En español | The income tax deduction for medical and dental expenses has always been a hard one to qualify for: Your out-of-pocket health costs have to be extremely high for you to see any benefit on your tax return.
Thanks to the 2017 tax law, the deduction is slightly more within reach this year, but that window is closing soon. For 2018 federal income taxes — the filing deadline is April 15 except in Massachusetts and Maine, where it is April 17 because of state holidays — you can deduct unreimbursed medical expenses that exceed 7.5 percent of your adjusted gross income. The threshold will be 10 percent next year.
“As you get older, you have more health issues, so it’s important to look at your medical expenses when you do your taxes,” says Sallie Mullins Thompson, a certified public accountant (CPA) in New York. “It could get you over the standard deduction and let you itemize."
Here’s what to look for.
What spending qualifies
Many medical expenses are deductible, starting with the insurance premiums you pay for your health, dental and prescription drug plans, as well as for long-term care insurance (up to certain limits). When tallying those up, don’t overlook the Medicare premiums that are deducted from your Social Security check, advises Troy Lewis, a Draper, Utah, CPA who teaches tax and accounting at Brigham Young University. This pertains to premiums for various Medicare benefits, not to payroll taxes that you paid toward Medicare — which are not a deductible medical expense, the IRS says.
Out-of-pocket health care costs like copays and deductibles qualify, and some other expenses may be less obvious. For example, you can include travel costs to doctors’ appointments at a rate of 18 cents a mile, plus parking fees and tolls.
You can deduct modifications you made to your home for medical reasons, such as installing grab bars, ramps and stair lifts. Acupuncture, treatment by a chiropractor, hearing aids and glasses count. So do doctor-directed weight loss programs and special diets — if they are for a specific disease diagnosed by a physician, such as obesity, hypertension or heart disease, according to the IRS. The cost of special food, for example, qualifies only if the food alleviates or treats an illness and doesn't satisfy normal nutritional needs, the IRS says.
“If it’s medically prescribed, you can deduct it,” says Gail Rosen, a CPA who leads the Somerset County, N.J., office of WilkinGuttenplan. “But you have to have the notes to back that up.”
Where to take more care
You’re out of luck if you were hoping to write off 2018’s face-lift: Cosmetic surgery generally does not qualify. Also a no-no: over-the-counter medications.
“People think anything that’s medically related qualifies,” says Lewis. “Cosmetic surgery only does if it’s to ameliorate a deformity.”
Plus, if you covered an out-of-pocket charge with money from a flexible spending account (FSA) or health savings account (HSA), you can’t also deduct that expense. Since FSAs and HSAs are funded with pretax dollars, that would be double-dipping, taxwise.
Finally, nursing home care is deductible, but it can be more complicated if you get care at an assisted living facility. It must be medically necessary for you to live there — either you’re chronically ill or cognitively impaired — and only what you pay for long-term care services and medical care is deductible. So, says Thompson, make sure you have a doctor’s letter explaining you need that care so that you can deduct at least a portion of the fees you pay.