Qualified Long-Term Care Services: What’s Deductible?

The qualified long-term care deduction lets you treat the cost of nursing care, in-home personal care, facility stays, and long-term care insurance premiums as medical expenses on Schedule A of Form 1040, deductible to the extent your total medical spending for the year exceeds 7.5% of your adjusted gross income.¹ To claim it, the person receiving care must be certified as chronically ill by a licensed practitioner, and the care itself must follow a written plan. Miss either requirement and the IRS can strip the deduction in full.

What Services Qualify

The tax code covers a broad range of long-term care: diagnostic and preventive services, treatment, rehabilitation, and the maintenance or personal care that helps a chronically ill person manage daily life.² That last bucket is where most long-term care sits: help with bathing, dressing, eating, and similar tasks the person can no longer manage alone.

Two conditions apply to every service. The recipient must be certified chronically ill, and the services must follow a plan of care prescribed by a licensed health care practitioner.² No written plan, no deduction, regardless of medical necessity. Facilities and home health agencies usually create the plan at intake. If you’re arranging care on your own, get the plan from the doctor in writing before services begin, with the specific services and the medical reasons behind them.

Who Counts as Chronically Ill

A licensed health care practitioner must certify the care recipient as chronically ill within the previous 12 months, and the certification has to be renewed annually.³ There are two ways to meet the standard.

The first is the Activities of Daily Living test. The six ADLs are eating, toileting, transferring (moving from bed to chair, for example), bathing, dressing, and maintaining continence. Someone qualifies if they cannot perform at least two of these without substantial help from another person, and the inability is expected to last at least 90 days.³

The second path is severe cognitive impairment. A person with Alzheimer’s, dementia, or a similar condition qualifies if they need substantial supervision to stay safe. No ADL failure is required; the cognitive impairment alone is enough. Certifying practitioners include physicians, registered nurses, and licensed social workers.

You can deduct qualified long-term care expenses you pay for yourself, your spouse, or a dependent. For medical expenses, the tax code uses a slightly broader definition of dependent than the general rule: even if your parent’s income is too high for them to be your dependent for other tax purposes, you can still deduct their medical costs as long as you provide more than half their support.⁴ That matters for adult children paying for a parent’s care.

Nursing Home, Assisted Living, and Memory Care

The IRS draws its line by primary purpose, not by the type of facility. If the main reason someone is in a nursing home or similar institution is to receive medical care, the entire cost is deductible, including room and board.⁵ If the main reason is personal (companionship, convenience, proximity to family), only the portion tied to actual medical or nursing care qualifies.

The IRS does not treat “nursing home,” “assisted living,” and “memory care” as different categories. What matters is the nature of the services and the person’s chronically ill status, not the label on the door.¹ A memory care resident with documented severe cognitive impairment who needs constant supervision is almost certainly there for medical reasons. Someone in independent living with occasional housekeeping is not. Assisted living is the gray area, since residents often get a mix of medical and non-medical services. Ask the facility to break out the medical portion of your bills in writing.

Paying a Family Member for Care

Hiring a relative to provide care is common, and it’s where many people accidentally lose the deduction. Payments to your spouse or a relative for long-term care services are not deductible unless that person is a licensed professional providing care within the scope of their license.⁴ “Relative” is broad: children, siblings, parents, stepparents, in-laws, aunts, and uncles.

If your daughter is a licensed registered nurse and provides skilled nursing care, those payments can qualify. If she has no healthcare license and provides the same physical assistance, the payments are not deductible no matter how necessary the care is. The rule applies whether you pay the relative directly or through a family-owned business.

Long-Term Care Insurance Premiums

Premiums for a qualified long-term care insurance policy count as medical expenses, but only up to an annual cap based on your age at the end of the tax year. The caps are adjusted for inflation each year. For 2026, the per-person limits are:

Age 40 or younger: $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 caps apply per person, so a married couple each get their own limit based on their individual ages.¹ Any premium dollars above the cap don’t count toward your medical expenses at all.

The policy itself has to meet the definition of a qualified long-term care insurance contract. It must be guaranteed renewable, cannot have a cash surrender value or let you borrow against it, and generally cannot duplicate Medicare coverage.² Most policies sold as “tax-qualified” already meet these rules, but it’s worth confirming with your insurer if you’re holding an older contract.

If You’re Self-Employed

Self-employed taxpayers get a better route. You can deduct long-term care insurance premiums as part of the self-employed health insurance deduction on Schedule 1 of Form 1040, calculated on Form 7206. This is an above-the-line deduction, so you get the benefit even without itemizing.⁶ The same age-based caps apply.

Any premium amount that exceeds the cap, or that you can’t fully deduct on Schedule 1 because it’s more than your net self-employment income, can still go on Schedule A as an itemized medical expense.⁶ You cannot deduct the same premium dollars in both places.

Paying Premiums From an HSA

Health Savings Account distributions can pay long-term care insurance premiums tax-free, subject to the same age-based limits that apply to the medical expense deduction.⁷ This is one of the few insurance premium categories HSA funds can cover. Premiums paid with HSA money cannot also be claimed as a medical expense deduction, since you’ve already gotten the tax benefit on the way in.

Insurance Reimbursements and Per Diem Benefits

Any insurance reimbursements you receive during the year, including Medicare payments, reduce your deductible medical expenses dollar for dollar.¹ If your long-term care policy reimburses specific expenses, those amounts come off the top of your deduction.

Per diem policies work differently. They pay a flat daily amount regardless of what you actually spend. For 2026, per diem payments up to $430 per day are excluded from gross income as long as they don’t exceed your actual long-term care costs. Anything above the greater of $430 per day or your actual expenses is taxable income. Per diem payments get reported on Form 8853.⁸

Claiming the Deduction on Your Return

The deduction lives on Schedule A, which means itemizing and giving up the standard deduction. Long-term care costs alone won’t always be enough to make itemizing worthwhile, but combined with your other medical spending for the year (doctor visits, prescriptions, dental, vision, long-term care premiums, care services), the total often pushes past the standard deduction.

Only the amount above 7.5% of your adjusted gross income actually reduces your tax.¹ On an $80,000 AGI, the first $6,000 of medical expenses produces nothing; every dollar past that is deductible. Someone with $50,000 in nursing home costs and $80,000 in income can deduct $44,000, which is a real reduction in taxable income.

Documentation to Keep

The IRS can ask you to prove every dollar, and long-term care deductions get scrutiny because the requirements are specific. Keep:

The written plan of care from a licensed practitioner, describing the services and the medical reasons for them.
The chronically ill certification, renewed within the past 12 months, documenting either which ADLs the person cannot perform or the cognitive impairment.
Receipts and invoices from every provider, showing name, dates of service, description, and amount paid.
Insurance and Medicare reimbursement records.
Premium payment records for any long-term care insurance policy.

Hold these records for at least three years after filing, and longer for larger deductions.⁹

If the IRS disallows the deduction, you’ll owe the tax you should have paid plus a failure-to-pay penalty of 0.5% per month on the unpaid balance, capped at 25%.¹⁰ In more serious cases, where the IRS treats the position as negligent or a substantial understatement, an accuracy-related penalty of 20% of the underpayment can apply on top.¹¹ A few hours organizing paperwork now costs far less than either outcome later.

1
Internal Revenue Service. Publication 502, Medical and Dental Expenses
2
Office of the Law Revision Counsel. 26 USC 7702B – Treatment of Qualified Long-Term Care Insurance
3
Internal Revenue Service. Instructions for Form 1099-LTC – Section: Chronically Ill Individual
4
Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses
5
Internal Revenue Service. Medical, Nursing Home, Special Care Expenses
6
Internal Revenue Service. Instructions for Form 7206
7
Internal Revenue Service. Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans
8
Internal Revenue Service. Instructions for Form 8853
9
Internal Revenue Service. How Long Should I Keep Records
10
Internal Revenue Service. Failure to Pay Penalty
11
Office of the Law Revision Counsel. 26 USC 6662 – Imposition of Accuracy-Related Penalty on Underpayments