deductions (medical expenses above the threshold, plus state and local taxes, mortgage interest, and charitable donations) exceed the standard deduction, itemizing saves you money.

Most taxpayers take the standard deduction because it is larger. You itemize only if you have high medical expenses, high state and local taxes, a large mortgage, or substantial charitable donations. A tax professional can calculate both scenarios for you to see which is larger in your specific situation.

Self-employed health insurance deduction

If you are self-employed, you can deduct health insurance premiums on Form 1040 as a business expense, separate from itemizing. This deduction is often more valuable than itemizing because it reduces your income before the 7.5% threshold is applied. You can deduct premiums for yourself, your spouse, and your dependents, but only if you have net self-employment income for the year. You cannot deduct more than your net profit.

This deduction appears on Form 1040 line 21 (or the equivalent line in the year you file). It does not require Schedule A and does not compete with the standard deduction, so you can use it even if you take the standard deduction instead of itemizing.

Expenses paid by insurance, Medicare, or Medicaid

You can only deduct medical expenses you paid out of your own pocket. If your health insurance, Medicare, or Medicaid paid the bill, that amount does not count. If you paid a copay or coinsurance, only your share counts — not the amount the insurance company paid.

This rule applies even if you paid the provider directly and the provider later billed your insurance. What matters is who ultimately paid the bill. If the insurance company reimbursed you after you paid, you can deduct what you paid, but you must subtract the reimbursement.

Record-keeping and IRS documentation

Keep receipts, invoices, and statements from all providers for at least three years after you file, though the IRS can request documentation for up to seven years in some cases. The IRS does not require you to attach receipts to your return, but you must have them if the IRS asks. A receipt should show the date, the provider's name, the service or item provided, and the amount you paid.

For mileage to medical appointments, keep a log with the date, destination, and miles driven. The IRS allows a standard mileage rate for medical travel; for 2024, it is 21 cents per mile. You can deduct either the mileage or your actual expenses (gas, parking, tolls), but not both.

Frequently Asked Questions

Can I deduct medical expenses my spouse paid if we file jointly?

Yes. When you file a joint return, you combine both spouses' medical expenses and compare the total to 7.5% of your combined AGI. It does not matter which spouse paid the bills — only that you file jointly and have the receipts to prove the expenses.

What if I paid medical bills in one year but the service was in another year?

The year you paid is what counts for the deduction, not the year you received the service. If you paid a hospital bill in December 2024 for surgery in January 2024, you deduct it in 2024. This timing can matter if your expenses are close to the threshold.

Can I deduct medical expenses for my adult child or parent?

You can deduct medical expenses you paid for anyone you could claim as a dependent, even if you did not actually claim them on your return. The rules for who qualifies as a dependent are strict — generally, the person must live with you for the entire year and you must provide more than half their support. If your adult child or parent does not meet these rules, their medical expenses are not deductible on your return.

Does the medical expense deduction explore to state taxes too?

Most states follow federal rules, but some have different thresholds or allow deductions only for certain types of expenses. Check your state's tax instructions or speak with a tax professional about your state's specific rules.

What if my medical expenses were very high because of a one-time event like surgery?

A single large expense can push you over the 7.5% threshold in one year even if your medical expenses are normally low. Some people bunch medical procedures into one year to exceed the threshold, then take the standard deduction in other years. This strategy works only if you can control the timing of the expenses.