Can You Write Off Medical Expenses Not Covered by Insurance?

You can write off medical expenses not covered by insurance on your federal return, but only the unreimbursed portion that exceeds 7.5% of your adjusted gross income, and only if you itemize deductions on Schedule A instead of taking the standard deduction.¹ For most households, the 7.5% floor is the real hurdle. If your AGI is $80,000, more than $6,000 in qualifying costs has to pile up before a single dollar starts reducing your tax.

How the 7.5% AGI Floor Works

Your AGI is your total income minus adjustments like student loan interest and retirement contributions, before any standard or itemized deduction. It sits on line 11 of Form 1040. Take that number, multiply by 7.5%, and everything you paid out of pocket up to that amount is absorbed by the floor.

A worked example makes it concrete. Suppose your AGI is $100,000 and you paid $25,000 in unreimbursed medical bills during the year. Your floor is $7,500. Subtract that from $25,000 and you get $17,500, which is what actually lands on Schedule A as a deduction.² The first $7,500 does nothing for your taxes.

The floor scales with income, which means higher earners have to spend more before the deduction opens up. Someone with a $200,000 AGI needs to clear $15,000 in medical costs. Someone at $50,000 clears the floor at $3,750. The deduction is built to relieve disproportionately heavy medical spending, not routine healthcare bills.

Is Itemizing Even Worth It?

The medical deduction only exists for filers who itemize. For 2026, the standard deduction is $16,100 for single filers and $32,200 for married couples filing jointly.³ Your medical deduction only helps if it, combined with your other itemizable expenses, beats those numbers.

Here’s where plans fall apart. You might have $8,000 in medical costs above the AGI floor, but if your mortgage interest, state and local taxes, and charitable gifts only add up to another $5,000, your $13,000 in itemized deductions falls short of the single filer’s standard deduction. Taking the standard deduction leaves you better off, and the medical write-off goes unused. Before committing to Schedule A, add up every itemizable expense you have.

What Counts as an Unreimbursed Medical Expense

The IRS defines medical expenses broadly: costs for diagnosing, treating, preventing, or curing disease, or for affecting any part or function of the body.⁴ Qualifying costs include:

Fees paid to doctors, dentists, surgeons, psychiatrists, psychologists, chiropractors, and other licensed practitioners
Inpatient hospital care and residential nursing home stays when the primary purpose is medical treatment
Prescription drugs and insulin (over-the-counter medications generally don’t qualify unless prescribed)
Hearing aids, eyeglasses, contact lenses, wheelchairs, crutches, and service animals for people with disabilities
Health, dental, and vision insurance premiums you pay yourself, out of pocket — premiums paid by an employer or deducted from your paycheck pre-tax don’t count⁴
Premiums on tax-qualified long-term care policies, subject to age-based annual caps
Transportation to and from medical appointments, including parking, tolls, and mileage at the 2026 standard medical rate of 20.5 cents per mile⁵

Only the amounts you actually bore count. If your insurer paid part of a bill and you paid the rest, only your portion is deductible.⁴ Expenses paid with funds from a Health Savings Account, Flexible Spending Account, or Health Reimbursement Arrangement are also excluded, because that money already received a tax benefit when it went into the account.⁶

What Doesn’t Count

Cosmetic surgery is out unless it corrects a deformity from a congenital abnormality, an injury, or a disfiguring disease.⁴ A nose job for looks fails; reconstructive surgery after an accident qualifies.

General wellness spending fails the test too. Vitamins, supplements, gym memberships, and health-oriented trips are not deductible unless a physician prescribed a specific item to treat a diagnosed condition.⁷ Toiletries, cosmetics, and toothpaste are always excluded. The line the IRS draws separates treating a specific medical problem from generally feeling better.

Whose Medical Bills You Can Include

You aren’t limited to your own costs. You can deduct qualifying expenses you paid for your spouse, your dependents, and people who would qualify as dependents except for income or filing status technicalities.² The person needs to have been your spouse or dependent either when the services were provided or when you paid the bill.

That second group matters more than most filers realize. If an adult child or aging parent would meet the dependency tests but earned slightly too much gross income, filed a joint return, or could be claimed by someone else, you can still deduct medical costs you paid on their behalf.

Divorced or separated parents get a separate rule. A child of divorced or separated parents is treated as a dependent of both parents for medical expense purposes, no matter which parent claims the child on their return. Each parent deducts the costs they personally paid, provided the child lived with one or both parents for more than half the year and got more than half of their support from the parents.²

When a Payment Counts, and the Bunching Strategy

Medical expenses are deductible in the year you pay them, not the year you received care.² Surgery in December 2025 that you settle in January 2026 goes on your 2026 return. For a check, the payment date is when you mail or deliver it. For a credit card charge, the date of the charge counts, even if you carry the balance for months.⁷

That credit card rule opens up planning space. If you’re close to the 7.5% floor late in the year, charging an upcoming expense in December instead of paying cash in January pulls it into the current tax year. This is the logic behind bunching: concentrating elective procedures, dental work, new glasses, and other controllable costs into one year gives you the best shot at clearing the floor. Splitting the same costs across two years often leaves you under the threshold in both.

The reverse works too. If your income spiked this year, delaying discretionary medical spending until next year, when your AGI and floor will likely be lower, can produce a bigger deduction.

A Separate Path for the Self-Employed

Self-employed filers get a more useful deduction for health insurance premiums that skips both the 7.5% floor and the itemizing requirement. Under federal law, self-employed individuals can deduct premiums for medical, dental, vision, and qualified long-term care insurance as an above-the-line adjustment to income.⁸ The deduction reduces AGI directly, and you can take it even while using the standard deduction.

It covers premiums for you, your spouse, your dependents, and your children under age 27, whether or not the children qualify as dependents. Sole proprietors, partners with net self-employment earnings, and shareholders owning more than 2% of an S corporation can all use it.⁹

Two limits apply. The deduction can’t exceed your net self-employment earnings from the business that established the plan.⁸ And you can’t claim it for any month in which you were eligible to participate in a subsidized employer plan through your own job or your spouse’s. Anything you couldn’t take above the line can still go on Schedule A with your other medical expenses if you itemize.⁴

How to Claim the Deduction

Medical expenses go on Schedule A (Form 1040). Enter total qualifying expenses on line 1, your AGI on line 2, and the form runs the 7.5% calculation. The remainder feeds your total itemized deductions, which flows to Form 1040 and reduces taxable income.⁴

Self-employed filers use Form 7206 to calculate the premium deduction, then report it on Schedule 1 (Form 1040), line 17.⁹ Because that deduction reduces AGI before Schedule A’s 7.5% calculation runs, taking it also lowers the floor for any remaining medical expenses you want to itemize. If you’re self-employed and have significant medical costs beyond premiums, running the numbers both ways is worth the time.

Records to Keep

Hold onto every receipt, provider statement, and Explanation of Benefits document. The records should show the name and address of the provider, the amount paid, the date of payment, and what the payment covered.² EOB statements from your insurer are particularly useful because they lay out what the insurer paid and what you owed.

For medical travel, keep a mileage log showing the date, destination, and miles for each trip. You can claim either your actual gas and oil costs or the 2026 standard medical mileage rate of 20.5 cents per mile, plus parking and tolls in either case.⁵

Retain supporting documents for at least three years after filing, which is the standard period during which the IRS can assess additional tax.¹⁰

1
Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses
2
Internal Revenue Service. Publication 502 – Medical and Dental Expenses
3
Internal Revenue Service. IRS Releases Tax Inflation Adjustments for Tax Year 2026, Including Amendments From the One, Big, Beautiful Bill
4
Internal Revenue Service. Topic No. 502, Medical and Dental Expenses
5
Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate at 72.5 Cents Per Mile
6
Internal Revenue Service. Frequently Asked Questions About Medical Expenses Related to Nutrition, Wellness and General Health
7
Internal Revenue Service. Publication 502 Medical and Dental Expenses
8
Office of the Law Revision Counsel. 26 USC 162 – Trade or Business Expenses
9
Internal Revenue Service. About Form 7206, Self-Employed Health Insurance Deduction
10
Internal Revenue Service. How Long Should I Keep Records