Is Long-Term Care Tax Deductible? Premium Limits and the AGI Floor

Long-term care is tax deductible as a medical expense on your federal return, but only the portion of your total medical costs that exceeds 7.5% of your adjusted gross income counts, and you have to itemize on Schedule A to claim it.¹ Premiums on a qualified long-term care insurance policy count too, up to an annual cap tied to the insured person’s age. Self-employed taxpayers get a better path: they can deduct qualifying premiums as an adjustment to income without itemizing. The catch for everyone else is that the AGI floor plus the standard deduction often swallow the benefit, so the math is worth running before you spend the year tracking receipts.

What Qualifies as Long-Term Care

The IRS doesn’t treat every form of elder care as a medical expense. The services must be provided to someone certified as chronically ill under a plan of care prescribed by a licensed health care practitioner, and they must involve medical treatment, rehabilitation, or personal care tied to a chronic condition.²

A person is chronically ill if a licensed practitioner has certified within the previous 12 months that they cannot perform at least two of six activities of daily living without substantial help. Those activities are eating, toileting, transferring, bathing, dressing, and continence. Someone with a severe cognitive impairment who requires substantial supervision for their own safety also qualifies.³ The certification has to be current. An old diagnosis on its own isn’t enough; the practitioner needs to have recertified within the last year.

Personal living costs don’t qualify even when you’re paying them at a care facility. The IRS specifically excludes household help (even when a doctor recommends it), special diet foods, and personal hygiene items.³ The nursing home rule works on primary purpose: if the stay is mainly for medical care, the full cost — meals and lodging included — is deductible. If the stay is mainly personal, only the amount specifically attributable to medical or nursing care counts.⁴

Long-Term Care Insurance Premium Limits for 2026

Premiums on a qualified long-term care insurance policy count as medical expenses, but only up to a per-person cap based on the insured’s age at the end of the tax year.³ The policy itself has to meet federal requirements: it can only cover long-term care services, it cannot offer a cash surrender value, and it must be guaranteed renewable.²

For tax year 2026, the maximum deductible premium per person is:⁵

Age 40 or under: $500
Age 41 to 50: $930
Age 51 to 60: $1,860
Age 61 to 70: $4,960
Age 71 or older: $6,200

The limits are per person, so a married couple both over 70 could count up to $12,400 in premiums. Anything you pay above your bracket simply isn’t deductible and doesn’t roll to a later year. These figures adjust for inflation, so check the current numbers each filing season.

The 7.5% AGI Floor and the Standard Deduction Problem

Only the combined medical expenses that exceed 7.5% of your adjusted gross income are deductible, and that floor applies to your total medical spending for the year, not long-term care alone.⁶ With an AGI of $80,000, the first $6,000 in medical costs gets you nothing. Spend $25,000 across long-term care and other medical bills and only $19,000 becomes a potential deduction.

Potential is the word doing work there, because the deduction only helps if your itemized total beats the standard deduction. 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.⁷ Your medical deduction has to combine with mortgage interest, state taxes, and other itemized items to clear that bar before itemizing pays off.

Taxpayers 65 and older face a taller wall. For tax years 2025 through 2028, seniors can claim an additional $6,000 standard deduction on top of the base amount, or $12,000 if both spouses qualify. That enhanced amount phases out for single filers with modified AGI above $75,000 and joint filers above $150,000.⁸ Because long-term care costs concentrate in this age group, many older taxpayers find the standard deduction wins unless the medical bills are very large.

The Self-Employed Route

If you’re self-employed, you have a much better path for premiums. Rather than itemizing and clearing the 7.5% floor, you can deduct qualifying long-term care insurance premiums as an adjustment to gross income on Schedule 1, using Form 7206.⁹ This above-the-line deduction reduces your AGI directly, whether or not you itemize.

The age-based premium caps still apply, and the deduction can’t exceed your net self-employment income for the year. The practical effect is still large. A 65-year-old self-employed taxpayer paying $5,000 in premiums can deduct up to $4,960 without worrying about the medical expense threshold. Don’t double-count: if you take a premium on Form 7206, don’t also include it on Schedule A.⁹ Any portion above your age cap that Form 7206 wouldn’t let you deduct can still go into the itemized medical pool.

Paying with an HSA

Health Savings Account distributions can cover both long-term care services and qualifying insurance premiums tax-free, though the two work differently. For actual care — nursing services, in-home help for a chronically ill person, and similar qualified expenses — you can withdraw HSA funds tax-free with no special dollar cap beyond the account balance.¹⁰

For premiums, the tax-free treatment is limited to the same age-based caps that apply to the itemized deduction. Pay $6,200 in premiums at age 72 and your HSA covers it tax-free; pay $8,000 and the extra $1,800 isn’t a qualified distribution. Flexible Spending Accounts are more restrictive: you can use FSA funds for nursing care and nursing services, but not for long-term care insurance premiums.

Paying for a Spouse or a Parent

You can include long-term care expenses you pay for your spouse in your own medical expense deduction with no additional test. For anyone else, the person generally has to be your dependent, which means passing a relationship test and a support test. The relationship test covers a broad range of relatives, including parents, grandparents, siblings, and in-laws, and it also covers a non-relative who lived with you as a member of your household for the full year. The support test requires that you provided more than half of the person’s total support for the year.³

Here’s the piece that matters for adult children paying for a parent. You can still deduct a relative’s medical costs even when their income is too high for you to claim them as a dependent. For 2026, the gross income limit for a qualifying relative is $5,300.⁵ If your mother receives $20,000 in Social Security and you provide more than half her support, she isn’t your dependent, but you can still deduct the long-term care expenses you pay for her, provided the only reason she fails the dependency test is her income, a joint return she filed, or someone else’s ability to claim you.³

Are Long-Term Care Insurance Benefits Taxable?

If you’re on the receiving end, the tax treatment depends on how the policy pays. Reimbursement policies that cover actual care costs are generally tax-free, since the insurer is simply covering what you spent on qualified care.

Per diem or indemnity policies, which pay a flat daily amount regardless of what you actually spend, are excluded from income up to the greater of your actual care costs or a daily IRS cap. For 2026, that cap is $430 per day. Anything above the greater of those two figures is taxable.² Most people receiving long-term care spend enough that the cap isn’t in play, but it’s worth the math if your policy pays generous daily benefits. The insurer sends Form 1099-LTC each year showing total benefits paid and the payment basis; you report the figures on Form 8853.¹¹

How to Claim the Deduction

Itemizers put total medical expenses, including qualifying long-term care costs and the age-capped premium amount, on Schedule A of Form 1040. The form applies the 7.5% AGI floor, and the resulting deduction reduces your taxable income.¹² Self-employed taxpayers using the above-the-line route file Form 7206 and carry the result to Schedule 1.

Keep good records. That means itemized receipts with dates and providers for each service, proof of premium payments, and a current written certification from a licensed health care practitioner confirming the chronic illness, dated within the 12 months before the services were provided. If the person is in a nursing facility that isn’t primarily providing medical care, your records need to separate the medical portion from personal living costs, since only the medical portion is deductible in that situation.

The IRS says to keep supporting documents for at least three years after filing, with longer periods when income is significantly underreported or a return isn’t filed at all.¹³ Long-term care claims often span multiple years and large dollar amounts, so six years is the safer floor to plan around.

1
Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses
2
Office of the Law Revision Counsel. 26 USC 7702B – Treatment of Qualified Long-Term Care Insurance
3
Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses
4
Internal Revenue Service. Medical, Nursing Home, Special Care Expenses
5
IRS.gov. Rev. Proc. 2025-32
6
Internal Revenue Service. Topic No. 502, Medical and Dental Expenses
7
Internal Revenue Service. IRS Releases Tax Inflation Adjustments for Tax Year 2026, Including Amendments from the One, Big, Beautiful Bill
8
Internal Revenue Service. Check Your Eligibility for the New Enhanced Deduction for Seniors
9
IRS.gov. Self-Employed Health Insurance Deduction
10
Internal Revenue Service. Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans
11
Internal Revenue Service. Instructions for Form 1099-LTC (Rev. April 2025)
12
Internal Revenue Service. 2025 Instructions for Schedule A (Form 1040)
13
Internal Revenue Service. How Long Should I Keep Records?