Medical Expenses You Can Actually Deduct

A set of dentures, a pair of hearing aids, and a few months of physical therapy can add up to more than many retirees spend on groceries in a year. The tax code offers some relief for years like that, but the rules are stricter than most people assume, and the deduction only helps if you clear two separate hurdles. Plenty of taxpayers keep shoeboxes of receipts that will never save them a dime; a smaller group leaves real money on the table because nobody told them what counts.

Here is how the medical expense deduction actually works in 2026, and how to tell which group you are in before you spend hours sorting paperwork.

Hurdle one: the 7.5 percent floor

You can deduct only the portion of your qualified medical and dental expenses that exceeds 7.5 percent of your adjusted gross income, the rule spelled out in IRS Topic 502. If your AGI is $50,000, the first $3,750 of medical costs gets you nothing. Spend $9,000 on qualified care that year and your deduction is $5,250, not $9,000.

Note that the floor is based on expenses you paid during the year, regardless of when the care happened, and only on costs nobody reimbursed. Anything your insurance covered, and anything paid from a health savings account or flexible spending account, is already tax-favored and cannot be counted again.

Hurdle two: you have to itemize

Medical costs go on Schedule A, which means they only matter if all of your itemized deductions together beat the standard deduction. For 2026, the IRS set the standard deduction at $16,100 for single filers and $32,200 for married couples filing jointly, with $24,150 for heads of household, and taxpayers 65 and older get an additional amount on top. Those are high bars. For most households, a big medical year only pays off at tax time when it lands alongside other deductions such as mortgage interest, state and local taxes, or large charitable gifts.

That is why the classic strategy is bunching: when you control the timing of a procedure, scheduling it in the same tax year as other major expenses can push you past both hurdles at once, instead of spreading costs across two years where neither clears the bar.

What counts, according to the IRS

The master list lives in IRS Publication 502, and it is broader than many people expect. Qualified expenses include payments to doctors, dentists, surgeons, chiropractors, psychiatrists, and psychologists; hospital and nursing home care that is primarily medical; prescription drugs and insulin; false teeth, prescription glasses and contacts, hearing aids, crutches, wheelchairs, and guide dogs. Transportation costs that are essential to getting medical care qualify too.

Two categories surprise people most. First, insurance premiums you pay with after-tax money can count, including Medicare Part B premiums and, within age-based dollar limits, premiums for qualified long-term care insurance. Second, home improvements made for a medical reason, such as ramps, grab bars, or widened doorways, can qualify to the extent they do not increase the home’s value.

What does not count

Publication 502 is equally clear about the other side of the ledger. Cosmetic surgery generally does not qualify unless it corrects a deformity or treats disease or injury. Over-the-counter medicines other than insulin are out if you deduct them on Schedule A, as are vitamins and supplements for general health, gym memberships in most cases, nonprescription nicotine products, and funeral or burial costs. Teeth whitening is on the no list; dentures are on the yes list. The dividing line, roughly, is whether the expense diagnoses, treats, or prevents a specific medical condition, or just keeps you generally healthy.

If a specific expense has you guessing, the IRS has a plain-language screening tool in its Interactive Tax Assistant that walks through whether your costs are deductible.

A worked example

Consider a married couple, both 68, with an AGI of $60,000. Their floor is 7.5 percent of that, or $4,500. During the year they paid $4,000 in dental work, $3,500 for hearing aids, $2,600 in Medicare Part B premiums, and $900 in prescription copays: $11,000 total. Their potential deduction is $11,000 minus $4,500, or $6,500. Whether it helps depends on hurdle two: added to their state taxes and other Schedule A items, that $6,500 has to help push them past their standard deduction, including the extra amounts for being over 65, before it changes their bill at all.

Keep the paper, run the numbers

The practical takeaway: track medical spending during any expensive year, because you cannot reconstruct it in April. Ask pharmacies and providers for annual printouts, keep premium statements, and log medical mileage as you go. Then, before you file, do the two-hurdle math or let your preparer or software do it, using the current figures on Schedule A. In an ordinary year the deduction will not apply to most people. In the year of the hip replacement, the memory care bills, or the uncovered dental work, it can be worth thousands, but only to those who kept the receipts.

This article was produced with AI assistance and reviewed by a human editor. Figures are linked to their primary sources; where a claim could not be verified from the public record, we say so.