Most health expenses are not tax deductible, but some are — and only if you itemize

The short answer: you can deduct certain medical and dental expenses, but only if two things are true. First, your total medical expenses for the year must exceed 7.5% of your adjusted gross income (AGI). Second, you must itemize deductions on your tax return instead of taking the standard deduction. For most people, the standard deduction is larger, so the medical deduction never comes into play.

The IRS treats health expenses differently from other deductions because medical costs are considered personal expenses. The 7.5% threshold exists specifically to exclude routine healthcare spending — the idea is that only unusually high medical bills deserve a tax break. If your AGI is $60,000, you would need medical expenses over $4,500 in a single year to deduct anything at all.

This matters because it changes how you should think about health savings accounts, insurance premiums, and out-of-pocket costs. Some of these reduce your taxes directly. Others reduce your taxable income but only under specific conditions. And some do neither — they straightforward cost money.

Key Takeaways

  • You can only deduct medical expenses if they exceed 7.5% of your adjusted gross income and you itemize deductions instead of taking the standard deduction.
  • may have access to medical expenses include doctor visits, hospital care, prescription drugs, dental work, vision care, and some medical equipment and supplies.
  • Health insurance premiums are deductible only if you are self-employed (as a business expense) or if you paid them while receiving unemployment benefits.
  • Money you contribute to a Health Savings Account (HSA) or Flexible Spending Account (FSA) reduces your taxable income before the 7.5% threshold applies, making these accounts more valuable than the medical deduction for most people.
  • Over-the-counter medications are not deductible unless prescribed by a doctor, and cosmetic procedures are never deductible even if performed by a medical professional.

What counts as a deductible medical expense

The IRS has a long list of medical expenses you can deduct if you meet the 7.5% threshold. These include doctor and dentist visits, hospital stays, surgery, prescription medications, insulin, and medical devices like wheelchairs or hearing aids. You can also deduct the cost of vision care (glasses, contacts, eye surgery), dental work (fillings, crowns, orthodontia), and psychiatric or psychological treatment.

Less obvious expenses also count: transportation to medical appointments (mileage at the IRS rate, or actual taxi and parking costs), lodging if you travel for medical treatment, and certain home modifications made for medical reasons (a wheelchair ramp, grab bars, or a stair lift). You can deduct the cost of a guide dog or service animal, including its food and care. Nursing care, in-home health aides, and assisted living facilities can be deductible if the primary reason you are there is medical care.

What does not count: over-the-counter medications (aspirin, cold medicine, antacids) unless a doctor prescribed them specifically; cosmetic procedures like teeth whitening, Botox, or hair removal; gym memberships or general wellness programs; and most vitamins or supplements unless prescribed for a specific medical condition. Maternity clothes are not deductible, but the cost of childbirth itself is.

Why the 7.5% threshold makes the deduction rare

The 7.5% floor exists because Congress decided that routine medical spending should not reduce your taxes — only catastrophic or unusually high costs should. This means you are only deducting the amount above the threshold, not the whole bill.

Example: if your AGI is $50,000, the threshold is $3,750. If you had $8,000 in medical expenses that year, you can only deduct $4,250 ($8,000 minus $3,750). You would then subtract that $4,250 from your other deductions. If your standard deduction is $13,850 (the 2024 amount for a single filer), you would take the standard deduction instead, and the medical deduction would save you nothing.

For the medical deduction to actually reduce your taxes, your medical expenses must be high enough that your total itemized deductions (medical plus charitable giving, mortgage interest, state and local taxes, and other deductible items) exceed your standard deduction. This happens most often for people with very high medical bills in a single year — a major surgery, extended hospitalization, or ongoing expensive treatment — combined with other large deductible expenses.

Health Savings Accounts and Flexible Spending Accounts work differently

An HSA (Health Savings Account) and an FSA (Flexible Spending Account) are more valuable than the medical deduction for most people because they reduce your taxable income before the 7.5% threshold is calculated. Money you put into these accounts is not subject to income tax or FICA tax (Social Security and Medicare). You then use the account to pay for may have access to medical expenses tax-free.

An HSA is available only if you have a high-deductible health insurance plan. You can contribute up to $4,150 per year (2024) if you have individual coverage, or $8,300 for family coverage. The money rolls over year to year, and you can invest it. An FSA is offered through some employers and lets you set aside pre-tax money for medical expenses, but any money you do not use by the end of the year is forfeited (with limited exceptions).

The advantage: if you put $3,000 into an HSA and spend it on medical care, you have saved the income tax on that $3,000 plus the FICA tax — roughly 25% to 35% depending on your tax bracket. The medical deduction, by contrast, only saves you income tax (not FICA), and only if you itemize and exceed the 7.5% threshold. For most people, an HSA or FSA is the only tax break they will see on medical expenses.

Health insurance premiums and the self-employed

If you are an employee and your employer deducts health insurance premiums from your paycheck, those premiums are already excluded from your taxable income — you do not pay income tax on them. You cannot deduct them again on your tax return.

If you are self-employed, you can deduct health insurance premiums as a business expense on Schedule C (the self-employment income form). This is separate from the medical deduction and does not require you to itemize or meet the 7.5% threshold. You can deduct premiums for yourself, your spouse, and your dependents, as long as you have net self-employment income for the year.

One exception: if you received unemployment benefits during the year, you can deduct health insurance premiums you paid while receiving unemployment, even if you are not self-employed. This deduction goes on your tax return as an adjustment to income, not as an itemized deduction.

Long-term care insurance and nursing home costs

Long-term care insurance premiums are partially deductible as a medical expense if you meet the 7.5% threshold and itemize. The deductible amount depends on your age: in 2024, the limit ranges from $450 per year (age 40 and under) to $3,000 per year (age 71 and older). You can only deduct the premiums you actually paid, up to that age-based limit.

Nursing home and assisted living costs are more complex. If you are in a facility primarily for medical care, the entire cost (room, board, meals, and care) is a deductible medical expense. If you are there primarily for custodial care or because you need help with daily living but do not have a medical condition requiring treatment, only the portion attributable to medical care is deductible — and you will need to separate those costs from the facility's bill.

What you need to document and report

If you itemize and claim medical deductions, keep receipts and invoices for all expenses. The IRS does not require you to attach them to your return, but you must have them if you are audited. For mileage to medical appointments, keep a log showing the date, destination, and miles driven.

You report medical deductions on Schedule A (Itemized Deductions), which you file with your Form 1040. You list your total medical expenses, subtract 7.5% of your AGI, and enter the result on the appropriate line. This amount then becomes part of your total itemized deductions, which you compare to your standard deduction.

For HSA and FSA contributions, your employer or the account administrator will report the amount on your tax documents. HSA contributions you make yourself go on Form 8889. FSA contributions are typically deducted from your paycheck before taxes, so they do not appear on your return — the deduction happens automatically.

Frequently Asked Questions

Can I deduct the cost of my prescription glasses or contacts?

Yes, if you meet the 7.5% threshold and itemize. Eyeglasses, contact lenses, and the cost of eye exams are all deductible medical expenses. Laser eye surgery (LASIK) is also deductible. However, if you buy glasses primarily for fashion or protection rather than vision correction, that portion would not count.

What about dental work like braces or implants?

Dental expenses are deductible medical expenses if you meet the threshold and itemize. This includes routine cleanings, fillings, root canals, crowns, bridges, dentures, and orthodontia (braces). Cosmetic dental work like teeth whitening is not deductible unless it is medically necessary — for example, if whitening is part of reconstructive work after an injury.

If I use an HSA, can I also deduct medical expenses on Schedule A?

No. You cannot deduct the same expense twice. If you paid for something with HSA money, you cannot also deduct it as a medical expense on your tax return. However, if you have medical expenses beyond what your HSA covers, those additional expenses may be deductible if they meet the 7.5% threshold.

Are fertility treatments and adoption expenses deductible?

Fertility treatments (including IVF, medications, and procedures) are deductible medical expenses if you meet the threshold and itemize. Adoption expenses are not deductible as medical expenses, but some adoption costs may be covered by an employer adoption benefit program, which has its own tax rules.

Can I deduct mental health or therapy expenses?

Yes. Psychiatric care, psychotherapy, and counseling are deductible medical expenses if you meet the 7.5% threshold and itemize. This includes both in-person and telehealth sessions. Medications prescribed by a psychiatrist or other doctor are also deductible.