IRS Tax Code Section 213(d) Eligible Medical Expenses

Section 213(d) eligible medical expenses fall into four categories: direct treatment, diagnosis, or prevention of disease; transportation to receive care; qualified long-term care services; and premiums for insurance covering medical care.¹ You can deduct these costs on Schedule A, but only the portion exceeding 7.5% of your adjusted gross income, and only if you itemize instead of taking the standard deduction.² The same definition also governs what you can pay for tax-free through an HSA, FSA, or HRA, so the list below matters even if you never itemize.

Will You Actually Benefit From This Deduction?

Two gates stand between your medical bills and a tax deduction.

First, only the portion of your qualifying expenses above 7.5% of AGI counts.³ On an $80,000 income, the first $6,000 in medical costs produces no deduction. Only what you spend above that line enters the calculation.

Second, you have to itemize. 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.⁴ Your medical expenses above the 7.5% floor, combined with state and local taxes, mortgage interest, and charitable contributions, need to exceed those numbers before itemizing beats the standard deduction. A $5,000 surgery on a $90,000 income produces nothing. The deduction mostly helps taxpayers facing major surgery, long hospital stays, chronic conditions, or long-term care costs.

Expenses already paid or reimbursed through an HSA, FSA, or HRA don’t count toward the deduction either, because they were already tax-free.⁵ If you paid $15,000 in bills and your FSA covered $3,000, only $12,000 enters the 7.5% math.

Treatment, Diagnosis, and Prevention

This is the biggest category: amounts paid to diagnose, treat, or prevent disease, plus costs that affect any structure or function of the body.¹ That structure-or-function language is what pulls in procedures like LASIK and orthodontics even when no disease is being treated.

Medical, Dental, and Mental Health Services

Payments to physicians, surgeons, dentists, psychiatrists, psychologists, and other licensed practitioners qualify, along with hospital services, nursing care, and related lab fees.³ Dental care covers cleanings, fluoride treatments, X-rays, fillings, braces, extractions, and dentures. Teeth whitening does not qualify.

Mental health care is fully included. You can deduct psychiatric care, psychoanalysis, and therapy received as medical treatment.

Prescriptions, Vision, and Hearing

Prescription drugs and insulin are deductible. Over-the-counter medications are not, with insulin as the sole exception.³ Eyeglasses, prescription contact lenses, hearing aids, guide dogs, and other service animals for people with visual, hearing, or physical disabilities all qualify, as does corrective eye surgery such as LASIK.²

Fertility, Reconstruction, and Addiction Treatment

Procedures to overcome an inability to have children qualify, including in vitro fertilization, temporary egg or sperm storage, and surgery to reverse a prior sterilization. Breast reconstruction and prostheses following a mastectomy for cancer are deductible. Inpatient treatment at a therapeutic center for alcohol or drug addiction qualifies, and the cost of meals and lodging at the facility during treatment is included.³

Transportation and Lodging for Medical Care

Transportation primarily for and essential to medical care counts as a medical expense.¹ Deductible costs include bus, taxi, train, and plane fares, ambulance services, parking, and tolls.³

Driving your own car gives you two options: deduct actual out-of-pocket costs for gas and oil, or use the standard medical mileage rate of 20.5 cents per mile for 2026.⁶ Parking and tolls are deductible under either method.²

When care requires traveling away from home, you can deduct lodging up to $50 per night per person. The cap applies to the patient and a necessary companion, so a parent traveling with a sick child can deduct up to $100 per night. Meals during medical travel are not deductible unless provided as part of inpatient care at a hospital or similar facility.³

Long-Term Care Services

Amounts paid for qualified long-term care services are their own category of medical care under Section 213(d), defined by cross-reference to Section 7702B(c).⁷ These are services needed by a chronically ill person under a plan of care prescribed by a licensed health care practitioner. Ongoing nursing care, personal care assistance, and similar services for a chronic illness or disability all fall inside this category.

Insurance Premiums

Premiums for insurance covering medical care are deductible, including policies covering hospitalization, surgical services, prescription drugs, dental care, and contact lens replacement. Medicare Part B and Part D premiums qualify.³

Qualified long-term care insurance premiums are deductible but subject to age-based annual caps per person. For 2025:

Age 40 or under: $480
Age 41 to 50: $900
Age 51 to 60: $1,800
Age 61 to 70: $4,810
Over age 70: $6,020

The limits are adjusted annually for inflation.⁸ The contract must meet the definition of a qualified long-term care insurance contract under Section 7702B(b), which requires among other things that the contract be guaranteed renewable and provide no cash surrender value.⁷

Life insurance premiums, disability insurance premiums, and premiums for policies that pay a fixed amount upon illness without regard to actual expenses do not qualify as medical care.

Medical Equipment and Home Modifications

Wheelchairs, crutches, oxygen equipment, prosthetic limbs, and vehicle modifications like hand controls for a driver with disabilities are fully deductible.³

Home improvements made for medical reasons are deductible only to the extent their cost exceeds any increase in the home’s fair market value. Install a $20,000 elevator that adds $8,000 to your home’s value, and you can deduct $12,000. Establishing that difference usually means a professional appraisal before and after.

Some modifications are treated as adding no value to the home, so their full cost is deductible:

Constructing entrance ramps
Widening doorways and hallways
Installing grab bars in bathrooms
Modifying fire alarms, smoke detectors, or other warning systems for hearing-impaired individuals
Lowering kitchen cabinets or modifying electrical outlets and fixtures

Ongoing costs to operate and maintain a medically necessary improvement, such as electricity to run a medical elevator, also qualify.³

Whose Expenses You Can Include

Your own expenses are not the only ones that count. You can deduct medical costs you pay for your spouse (if you were married when the services were provided or when you paid) and for anyone who qualifies as your dependent.³

You can also deduct expenses for someone who would have been your dependent except that they earned too much gross income, filed a joint return, or you could be claimed as a dependent on someone else’s return. This matters for adult children helping an aging parent whose Social Security income pushes them above the qualifying relative threshold.

For divorced or separated parents, either parent can deduct the medical expenses they actually pay for a child, as long as the child was in one or both parents’ custody for more than half the year and received more than half their support from the parents together. Which parent claims the child as a dependent for other tax purposes doesn’t control.³

What Section 213(d) Excludes

The exclusions matter as much as the inclusions, because they catch some of the most common health-related spending.

Cosmetic Surgery

Any procedure directed at improving your appearance that does not meaningfully promote the proper function of your body or treat illness is excluded.¹ Elective facelifts and teeth whitening fail. The exception is surgery necessary to correct a deformity from a congenital abnormality, an accidental injury, or a disfiguring disease. Breast reconstruction after a cancer mastectomy is the clearest example.³

General Health and Wellness

Expenses merely beneficial to general health are out, even on a doctor’s recommendation. Health club memberships, swimming lessons, dance classes, vitamins, and nutritional supplements don’t qualify unless a physician prescribes them for a specific diagnosed disease.⁵

Weight-loss programs sit on this line. A program for general health or appearance doesn’t qualify. The same program becomes deductible when a physician diagnoses obesity, hypertension, heart disease, or another specific condition and prescribes weight loss as treatment.³ A gym membership to feel healthier is never deductible; the same membership prescribed as therapy for a diagnosed condition can be.

Over-the-Counter Products

Non-prescription drugs other than insulin don’t qualify. Vitamins, herbal supplements, and natural medicines count only if recommended by a medical practitioner as treatment for a specific physician-diagnosed condition.³

Timing and Recordkeeping

You deduct medical expenses in the year you pay them, regardless of when care was provided. A December surgery paid in February belongs on the later year’s return.³

Credit card charges work the other way: the deduction belongs to the year you charged the expense, not the year you paid the credit card balance. Charge a procedure in December, pay the card off in March, and the deduction goes on the earlier year.

If you missed a deduction in a prior year, don’t add it to the current return. File an amended return (Form 1040-X) for the year the expense should have been claimed. You generally have three years from the original filing date to amend.

Hold onto receipts, billing statements, and insurance explanation-of-benefits documents showing what you paid and what was reimbursed. For expenses that straddle personal and medical, like a weight-loss program or a home modification, get a written statement from your physician tying the expense to a specific diagnosed condition. That documentation is your first line of defense in an audit, and the piece most people forget to collect until it’s too late.

1
Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses
2
Internal Revenue Service. Topic No. 502, Medical and Dental Expenses
3
Internal Revenue Service. Publication 502, Medical and Dental Expenses
4
Internal Revenue Service. IRS Releases Tax Inflation Adjustments for Tax Year 2026
5
Internal Revenue Service. Frequently Asked Questions About Medical Expenses Related to Nutrition, Wellness and General Health
6
Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate at 72.5 Cents Per Mile, Up 2.5 Cents
7
Office of the Law Revision Counsel. 26 USC 7702B – Treatment of Qualified Long-Term Care Insurance
8
Internal Revenue Service. Eligible Long-Term Care Premium Limits