Section 213(d) Qualified Medical Expenses: Rules and HSA Use

Section 213(d) qualified medical expenses are the costs the Internal Revenue Code counts as “medical care” — money you spend to diagnose, treat, cure, mitigate, or prevent disease, or to affect a structure or function of the body, plus related transportation, qualified long-term care services, and insurance premiums.¹²³

The Core Test

Every question about whether something qualifies comes back to one idea: does the expense target a specific medical condition or physical function? A surgery to repair a torn ligament qualifies because it treats a diagnosed injury. A gym membership to “stay healthy” does not, because it lacks a specific medical purpose. Items ordinarily used for personal or family purposes don’t qualify unless they primarily prevent or treat a diagnosed physical or mental condition.⁴

That test runs through four broad categories the statute recognizes as medical care: diagnosis and treatment, transportation to get that care, qualified long-term care services, and insurance premiums covering medical treatment.¹

What Qualifies

Professional Services and Facility Care

Fees paid to physicians, surgeons, dentists, optometrists, psychologists, psychiatrists, and other licensed practitioners qualify, along with routine exams, dental cleanings, diagnostic lab work, X-rays, and surgical procedures. Hospital admission covers room, meals, and nursing care as part of inpatient treatment. Nursing services don’t require a registered nurse — the IRS allows the expense as long as the services are the kind a nurse would typically perform.⁴

Qualified long-term care services for chronically ill individuals count when they’re provided under a plan of care prescribed by a licensed health care practitioner, and cover diagnostic, preventive, therapeutic, and personal care services needed when someone can’t perform daily living activities without help.⁴

Equipment and Supplies

Hearing aids (including batteries, repairs, and maintenance), crutches, wheelchairs and their operating costs, artificial limbs, oxygen equipment, prescription eyeglasses, and diagnostic devices such as blood sugar test kits all qualify. Service animals qualify broadly: the purchase price, training, food, grooming, and veterinary care for a guide dog or other service animal that assists someone with a physical disability. Ordinary pet veterinary fees are explicitly excluded.⁴

Insurance Premiums

Medical insurance premiums paid with after-tax dollars qualify, including premiums for Medicare Part B, and the same logic extends to Medicare Part D and Medicare Advantage plans.¹ For 2026, the standard Part B premium is $202.90 per month, with higher-income beneficiaries paying surcharges.⁵

Premiums your employer pays, or that you pay through pre-tax salary deductions in a workplace plan, don’t count, because you’ve already received the tax benefit through the exclusion from income. Premiums subsidized by the Affordable Care Act’s Premium Tax Credit are likewise not deductible.

Qualified long-term care insurance premiums are deductible up to age-based annual limits. For 2026:

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

Only federally tax-qualified policies count, and if a policy bundles medical care with other benefits (such as a life insurance rider), the medical portion must be separately stated.⁶

Home Modifications

Permanent improvements installed primarily for medical care qualify, reduced by any increase in the home’s value. If the modification doesn’t add value, the whole cost qualifies.⁴ Most disability-related work falls in this bucket: entrance ramps, widened doorways, grab bars and railings, lowered kitchen cabinets, porch lifts, modified fire alarms, and grading the ground to reach an entrance. Only reasonable costs to accommodate the disability count — cosmetic upgrades attached to the same project are personal expenses.

Travel and Lodging

Transportation primarily for and essential to medical care qualifies: bus, taxi, train, plane fares, and ambulance costs. If you drive, you can 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, plus parking and tolls either way.⁷ Travel by a parent who must accompany a child, or by a nurse or caregiver accompanying a patient who can’t travel alone, also qualifies, as do regular visits to a mentally ill dependent when recommended as part of treatment.⁴

Lodging is capped at $50 per night per person when the stay is primarily for medical care — up to $100 per night when a parent travels with a sick child. Meals during the trip are not included. Travel for general health improvement doesn’t qualify.⁴

Prescription and Over-the-Counter Drugs: A Split Rule

Drugs are the one area where Section 213(d) works differently depending on which tax benefit you’re using, and getting it wrong costs money in both directions.

For the Schedule A itemized deduction, only prescribed drugs and insulin qualify. Over-the-counter medicines like ibuprofen or allergy pills are not deductible unless a doctor writes a prescription for them. Insulin is the exception and qualifies with or without a prescription.⁴

For HSAs, FSAs, and HRAs, the CARES Act removed the prescription requirement for over-the-counter medicines in 2020 and also made menstrual care products eligible for tax-free reimbursement.⁸ Cold medicine or pain relievers bought with an HSA debit card need no prescription. Those same purchases don’t count toward the itemized deduction without one.

What Doesn’t Qualify

Cosmetic surgery is specifically excluded from the definition of medical care unless it corrects a deformity from a congenital abnormality, an accident or trauma, or a disfiguring disease. Face lifts, liposuction, and similar appearance-directed procedures don’t qualify.⁶

Other commonly claimed items the IRS rejects:

Health club dues, unless prescribed to treat a specific diagnosed condition
Nutritional supplements and vitamins, unless recommended by a medical practitioner for a specific diagnosed condition⁹
Teeth whitening, hair transplants, and electrolysis (appearance-related)
Controlled substances illegal under federal law, even where state law permits them
Funeral expenses
Household help, even when a doctor recommends it
Maternity clothes
Swimming or dancing lessons for general health, even if recommended by a doctor

If the primary purpose is general well-being or appearance rather than treating a specific condition, the expense doesn’t qualify.⁴

Whose Expenses You Can Include

You can claim qualifying expenses for yourself, your spouse, and your dependents. A spouse’s expenses count as long as you were married either when the services were provided or when you paid for them. A dependent must have been your qualifying child or qualifying relative at the time of service or payment.⁴

You can also claim medical expenses for someone who would have been your dependent except that the person earned too much gross income, filed a joint return, or could be claimed on someone else’s return. That rule matters for adult children or elderly parents whose bills you’re paying but who don’t technically qualify as dependents.

Using 213(d) for the Schedule A Deduction

Medical expenses on Schedule A are deductible only to the extent they exceed 7.5% of your adjusted gross income.² If your AGI is $80,000, the first $6,000 in medical costs produces no tax benefit — only amounts above that floor count. The 7.5% figure is now permanent.

You can only deduct amounts you actually paid out of pocket. Any reimbursement from insurance, Medicare, or another health plan reduces your total medical expenses for the year, even if the policy only reimburses certain specific costs.⁴ If you’re reimbursed in a later year for expenses you already deducted, report the reimbursement as income up to the amount previously deducted. Expenses paid with tax-free HSA distributions or reimbursed through an HRA cannot also be deducted on Schedule A.

Using 213(d) for HSAs, FSAs, and HRAs

These accounts all use the Section 213(d) definition to decide which withdrawals and reimbursements are tax-free.³ The CARES Act additions — over-the-counter medicines without a prescription and menstrual care products — apply here even though they don’t reach the itemized deduction.

For 2026, HSA contribution limits are $4,400 for self-only coverage and $8,750 for family coverage, with a $1,000 catch-up available at age 55 or older.¹⁰ The health FSA contribution limit for 2026 is $3,400.

The penalty for a wrong HSA withdrawal is steep. If you use HSA funds for something that isn’t a qualified medical expense, the withdrawal is added to taxable income and hit with an additional 20% tax. The 20% penalty disappears at age 65 or on disability, though regular income tax still applies to non-medical withdrawals after that point.³

Records to Keep

Keep receipts or invoices showing the provider’s name, the date of service, what the expense was for, and the amount paid. For items that could serve both a medical and personal purpose, get a letter of medical necessity from your doctor identifying the condition being treated.⁴ Explanation of Benefits statements document what insurance didn’t cover. Hold the records for at least three years from the date you file the return claiming the deduction; if you’re audited, that documentation is what preserves the tax benefit.

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 969 – Health Savings Accounts and Other Tax-Favored Health Plans
4
Internal Revenue Service. Publication 502 – Medical and Dental Expenses
5
Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
6
Office of the Law Revision Counsel. 26 U.S. Code 213 – Medical, Dental, Etc., Expenses
7
Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate at 72.5 Cents Per Mile, Up 2.5 Cents
8
Internal Revenue Service. IRS Outlines Changes to Health Care Spending Available Under CARES Act
9
Internal Revenue Service. Frequently Asked Questions About Medical Expenses Related to Nutrition, Wellness and General Health
10
Internal Revenue Service. Rev. Proc. 2025-19