Deductions and Credits · Itemized deductions and QBI

Medical, dental, vision and long-term care expenses

Verification 2026 Verified
tax year · reviewed 2026-08-19 · Draft for I. Ohu review

The floor is a subtraction, not a gate. Expenses are deductible to the extent that they exceed 7.5 percent of adjusted gross income — so a taxpayer who clears the floor deducts only the excess, not the whole amount. Two other features do most of the remaining work: an over-the-counter medicine is not deductible however necessary it is, and a capital improvement to a home can be, even a rented one.

The rule

The allowance and the floor. There is allowed as a deduction the expenses paid during the taxable year, not compensated for by insurance or otherwise, for medical care of the taxpayer, spouse, or a dependent, to the extent that those expenses exceed 7.5 percent of adjusted gross income (IRC § 213(a)).

Whose expenses count. A dependent within § 152, determined without regard to the gross income test, the not-a-dependent-of-another test, and the joint return test (IRC § 213(a)). A person who is not a dependent for exemption or credit purposes may therefore still have their medical expenses paid and deducted.

What medical care means. Amounts paid for the diagnosis, cure, mitigation, treatment or prevention of disease, or for the purpose of affecting any structure or function of the body; for transportation primarily for and essential to that care; for qualified long-term care services within § 7702B(c); and for insurance covering such care, including Medicare Part B premiums (IRC § 213(d)(1)(A)–(D)).

Medicines must be prescribed. An amount paid for medicine or a drug is taken into account only if it is a prescribed drug or is insulin (IRC § 213(b)). This is a bright line and it is not a question of medical necessity.

Lodging, but not meals. Lodging away from home, not lavish or extravagant, primarily for and essential to medical care counts where the care is provided by a physician in a licensed hospital or an equivalent facility, and there is no significant element of personal pleasure, recreation or vacation in the travel (IRC § 213(d)(2)(A), (B)). The amount is capped per night per individual at the figure in the table below. Meals away from home are not mentioned and are not included.

Cosmetic surgery is out, with three exceptions. Medical care does not include cosmetic surgery or similar procedures unless necessary to ameliorate a deformity arising from or directly related to a congenital abnormality, a personal injury resulting from accident or trauma, or a disfiguring disease (IRC § 213(d)(9)(A)). Cosmetic surgery means a procedure directed at improving appearance which does not meaningfully promote the proper function of the body or prevent or treat illness (§ 213(d)(9)(B)).

Long-term care premiums are capped by age. For a qualified long-term care insurance contract, only eligible long-term care premiums within § 213(d)(10) count, on a five-band scale by attained age before the close of the year.

And care from relatives usually does not count. A payment for a qualified long-term care service is treated as not paid for medical care where the service is provided by the individual’s spouse or a relative, unless they are a licensed professional, or by a related corporation or partnership (IRC § 213(d)(11)).

A decedent’s expenses have their own timing rule. Expenses for the decedent’s medical care paid out of the estate within the 1-year period beginning the day after death are treated as paid by the taxpayer at the time incurred (IRC § 213(c)(1)) — unless the amount is allowed as a § 2053 estate tax deduction, which requires a filed statement and waiver to avoid (§ 213(c)(2)).

Current figures

Item	2026
The floor	7.5 percent of adjusted gross income — a permanent figure since Pub. L. 116-260 § 101(a) struck the alternative, with no sunset in the text^TY2026
Whose expenses	the taxpayer, spouse, or a dependent within IRC § 152 determined without regard to the gross income test, the not-a-dependent-of-another test, and the joint return test^TY2026
Medical care	amounts paid for diagnosis, cure, mitigation, treatment or prevention of disease or to affect any structure or function of the body; transportation primarily for and essential to that care; qualified long-term care services; and insurance covering such care^TY2026
Medicines	an amount paid for medicine or a drug counts only if it is a prescribed drug or is insulin — so over-the-counter medicines are outside the deduction however medically necessary^TY2026
Lodging	lodging away from home, not lavish or extravagant, primarily for and essential to medical care, counts where the care is provided by a physician in a licensed hospital or equivalent facility and there is no significant element of personal pleasure — capped at $50 per night per individual^TY2026
Cosmetic surgery	cosmetic surgery is not medical care unless necessary to ameliorate a deformity arising from or directly related to a congenital abnormality, a personal injury from accident or trauma, or a disfiguring disease^TY2026
Long-term care premiums	only eligible long-term care premiums within IRC § 213(d)(10) are taken into account for a qualified long-term care insurance contract, on the age-banded scale^TY2026
Long-term care premium scale	$500 at age 40 or less; $930 above 40 up to 50; $1,860 above 50 up to 60; $4,960 above 60 up to 70; $6,200 above 70 — by attained age before the close of the taxable year^TY2026
Care provided by relatives	a payment for qualified long-term care services is treated as not paid for medical care where the service is provided by the individual's spouse or a relative unless they are a licensed professional, or by a related corporation or partnership^TY2026
A decedent’s expenses	expenses for the decedent's medical care paid out of the estate within the 1-year period beginning the day after death are treated as paid by the taxpayer when incurred — unless allowed as an IRC § 2053 estate tax deduction, which requires a waiver statement to avoid^TY2026
No double benefit	amounts allowed under the dependent care credit provisions are excluded, and an expense deducted elsewhere — including under IRC § 162(l) or paid from a health savings account — cannot be counted again here^TY2026

How it works in practice

Total the qualifying expenses first, then subtract the floor, and quote the difference. The most common client misunderstanding is that clearing 7.5 percent makes the whole amount deductible; the statute says “to the extent that”, and the floor is subtracted from the total rather than being a qualifying condition.

Strip out what is compensated. Amounts reimbursed by insurance, paid from a health savings account, or deducted under § 162(l) as self-employed health insurance are not available again here — the § 213(a) phrase “not compensated for by insurance or otherwise” and the specific bar in § 162(l)(3) both bite. In practice the largest single item on a client’s list is often already covered.

Capital improvements are deductible to the extent the cost exceeds the increase in the value of the property, and where the taxpayer does not own the property there is no value increase to subtract — so a tenant’s ramp or grab rails are deductible in full, subject to the floor. Improvements of a kind that ordinarily do not increase value, such as a ramp or widened doorway, are commonly treated the same way.

For long-term care, two limits apply in sequence: § 213(d)(10) caps the premium by age band, and § 213(d)(11) may disqualify the service payments entirely where the carer is a family member. Both are easily missed on a return that simply totals what was spent on care.

Scenario 1 — clearing the floor and deducting almost nothing

Ruby has adjusted gross income of 96,000 dollars and 8,000 dollars of unreimbursed medical expenses. She tells her preparer she has “cleared the threshold”.

Her floor is 7,200 dollars, so 800 dollars is deductible under IRC § 213(a) — the statute allows the expenses “to the extent that” they exceed the floor. And because her itemized deductions in total may not exceed her standard deduction, that 800 dollars may produce no benefit at all. Clearing the floor and obtaining a deduction are different things, and this is the ordinary case rather than the exception.

Scenario 2 — the tenant's ramp

Sami uses a wheelchair, rents his home, has adjusted gross income of 35,000 dollars, and spends 1,500 dollars on a ramp to the front door plus 3,000 dollars of other unreimbursed medical costs.

The ramp is a capital expenditure whose purpose is to affect a structure or function of the body within IRC § 213(d)(1)(A), and because Sami does not own the property there is no increase in the value of his property to offset against it. The full 1,500 dollars therefore joins the 3,000 dollars, and the 4,500 dollar total is reduced by the 2,625-dollar floor, giving 1,875 dollars. Had he owned the house, the deduction would have been reduced by any increase in its value — though a ramp is a modification that usually adds none.

Scenario 3 — the daughter who gave up work

Tomas pays his daughter 40,000 dollars a year to provide full-time long-term care for him at home. She is not a licensed care professional. He also pays 4,900 dollars in premiums on a qualified long-term care insurance contract; he is 72.

The 40,000 dollars is treated as not paid for medical care by IRC § 213(d)(11), because the qualified long-term care service is provided by a relative who is not a licensed professional. The premiums are medical care, but only to the extent of the eligible long-term care premium for his age band under § 213(d)(10) — so part of the 4,900 dollars is excluded too. Engaging an agency rather than his daughter would have made the care payments deductible; the family arrangement is what disqualifies them.

The floor is subtracted, not satisfied. Section 213(a) allows the excess only.

Prescribed or insulin. Section 213(b) admits no medical-necessity argument for an over-the-counter medicine.

Lodging is capped and meals are absent. Section 213(d)(2) caps lodging per night per person and says nothing about meals away from home.

Long-term care from a relative is generally not medical care under § 213(d)(11), whatever the qualifications or the amount paid.

How this has changed

The floor is now permanent at the lower figure. It moved between 7.5 and 10 percent repeatedly between 2013 and 2020 and was finally fixed by Pub. L. 116-260 § 101(a), which struck the alternative entirely. The current § 213(a) carries a single rate and no sunset — which is unusual among the provisions on this site, most of which now depend on a Revenue Procedure or a temporary extension.

The alternative minimum tax difference disappeared with it. Before 2017 the floor was higher for minimum tax purposes than for regular tax, producing a separate computation; that distinction is gone.

Over-the-counter medicines moved twice. They were excluded from § 213(b) throughout, but the parallel rules for reimbursement from health savings accounts and flexible spending arrangements were narrowed in 2010 and then reopened in 2020. The § 213(b) deduction rule itself never changed — which is why a client whose HSA reimburses an over-the-counter purchase may reasonably think the deduction follows. It does not.

Long-term care insurance came into the section in 1996 by Pub. L. 104-191, and the eligible premium scale in § 213(d)(10) has been indexed ever since. Two provisions added at the same time cut in opposite directions: the premiums became deductible within limits, and § 213(d)(11) removed most family-provided care from the definition entirely.

Exam focus

Expect an arithmetic question where the answer is the excess over the floor. Candidates who quote the full expense have not read “to the extent that”.

Expect an over-the-counter medicine among a list of otherwise deductible items.

Expect a capital improvement, with ownership as the variable — a tenant deducts the full cost, an owner reduces it by any increase in value.

Expect long-term care, either as the age-banded premium cap or as the family-carer disqualification.

Check yourself

1. A taxpayer with adjusted gross income of 80,000 dollars has 7,000 dollars of unreimbursed medical expenses. What is deductible?

Answer: 1,000 dollars. IRC § 213(a) allows the expenses to the extent they exceed 7.5 percent of adjusted gross income, so 7,000 less the 6,000-dollar floor.

2. Are non-prescription pain relievers deductible where a physician recommends them?

Answer: No. IRC § 213(b) takes an amount paid for medicine or a drug into account only if it is a prescribed drug or is insulin, and a recommendation is not a prescription for this purpose.

3. A taxpayer stays four nights near a hospital while a spouse receives inpatient treatment. What is deductible for the lodging?

Answer: Up to the statutory cap per night per individual under IRC § 213(d)(2), provided the care is given by a physician in a licensed hospital or equivalent and there is no significant element of personal pleasure in the travel. Meals are not covered.

4. A taxpayer pays their brother, who is not a licensed carer, to provide qualified long-term care services. Is the payment medical care?

Answer: No. IRC § 213(d)(11) treats a payment for qualified long-term care services as not paid for medical care where the service is provided by a relative who is not a licensed professional.

5. Medical expenses of a decedent are paid by the estate five months after death. Whose deduction are they?

Answer: The decedent’s, treated as paid at the time incurred under IRC § 213(c)(1) because payment fell within the one-year period beginning the day after death — unless allowed as an estate tax deduction under § 2053, which § 213(c)(2) requires be waived by a filed statement.

Change log

2026-08-19Initial draft. Sets out the IRC § 213(a) allowance and its 7.5 percent floor, the modified § 152 dependency test, the § 213(d)(1) definition of medical care with the § 213(b) prescription requirement, the § 213(d)(2) lodging rule and its per-night cap, the § 213(d)(9) cosmetic surgery exclusion, the § 213(d)(10) long-term care premium scale and the § 213(d)(11) related-provider rule, and the § 213(c) treatment of a decedent's expenses.