Medical Expense Deduction 2026
Had a big medical year and heard you can write it off? You can — but there's a catch that trips people up every year on r/tax: only the amount above 7.5% of your income counts, and you have to itemize. Here's the real math.
Threshold
7.5%
Of AGI
Deductible
Above that
Only the excess
Requires
Itemizing
Schedule A
Who benefits
High medical
Or low income
The 7.5% Threshold, Explained
You can only deduct medical expenses that exceed 7.5% of your adjusted gross income (AGI). The first 7.5% is "on you" — the tax code assumes that's a normal, expected amount. Anything above it is deductible (if you itemize).
In practice, this means the deduction helps two groups: people with very high medical costs (a major surgery, chronic condition), and people with low incomes (where 7.5% is a small number).
Understand your income picture
Plug in your numbers to see where 7.5% of your AGI falls.
What Counts as a Medical Expense
- Doctor and dentist visits, surgeries, hospital stays.
- Prescription drugs and insulin.
- Health, dental, and vision insurance premiums (if not already pre-tax).
- Therapy, medical equipment, and certain home care.
- Mileage to and from medical appointments (at the IRS medical mileage rate).
Note: pre-tax premiums (like those deducted from your paycheck or HSA reimbursements) generally can't be double-counted.
The Itemizing Catch
Medical expenses are an itemized deduction, which means they only help if your total itemized deductions beat the standard deduction ($16,100 single / $32,200 joint in 2026). With the standard deduction that high, a lot of people with moderate medical costs never clear the bar — so they get zero benefit. That's the honest, often-disappointing truth.
A Worked Example
Say your AGI is $60,000 and you had $10,000 in medical expenses this year:
- 7.5% of $60,000 = $4,500 (not deductible).
- $10,000 − $4,500 = $5,500 (potentially deductible).
That $5,500 only helps if, combined with your other itemized deductions (mortgage interest, SALT, charity), your total exceeds the standard deduction. If it does, at a 22% bracket that $5,500 saves about $1,210.
Frequently Asked Questions
Can I deduct health insurance premiums?
Only if they're paid with after-tax dollars. Premiums taken out of your paycheck pre-tax (or reimbursed by an HSA) can't be deducted again. Self-employed people have a separate, better deduction for their premiums.
Does an HSA change this?
Yes — if you paid a medical bill with HSA money, you can't also deduct it. The HSA already gave you the tax break on the way in. Don't double-dip.
Is the 7.5% based on my gross or net income?
It's based on adjusted gross income (AGI) — your income after things like retirement contributions and the student loan deduction, but before the standard deduction. It's line 11 on your Form 1040.
Can I deduct my family's medical expenses?
Yes — medical expenses for you, your spouse, and your dependents all count toward the same 7.5% threshold. Keep receipts for all of them.
Sources
- IRS Publication 502 — Medical and Dental Expenses.
- IRS Revenue Procedure 2025-32 — 2026 standard deduction.
- IRS — Schedule A itemized deduction rules.
This is informational, not tax advice. Whether itemizing helps depends on your full deduction picture.