Medical expense deduction: how the 7.5% of AGI threshold works

Can I deduct medical expenses? The 7.5% rule

You can, but two tests stand in the way. First, the medical expense deduction is an itemized deduction, so your Schedule A total has to beat your standard deduction. Second, only the portion of qualifying costs above 7.5% of your adjusted gross income counts. Both tests use the same year: the costs you actually paid in 2026 against your 2026 AGI.

The math takes three lines:

1. Add up medical and dental costs you paid in the year, minus any reimbursements.
2. Multiply your AGI by 7.5%.
3. Subtract line 2 from line 1. A positive result is your deduction; zero or less means none.

Example: AGI is $70,000, so the threshold is $5,250. You paid $9,000 in unreimbursed bills. Your medical expense deduction is $9,000 minus $5,250, or $3,750, which then joins your other items on Schedule A.

Medical expense deduction 2026: when it actually pays off

Because of the threshold and the standard deduction, this deduction mostly helps in years with a large, concentrated cost: surgery, a new baby with complications, dental implants, or assisted living. It is also common among retirees, whose AGI is often lower and whose premiums and care costs are higher.

Consider a single 67-year-old with AGI of $48,000 who paid $22,000 in 2026 for Medicare premiums, dental work, hearing aids and a hospital stay. The threshold is $3,600, leaving $18,400 of deductible medical costs. Add $4,000 of state income and property taxes, and Schedule A totals $22,400. That beats the $18,150 standard deduction for a single filer 65 or older ($16,100 plus $2,050) by $4,250.

The senior deduction of up to $6,000 is claimed separately on Schedule 1-A, so it does not change this comparison. Our guide to whether to itemize or take the standard deduction covers the full decision.

Deductible medical expenses: what counts and what does not

Publication 502 defines medical care as costs to diagnose, cure, treat or prevent disease, or to affect any structure or function of the body. You can include costs for yourself, your spouse and your dependents.

Costs that count

• Doctor, dentist, hospital, lab and therapy bills, including psychiatric and psychological care.
• Prescription drugs and insulin.
• Health, dental and vision insurance premiums paid with after-tax money, and Medicare Part B and Part D premiums.
• Glasses, contact lenses, hearing aids, crutches, wheelchairs and dentures.
• Driving to care at 20.5 cents a mile from January through June 2026 and 23.5 cents a mile from July through December, plus parking and tolls.
• Lodging while away from home for medical care, up to $50 a night per person.
• Qualified long-term care services and premiums, up to the age-based caps below.

Costs that do not count

• Premiums your employer paid or that came out of your pay before tax.
• Anything paid or reimbursed by insurance, an HSA, an FSA or an HRA.
• Over-the-counter medicines other than insulin.
• Cosmetic surgery, unless it corrects a deformity from a congenital condition, an accident or a disease.
• Gym memberships and general health items such as vitamins taken for general wellness.

Long-term care premium limits for 2026

Premiums for a qualified long-term care insurance policy count as medical expenses, but only up to a cap that depends on the insured person's age at the end of the year. Anything above the cap is ignored. The caps are set each year by the IRS; the 2026 figures come from Rev. Proc. 2025-32.

Each spouse has a separate cap. A married couple aged 62 and 72 could count up to $4,960 plus $6,200, or $11,160, of long-term care premiums toward their medical total for 2026.

Are health insurance premiums deductible if you are self-employed?

Self-employed people usually get a better deal elsewhere. The self-employed health insurance deduction on Schedule 1 lets you subtract premiums for yourself, your spouse and dependents directly from income, with no 7.5% threshold and no need to itemize. It is limited to your net profit from the business and is not allowed for any month you could join an employer-subsidized plan, including through a spouse.

You cannot count the same premium twice. Any premiums left over after the Schedule 1 deduction, for example because your profit was too small, can go on Schedule A as a medical expense. Because the Schedule 1 deduction lowers AGI, it also shrinks your 7.5% threshold.

Ways to get over the threshold

If you are close, timing matters more than anything. Schedule elective care, such as dental work or new hearing aids, in a year when you already expect large bills. Keep itemized receipts and your insurer's explanation of benefits statements, since those show what you paid after coverage.

Lowering AGI also lowers the threshold. Contributions to a traditional 401(k) or deductible IRA reduce AGI; the non-itemizer charitable deduction does not, because it is taken after AGI, as explained on our page about the charitable deduction without itemizing. Very high earners should also read about the itemized deduction limit for high income, which can trim the final total. The base amounts you are comparing against are in our standard deduction amounts guide.