What Counts as Medical Care

Medical care is defined broadly under the Internal Revenue Code:

• Diagnosis, Treatment, Prevention, and Function: Payments for diagnosis, treatment, or prevention of disease; and for affecting any structure or function of the body (for example, physician and hospital bills; medically necessary dental and vision care; and prescribed therapies) IRC § 213(d)(1).

• Transportation for Medical Care: Transportation primarily for and essential to medical care (including mileage to and from appointments) is explicitly included as medical care IRC § 213(d)(1)(B).

• Medically Necessary Lodging: Lodging up to $50 per person per night when away from home for medically necessary care provided by a physician in a licensed hospital or equivalent medical facility, provided there is no significant element of personal pleasure, recreation, or vacation IRC § 213(d)(2).

• Long‑Term Care and Premiums: Qualified long‑term care services and premiums for qualified long‑term care insurance (subject to age‑based limits) IRC § 213(d)(1)(C); IRC § 213(d)(10).

Insurance Premiums That Qualify

Premiums paid for insurance covering medical care are included in medical expenses. This includes Medicare premiums and other health insurance premiums for medical and hospital care, as well as qualified long‑term care insurance (subject to statutory limits) IRC § 213(d)(1)(D).

Timing: When an Expense Is “Paid” and How Reimbursements Affect the Deduction

Only expenses actually paid during the taxable year are deductible—regardless of when the medical incident occurred or your accounting method. Payment date is generally when you mail or deliver a check, when your financial institution shows payment for pay‑by‑phone/online transactions, or when a charge posts to your credit card. If an insurer reimburses you, or a plan pays the provider, you cannot deduct that reimbursed portion. The regulations emphasize that deductions are confined to amounts paid during the year and reduced for insurance or other reimbursements Treas. Reg. § 1.213-1(a).

• Special Rule for Decedents: If the decedent’s estate pays medical expenses for the decedent within the one‑year period beginning the day after death, those costs may be treated as paid by the decedent when the services were provided—allowing them on the decedent’s final return (if not taken on the estate’s return) IRC § 213(c).

Whose Expenses You Can Include

You can include medical expenses you paid for yourself, your spouse, and your dependents, provided the person was your spouse or dependent when the services were provided or when you paid the expenses. IRS Publication 502 explains special situations, such as children of divorced or separated parents: a child may be treated as the dependent of both parents for medical deduction purposes if statutory custody and support criteria are met, allowing each parent to deduct amounts they paid for the child’s care (notwithstanding which parent claims the dependency exemption) Publication 502 (2024).

Little‑Known Eligible Costs (and Important Limitations):

Smoking‑Cessation Programs and Prescribed Cessation Drugs

Amounts paid for a smoking‑cessation program are deductible medical expenses, as are prescribed drugs designed to alleviate nicotine withdrawal. However, nicotine gum and patches that don’t require a prescription are not deductible as medical expenses (unless insulin)—reflecting the statutory rule that only prescribed drugs or insulin qualify as medicine under the medical deduction Rev. Rul. 99‑28; IRC § 213(b).

Condoms Treated as Medical Care

The Treasury and IRS have established a safe harbor treating amounts paid for condoms as medical care under § 213(d). Amounts paid for condoms qualify as medical care for deduction purposes (subject to the 7.5% AGI threshold and the rule against double‑counting if reimbursed by a tax‑favored plan) Notice 2024‑71; see also Instructions for Form 8889 noting this safe harbor Instructions for Form 8889 (2024).

Nutritional Counseling, Special Foods, Gym Memberships, and Therapy

• Nutritional Counseling: Deductible only if it treats a specific disease diagnosed by a physician (for example, obesity or diabetes). Otherwise, it’s not deductible IRS FAQ on nutrition and wellness.

• Special Food and Beverages: May be deductible only if (1) they don’t satisfy normal nutritional needs; (2) they alleviate or treat a diagnosed illness; and (3) a physician substantiates the need. Deduct only the cost that exceeds normal food cost IRS FAQ on nutrition and wellness.

• Gym Memberships: Deductible only if purchased for the sole purpose of affecting a structure or function of the body (for example, a physician‑prescribed plan of physical therapy to treat an injury) or the sole purpose of treating a specific disease diagnosed by a physician. General health and fitness do not qualify IRS FAQ on nutrition and wellness.

• Therapy: Deductible if it is treatment for a disease (for example, psychotherapy for a diagnosed mental illness). Marriage counseling or general wellness counseling is not IRS FAQ on nutrition and wellness.

Capital Improvements to Your Home for Medical Care

You may deduct the cost of home improvements whose primary purpose is medical care (for example, constructing entrance or exit ramps; widening doorways; installing handrails; modifying bathrooms), but only to the extent the cost exceeds any increase in the home’s value. If an improvement does not increase the property’s value, the full cost may be deductible. Publication 502 provides examples and explains the “cost minus value increase” calculation Publication 502 (2024).

Guide Dogs and Other Service Animals; Accessibility Aids

The cost and care of a guide dog or other service animal aiding a person with a physical disability are medical expenses. Publication 502 also notes special accessibility costs such as the extra cost of Braille books and magazines above standard editions can be included in medical expenses Publication 502 (2024).

Alcohol and Substance Use Disorder Treatment; Medically Advised Recovery Support

Inpatient treatment for alcohol addiction—including meals and lodging provided by the facility—qualifies as medical expenses. Transportation to and from alcohol recovery support organization meetings (for example, AA) may be deductible if competent medical advice indicates that membership is necessary to treat a disease involving excessive alcohol use Publication 502 (2024). Similarly, treatment for drug‑related substance use disorder is medical care IRS FAQ on nutrition and wellness.

Prescription Drugs, Insulin, and OTC Items

Only prescribed drugs or insulin count as medical expenses under the itemized medical deduction; non‑prescription drugs generally do not (even if recommended). This is a statutory limitation under § 213 IRC § 213(b).

• Important Distinction for HSAs/FSAs: Under separate rules governing HSAs, FSAs, Archer MSAs, and HRAs, OTC medicines and menstrual care products may be reimbursed—even without a prescription—but amounts paid or reimbursed by one of these plans generally cannot also be deducted on Schedule A. Publication 969 and IRS guidance outline these reimbursements and the prohibition against “double‑dipping” Publication 969 (2024).

Cosmetic Surgery Exclusion and the Disease/Disfigurement Exception

Cosmetic surgery and similar procedures are not medical expenses unless necessary to ameliorate a deformity arising from or directly related to a congenital abnormality, personal injury from accident or trauma, or disfiguring disease. The statute defines cosmetic surgery and sets this “medical necessity” exception IRC § 213(d)(9). IRS guidance confirms that breast reconstruction surgery following a mastectomy and laser eye surgery to correct defective vision are medical expenses, while purely cosmetic teeth‑whitening is not Rev. Rul. 2003‑57.

Personal Expenses That Are Not Deductible

General personal, living, and family expenses are not deductible unless expressly allowed in the Code. Examples include typical household costs, commuting, and general wellness expenditures not directed at treating or preventing disease. The regulations reaffirm that personal and household costs are nondeductible unless they meet specific statutory medical criteria Treas. Reg. § 1.262-1.

Avoiding Double‑Counting and Coordinating With Reimbursements

If medical expenses are reimbursed (for example, by insurance, HSA, FSA, or another plan), you may not deduct the reimbursed amount. The deduction is for uncompensated amounts only. The regulations show how to net reimbursements against payments and provide examples of calculating the allowable deduction Treas. Reg. § 1.213-1(a). HSAs, FSAs, Archer MSAs, and HRAs can be excellent tools to pay for qualified medical costs, including some items that aren’t deductible on Schedule A (like certain OTC products), but reimbursements generally preclude also taking a medical itemized deduction. Publication 969 explains these plan rules and common reimbursements Publication 969 (2024).

Documentation and Best Practices

• Recordkeeping: Keep detailed records for all medical payments (date paid, amount, provider, medical purpose, and whether reimbursed). The regulations emphasize “actually paid” timing and reducing for reimbursements Treas. Reg. § 1.213-1(a).

• Travel and Lodging: For transportation and lodging, document mileage, travel dates, and medical appointment details to support that travel was primarily for and essential to medical care and meets the lodging criteria IRC § 213(d)(1)(B); IRC § 213(d)(2).

• Targeted Treatments: For nutritional counseling, therapy, special foods, and gym memberships, keep physician diagnoses and written substantiation showing the expense treats a specific disease, and calculate the incremental cost over normal consumption where required IRS FAQ on nutrition and wellness.

• Home Improvements: Retain contractor invoices and any valuation documentation to determine whether the improvement increased property value; deduct only the portion of cost exceeding any value increase Publication 502 (2024).

Key Takeaways

• The medical expense deduction allows itemizers to deduct qualified medical costs exceeding 7.5% of AGI. Deductible medical care is defined broadly but must be primarily to prevent or alleviate disease and cannot include general personal expenses IRC § 213(a); Treas. Reg. § 1.262-1.

• Timing matters: deduct only amounts actually paid during the year, net of reimbursements. Special rules apply for medical expenses paid by an estate within one year of death Treas. Reg. § 1.213-1(a); IRC § 213(c).

• Under‑the‑radar eligible costs include smoking‑cessation programs and prescribed cessation drugs; condoms; medically necessary nutrition and therapy; transportation and limited lodging; capital improvements for medical care; service animals; and some accessibility expenses—subject to strict qualification criteria and documentation Rev. Rul. 99‑28; Notice 2024‑71; IRS FAQ on nutrition and wellness; IRC § 213(d); Publication 502 (2024); Publication 969 (2024).

By applying the statutory definitions, timing rules, and special eligibility criteria—and maintaining thorough documentation—you can maximize legitimate medical deductions while avoiding common pitfalls like double‑counting reimbursed expenses or claiming general wellness costs that don’t meet the medical care standard IRC § 213; Treas. Reg. § 1.213-1; Treas. Reg. § 1.262-1.