No one wants to be ill, but at least Uncle Sam gives Americans a little relief in the form of federal income-tax deductions for medical expenses.
"Medical bills can be a huge expense, so the Internal Revenue Service gives people a break so they can recoup some of that money," says Lisa Greene-Lewis, a certified public accountant with TurboTax.
But who can deduct what can be complicated. Experts say few taxpayers fully understand the rules.
Here's a look at the basics of deducting medical expenses from your federal income taxes. Consult your tax adviser for specifics regarding your personal situation.
Who qualifies for medical-expense tax deductions?
The Internal Revenue Code includes two important rules that can limit who truly qualifies for relief from medical expenses:
- You must generally itemize deductions on Form 1040 Schedule A rather than take the "standard deduction" if you want a break on medical expenses. If what you plan to deduct for everything (from medical bills to mortgage interest) adds up to less than the standard deduction ($12,000 for singles, $18,000 for heads of household and $24,000 for married joint filers for tax year 2018), there's no point in itemizing. The Tax Cuts and Jobs Act of 2017 increased these numbers substantially.
- Taxpayers can only deduct allowable medical expenses that exceed 7.5 percent of "adjusted gross income" (AGI). That's the amount you earn in a given year from wages, investments and other sources minus what you paid for alimony, student-loan interest and a few other things. Starting in tax year 2019, that percentage will increase to 10 percent, which was the level previously. So, for 2018 tax year, if a married couple has $100,000 AGI and $8,000 in qualified medical expenses, they can deduct only $500. That's because 7.5 percent of $100,000 is $7,500. You can find your AGI on line 37 of Form 1040.
Are health insurance premiums tax deductible?
Yes, in certain circumstances, you can deduct your health insurance premiums as part of your overall medical expenses.
But you can deduct only premiums that you pay with after-tax money from your own pocket. For example:
- If your health insurance premiums are paid entirely by your employer or the government, you cannot deduct the cost.
- If you have health insurance through your employer and your share of the premium is deducted from your paycheck pre-tax, you cannot deduct the cost because the premiums were tax-free already. If you don’t know whether you pay pre-tax or after-tax, ask your human resources department.
- If you buy health insurance through the state- or federally run health insurance marketplaces, you can deduct only the portion of the premium you pay out of your own pocket. You cannot deduct the amount of any subsidy.
- If you buy an individual or family health insurance plan, either on the open market or through a marketplace, and you pay all of the cost out of pocket, then the whole amount is deductible.
- Your total medical expenses, including premiums, must surpass 7.5 percent of your adjusted gross income to be deductible.
What other medical costs are tax deductible?
Assuming you pass the above tests, the IRS lets you write off pretty much every out-of-pocket medical expense that's ordered by a doctor or other health care professional. (See IRS Publication 502 for a list.)
Common items you can deduct from taxes include medical appointments, tests, prescription drugs and durable items like wheelchairs and prescription glasses. In fact, you can even write off unusual expenses if they're medically necessary.
You can also deduct transportation expenses for going to the doctor -- parking, tolls, mileage, cab or bus fares -- and even air fare and certain lodging costs for out-of-town treatments.
But remember, you can only write off out-of-pocket expenses -- copays, deductibles, etc. -- not bills that your insurance covers.
An important thing to remember is that a health insurance deductible is completely different than tax deductibles. A health insurance deductible is the level in which you have to pay the health services costs until your plan kicks in money.
Health insurance deductibles have skyrocketed in recent years. So, even though people's premiums are only rising a few percentage points a year, they are faced with much higher deductibles.
The only silver lining in higher deductibles is that you may be able to get some of that money back through deducting those medical costs on your taxes.
What health expenses are not tax deductible?
There's a wide list of things you can't deduct, from medical marijuana to over-the-counter vitamins and drugs (except insulin). Hair transplants and cosmetic surgery are also out, unless procedures correct underlying medical problems (like breast-reconstruction surgery following mastectomies).
As noted above, you also can't deduct expenses that your insurance covers, nor things you paid for with money from a flexible spending account or health savings account. If you get insurance through work, you typically can't write off your share of the premiums because your employer won't normally withhold taxes on the money in the first place.
Writing off health insurance for the self-employed
One big exception to the above rules involves health insurance premiums paid by self-employed people. You can write those off as adjustments to income even if you don't itemize your deductions. The adjustment to income cannot exceed what you earned, though.
Self-employed people can deduct health insurance premiums directly on Form 1040 (Line 29 on returns for the 2018 tax year). You deduct all other qualified medical expenses on Schedule A, Line 1.
How to maximize your health care deductions
You obviously can't control when you get sick, but Greene-Lewis says Americans who are close to meeting the annual AGI threshold should "bunch up" procedures to maximize any deductibility.
For instance, if one family member has a major illness in a given year and rings up big hospital bills, everyone else in the family should get any needed dental work, prescription eyeglasses, etc., during the same year in order to boost the available tax break.
"You should look at anything you were putting off and bump it up [to the current tax year] if that's going to put you over the AGI threshold," she says.
You don't need to attach receipts to your 1040, but it's a good idea to keep them for three years after filing your return just in case the IRS audits you.