IRS Publication 502: Eligible Expenses, Exclusions, and Deductions

IRS Publication 502 defines the medical and dental expenses you can deduct on your federal return, and it applies one test to every item: was the cost paid primarily to prevent or treat a physical or mental condition? If yes, it qualifies. You claim the deduction on Schedule A, but only the portion of your total qualifying costs that exceeds 7.5% of your adjusted gross income, and only if you itemize instead of taking the standard deduction.¹

The Primary Purpose Test

Every eligible expense has to clear the same threshold. A cost paid to prevent or treat a diagnosed condition qualifies. A cost that just promotes general health or comfort does not. A treadmill your doctor recommends for cardiac rehabilitation can qualify; the same treadmill bought to stay in shape cannot.²

You can include expenses paid for yourself, your spouse, or a dependent. The dependency definition here is broader than the one used for claiming someone on your return: the person only needs to have been your dependent either when the services were provided or when you paid the bill.²

Timing follows the payment, not the service. A bill you pay in January 2026 for a procedure done in December 2025 goes on your 2026 return. Any portion insurance or another source reimburses must be subtracted from your total.²

What Counts as an Eligible Medical Expense

Professional Care and Treatment

Fees charged by physicians, surgeons, dentists, chiropractors, osteopaths, psychiatrists, psychologists, and other licensed practitioners all qualify. Hospital stays qualify when the primary reason for being there is medical care, and that includes the room, board, and nursing services. Acupuncture, physical therapy, psychiatric care, psychoanalysis, and diagnostic lab work and X-rays ordered by a practitioner are all eligible.²

Smoking cessation programs qualify, along with prescription medications for nicotine withdrawal. Weight-loss programs qualify only when a physician has diagnosed a specific condition such as obesity or hypertension and prescribed the program as treatment; a program you join on your own does not pass the test.²

Dental, Vision, and Hearing

Cleanings, fillings, extractions, braces, and dentures qualify. Cosmetic dental work such as teeth whitening is specifically excluded. Eye exams, prescription eyeglasses, and contact lenses all count. Hearing aids are eligible at their full purchase price when medically prescribed.²

Cosmetic surgery is barred unless it corrects a deformity from a congenital abnormality, an accident-related injury, or a disfiguring disease. Publication 502 uses breast reconstruction after a mastectomy as the standard example.²

Prescription Drugs

For the Schedule A deduction, only drugs that require a physician’s prescription qualify. Insulin is the sole exception and is always eligible without a formal prescription. Common over-the-counter medicines — pain relievers, cold medicine, allergy pills — do not qualify for Schedule A unless a doctor writes a prescription for them.² The HSA and FSA rules are different, and that difference is covered below.

Fertility Care

Procedures to overcome an inability to have children qualify. In vitro fertilization, including temporary storage of eggs or sperm, is eligible, as is surgery to reverse a prior sterilization. Surrogacy expenses are specifically excluded: the IRS treats payments for the identification, compensation, and medical care of a gestational surrogate as costs for an unrelated party.²

Medical Equipment and Service Animals

Wheelchairs, crutches, oxygen equipment, hospital-style beds, elastic stockings, and specialized car controls prescribed for a medical condition all qualify at their full purchase price. Ongoing costs to operate and maintain the equipment count too, including the extra electricity to run an air conditioner used specifically for a respiratory condition.²

Service animals are generously treated. The costs of buying, training, and maintaining a guide dog or other service animal for a person with a visual, hearing, or physical disability all qualify. Maintenance covers food, grooming, and veterinary care.²

Home Modifications

Medically necessary home improvements follow a special rule. If the improvement increases your home’s fair market value, only the portion of the cost that exceeds that increase is deductible. A $10,000 wheelchair ramp that adds $7,000 to the home’s value produces a $3,000 deduction.²

Certain modifications are presumed not to increase value and are fully deductible: widening doorways and hallways, installing ramps, lowering kitchen cabinets, installing grab bars and handrails, modifying fire alarms or smoke detectors, and adjusting electrical outlets and plumbing for accessibility. You still need documentation that the improvement was medically necessary, and a letter from your physician connecting the modification to a diagnosed condition is the standard proof.²

Nursing Homes and Long-Term Care

Nursing home costs are deductible in full — meals and lodging included — when the primary reason for being in the facility is medical care. If the person is there for personal reasons, only the portion directly attributable to medical or nursing care is deductible.²

Qualified long-term care services for a chronically ill person also qualify, provided the services follow a plan of care prescribed by a licensed practitioner. Premiums for qualified long-term care insurance are deductible up to age-based dollar limits that adjust annually; check the current year’s limits on the IRS website before filing.³

Health Insurance Premiums

Premiums for medical insurance qualify when you itemize. This covers your share of an employer-sponsored plan (not the portion your employer pays), individual marketplace plans, and Medicare premiums, including Part B, Part D, Medigap policies, and the IRMAA high-income surcharges on Parts B and D.¹

Self-employed filers have a better option. You can deduct health insurance premiums for yourself, your spouse, and your dependents as an adjustment to income on Schedule 1, which reduces AGI directly and does not require itemizing or clearing the 7.5% floor. You cannot claim the same premiums in both places.⁴

Travel for Medical Care

Transportation to and from medical appointments qualifies when the trip is primarily for medical care. Bus, train, and taxi fares count. Ambulance service is fully deductible when medically necessary. If you drive, you can use the IRS standard mileage rate; for 2026 the medical rate is 20.5 cents per mile, with parking fees and tolls deductible on top.⁵²

Lodging during medical travel is deductible up to $50 per night per person. If a companion needs to travel with the patient, their lodging qualifies too, so the maximum reaches $100 per night. The lodging cannot be lavish, and the trip cannot have a significant personal or vacation element. Meals during medical travel generally do not qualify unless they are part of inpatient care.¹

What Publication 502 Excludes

Publication 502 explicitly rules out several expenses taxpayers commonly try to claim:

Gym memberships and health club dues, even with a doctor’s recommendation, when aimed at general fitness
Cosmetic procedures such as facelifts, hair transplants, electrolysis, and liposuction, unless correcting a deformity from a congenital abnormality, accident, or disfiguring disease
Vitamins, supplements, and herbal or “natural” remedies, unless a physician prescribes them for a specific diagnosed condition
Teeth whitening
Dancing lessons, swimming lessons, and similar activities recommended for general well-being
Babysitting or nursing care for a healthy child, even if it allows a parent to get medical treatment
Funeral expenses and maternity clothes
Surrogacy costs
Ordinary tuition at a regular school, even for a child with a diagnosed condition (only specialized schooling recommended by a physician to help a child overcome a learning disability qualifies, and then only the portion attributable to the specialized instruction)

The common thread is the primary purpose test. If the expense does not directly prevent or treat a diagnosed condition, it fails.²

How HSAs and FSAs Change the List

Health Savings Accounts and health care Flexible Spending Arrangements let you pay for eligible medical expenses with pre-tax dollars. The list of qualifying expenses largely mirrors Publication 502, with one meaningful addition: HSAs and FSAs cover over-the-counter medicines without a prescription, a change made by the CARES Act in March 2020. That is why you can buy allergy medicine with an FSA debit card at the pharmacy but cannot add that same purchase to your Schedule A total.

You cannot double-dip. Any expense paid or reimbursed with tax-free HSA or FSA funds cannot also be claimed as an itemized deduction. Publication 502 is explicit that you cannot use other funds equal to the amount of a tax-free HSA distribution and then include those expenses on your return. The same logic applies to FSA reimbursements funded with pre-tax payroll contributions.²

A workable strategy: use HSA or FSA funds for expenses that would fall below your 7.5% AGI floor (where they would produce no deduction anyway), and consider paying out of pocket for expenses above the floor if itemizing produces a larger tax benefit. The right answer depends on your tax bracket, total medical spending, and whether your itemized deductions exceed the standard deduction.

Claiming the Deduction

You claim medical expenses on Schedule A of Form 1040. Add up your total eligible costs, subtract 7.5% of your AGI, and deduct only what remains.¹

An example. If your AGI is $80,000, your floor is $6,000. If you spent $14,000 on qualifying medical expenses, your deduction is $8,000. The 7.5% threshold is permanent under federal law, so the calculation works the same way every year.

Itemizing pays off only if your total itemized deductions — medical, state and local taxes, mortgage interest, charitable contributions, and other eligible items combined — exceed the standard deduction for your filing status. For 2026, the standard deduction is $16,100 for single filers, $32,200 for married couples filing jointly, and $24,150 for heads of household.⁶ For most taxpayers the standard deduction wins. The medical deduction tends to pay off in years with unusually high costs, such as a major surgery or extended hospital stay.

Keep every receipt, explanation of benefits statement, and record of payment. The IRS expects documentation of the purpose of each expense, the amount, and the date paid. Canceled checks and credit card statements showing a medical provider’s name help. If the IRS questions a deduction, the burden of proof is on you.²

1
Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses
2
Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses
3
Internal Revenue Service. Eligible Long-Term Care Premium Limits
4
Internal Revenue Service. Form 7206 – Self-Employed Health Insurance Deduction
5
Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate at 72.5 Cents Per Mile, Up 2.5 Cents
6
Internal Revenue Service. IRS Releases Tax Inflation Adjustments for Tax Year 2026