Life changes
Big Medical Expenses This Year? What You Can Deduct
A surgery, a long hospital stay or ongoing care can make medical costs deductible, but only above a floor tied to your income and only if you itemize. Here is how to tell whether it helps you.
Reviewed by LaToya Clark-Thompson, FounderLast updated
How the deduction works
Medical and dental expenses are an itemized deduction on Schedule A. Only the part of your unreimbursed expenses above a floor set as a share of your adjusted gross income counts. And itemizing only helps if all your itemized deductions together (medical, state and local taxes, mortgage interest, gifts to charity) are larger than your standard deduction, which is substantial. In a year with very high medical costs, or a year with lower income, that test can tip in your favor.
Because the floor is based on income, two families with the same bills can get very different results. Our refund calculator gives a quick sense of whether itemizing is likely to win.
What counts as a medical expense
- Doctor, hospital, dental and vision care, including copays and deductibles
- Prescription medicines and insulin (not over-the-counter items, for the itemized deduction)
- Health insurance premiums you paid with after-tax money, including Medicare premiums
- Long-term care premiums, up to an age-based limit, and qualified long-term care services
- Medical mileage, parking and tolls, and lodging for treatment away from home within limits
- Hearing aids, eyeglasses, medical equipment and home changes made for a medical reason (less any increase in the home’s value)
- Costs you paid for a spouse or dependent
Things that do not count include cosmetic procedures, general health items and premiums paid with pre-tax money through payroll.
HSAs, FSAs and insurance reimbursements
Money from a health savings account or flexible spending account already came out tax-free, so expenses paid from it cannot be deducted again. HSA withdrawals arrive on Form 1099-SA and contributions on Form 5498-SA; both go on Form 8889. Insurance reimbursements reduce the deductible amount, and if you deducted a cost one year and were reimbursed the next, the reimbursement may become income.
If you had Marketplace coverage, Form 1095-A and the premium tax credit on Form 8962 affect what you can count as premiums paid. If you are self-employed, health insurance premiums are usually better taken as the self-employed health insurance deduction rather than on Schedule A (see W-2 to 1099).
What to bring and common mistakes
- A list or spreadsheet of medical costs by provider, with amounts you actually paid
- Explanation of benefits statements from your insurer
- Pharmacy printouts for the year
- Forms 1099-SA, 5498-SA and 1095-A if they apply
- Your medical mileage log
- Your SSA-1099 if Medicare premiums were withheld from benefits
Common mistakes: deducting amounts paid from an HSA, counting the billed amount instead of what you paid after insurance, missing Medicare premiums withheld from Social Security, and forgetting mileage to appointments. Medical costs are deductible in the year you pay them, so a payment plan spreads the deduction over the years you pay.
Is it worth a preparer?
If your bills were large, it is worth having someone run the itemized and standard calculations side by side and organize the records. We do that as part of tax preparation, and our tax deduction checklists help you gather receipts beforehand. If medical costs came with a job loss or retirement, see lost a job or retired for the other pieces. If you missed medical deductions on a past return, our free prior-year review can check whether an amendment is worth filing.
Frequently asked questions
Can I deduct medical expenses if I take the standard deduction?
No. Medical expenses are an itemized deduction, so they only help if you itemize on Schedule A instead of taking the standard deduction. Even then, only the unreimbursed amount above a floor tied to your adjusted gross income counts. In years with large medical bills or lower income, itemizing can come out ahead, so it is worth running both ways.
Can I deduct mileage to doctor appointments?
Yes, if you itemize. Driving to medical care counts as a medical expense at the IRS medical mileage rate, or actual gas and oil costs, plus parking and tolls. Keep a simple log with the date, destination and miles. Mileage often adds up to more than people expect when there were regular treatments or a hospital far from home.
Are Medicare premiums tax deductible?
Medicare premiums you pay, including Part B and Part D premiums withheld from Social Security, count as medical expenses for the itemized deduction. Check your SSA-1099, which shows the amount withheld. Self-employed people may be able to deduct Medicare premiums as self-employed health insurance instead, which does not require itemizing.
Can I deduct medical bills I paid for my parent?
You can include medical expenses you paid for a parent if the parent is your dependent, or would be except for the gross income test or because they filed a joint return. The costs must be ones you actually paid. If siblings share support under a multiple support agreement, the one claiming the parent can generally include what they paid.
Not the question you had? The full tax FAQ covers more ground, and our client reviews say what the work is actually like.
Related pages
Supporting a parent
When a parent counts as your dependent, head of household, medical bills and care costs.
Learn moreYou retired
Pensions and IRAs on a 1099-R, required distributions, withholding and SC’s retirement deduction.
Learn moreYou started Social Security
SSA-1099, how much is taxable, withholding with Form W-4V and SC’s exemption.
Learn moreYou lost your job
Unemployment on a 1099-G, severance on a W-2, a cashed-out 401(k) and Marketplace coverage.
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