Key Takeaways
- You can deduct unreimbursed medical and dental expenses that exceed 7.5% of your Adjusted Gross Income (AGI) - but only if you itemize on Schedule A.
- The 7.5% floor is permanent for all ages (made so by the Consolidated Appropriations Act back in 2021) - there's no separate, lower threshold for seniors.
- For 2026, the standard deduction is $16,100 (single) / $32,200 (married filing jointly) / $24,150 (head of household), per the 2026 tax brackets. Your total itemized deductions - medical above the floor, state and local taxes, mortgage interest, charitable gifts - have to beat that number before the medical deduction does you any good.
- The 2026 IRS standard mileage rate for medical travel is 20.5 cents per mile, down half a cent from 2025.
- Expenses reimbursed by insurance, an HSA, or an FSA don't count - no double-dipping.
- Self-employed people generally deduct health insurance premiums a different way (an above-the-line adjustment), not through this itemized deduction.
I get asked about this deduction every tax season, usually from someone who just had a rough year medically and wants to know if any of it comes back at tax time. The honest answer: sometimes, but the bar is higher than most people assume.
The rule itself is simple. You can deduct medical and dental expenses for yourself, your spouse, and your dependents — but only the amount that exceeds 7.5% of your Adjusted Gross Income (AGI), and only if you itemize instead of taking the standard deduction.
That second part is where most people get tripped up. With the standard deduction sitting at $16,100 for single filers and $32,200 for married couples filing jointly in 2026, a lot of taxpayers who’d have itemized a decade ago no longer clear that bar — even with a legitimate pile of medical bills.
Here’s how the math actually works, what qualifies, and where I see people make mistakes.
The 7.5% AGI Floor, With a Real Example
Take your AGI, multiply by 7.5%, and that’s the amount of medical spending that isn’t deductible no matter what. Only the excess counts.
Example: Priya, single, has an AGI of $60,000. 7.5% of that is $4,500 — the floor.
She had $9,200 in unreimbursed medical expenses in 2026: a surgery copay, physical therapy, and a new pair of glasses. Subtract the $4,500 floor, and she can deduct $4,700 on Schedule A — but only if her total itemized deductions (this $4,700 plus mortgage interest, state and local taxes, and any charitable giving) exceed her $16,100 standard deduction.
If she doesn’t have a mortgage or other big itemized deductions, $4,700 alone won’t get her past $16,100 — so she’d take the standard deduction instead and the medical expenses provide no additional tax benefit that year.
Do You Actually Clear the Standard Deduction?
This is the real gatekeeping question, and it’s why the medical expense deduction matters less than it used to for a lot of filers.
Example: The Hendersons, married filing jointly, have a $32,200 standard deduction to beat in 2026. Their AGI is $140,000, so the 7.5% floor is $10,500.
They had a difficult year: $28,000 in out-of-pocket medical costs from a family member’s extended care, plus $9,000 in mortgage interest and $8,000 in state and local taxes (capped, depending on the SALT limit that applies to their situation).
Medical deduction after the floor: $28,000 − $10,500 = $17,500. Add the $9,000 mortgage interest and $8,000 SALT: total itemized deductions come to $34,500 — just over their $32,200 standard deduction. In a year like this, itemizing wins, even if narrowly.
Run the numbers before assuming either way. A single major medical event can be the difference between itemizing being worth it and not.
Subscribe or follow us and I’ll flag it here if the AGI floor or standard deduction amounts change.
What Counts as a Qualifying Medical Expense
The IRS defines this broadly in Publication 502. Common qualifying costs include:
- Doctor, dentist, and specialist visit copays and fees
- Prescription medications
- Hospital and surgery costs
- Mental health treatment, including therapy and counseling
- Vision care — eye exams, glasses, contacts
- Hearing aids
- Long-term care premiums and services, up to age-based IRS limits
- Medical travel: 20.5 cents per mile in 2026, plus parking and tolls, for trips to and from medical care
What generally does not qualify: cosmetic procedures (unless medically necessary), general health items like vitamins or gym memberships, and — importantly — any expense already reimbursed through insurance, an HSA, or an FSA.
HSA, FSA, and This Deduction Don’t Stack
If you paid for an expense using HSA or FSA funds, you already got the tax break on that money going in — you can’t also deduct it here. That would be double-dipping, and the IRS checks for it.
This is one reason I think the HSA is the better tool for most people with predictable medical costs: the tax benefit is automatic and doesn’t depend on clearing a 7.5% floor or beating the standard deduction. The itemized medical deduction is really a backstop for the years an HSA or FSA wasn’t enough to cover what happened.
Common Issues to Watch Out For
1. Assuming any medical spending is deductible. I see this misunderstanding a lot. Only the portion above 7.5% of AGI counts, and only if you itemize. A $2,000 medical bill on a $70,000 AGI ($5,250 floor) deducts nothing on its own.
2. Forgetting insurance premiums might already be pre-tax. If your health insurance premiums come out of your paycheck pre-tax (common with employer plans), you can’t deduct them again here. Only after-tax premiums — like COBRA payments or individual marketplace premiums paid out of pocket — potentially qualify.
3. Not tracking medical mileage. The 20.5 cents/mile rate for 2026 adds up if you’re making regular trips for treatment, dialysis, or a dependent’s therapy appointments. Keep a simple log — date, destination, purpose, miles.
4. Missing the self-employed health insurance deduction. If you’re self-employed, your health insurance premiums are usually deducted above-the-line on Schedule 1, not run through this itemized calculation. Don’t do both.
5. Not comparing itemizing vs. the standard deduction each year. Your itemizing decision resets annually. A year with unusually high medical costs might tip the scale toward itemizing even if you took the standard deduction the year before — and vice versa.
Looking Ahead: 2027
The 7.5% AGI floor is set in the tax code and isn’t scheduled to change — it’s been permanent since 2021 and doesn’t require an annual IRS adjustment the way contribution limits do.
What will move for 2027: the standard deduction (inflation-adjusted under the OBBBA, typically announced in October or November) and the medical mileage rate (usually announced in December for the following year). I’ll update this page once those are confirmed.
For more on this year’s other key thresholds, see the 2026 IRS tax brackets and the HSA contribution limits guide.
