On a U.S. federal return, unreimbursed medical and dental expenses can be itemized on Schedule A—but only the amount above 7.5% of your adjusted gross income (AGI) counts. If your AGI is $80,000, the first $6,000 of qualified medical expenses is disallowed by the floor; only spending above that line can join mortgage interest, charity, and SALT on the itemizing side. Many households never clear both the floor and the standard-deduction bar in the same year.
Pair this with Standard vs itemized deductions and the filing overview in Filing taxes for beginners. Expenses paid with HSA or FSA dollars are generally not deductible again.
How the 7.5% floor works
| Step | What you do |
|---|---|
| 1. Total qualified unreimbursed medical expenses for the tax year | Include amounts you paid—not amounts merely billed |
| 2. Multiply AGI × 7.5% | That product is the floor |
| 3. Subtract the floor from qualified expenses | Only the remainder goes on Schedule A |
| 4. Compare full itemized total vs standard deduction | Take the larger (all else equal) |
The percentage is set by law and has changed in past years; confirm the figure in IRS Publication 502 / Schedule A instructions for the year you are filing. State returns may use a different floor or no medical itemizing at all.
What often qualifies (and what does not)
Publication 502 is the checklist. Common in categories (rules and exceptions apply):
- Diagnosis, treatment, and prevention of disease (doctors, dentists, hospitals, prescription drugs)
- Certain insurance premiums you pay with after-tax dollars (not pre-tax payroll premiums)
- Qualifying long-term care premiums within IRS age-based limits
- Medically necessary equipment, glasses, hearing aids, and some home modifications prescribed for a condition
- Transportation primarily for and essential to medical care (mileage at the medical rate, parking, some fares)
Common out or limited items:
- Expenses reimbursed by insurance, employer plans, or paid from HSA/FSA
- Most cosmetic procedures
- General health clubs, vitamins for general health, and nonprescription drugs (unless IRS lists an exception)
- Funeral expenses
Self-employed health insurance is often an above-the-line deduction instead of Schedule A—see Self-employed health insurance deduction. Keep EOBs and itemized bills aligned with Medical bills and insurance.
Worked example
Taylor’s AGI is $100,000. Qualified unreimbursed medical expenses for the year total $11,500 (surgery patient share, prescriptions, and medically necessary transport). The 7.5% floor is $7,500. Schedule A medical line = $4,000 ($11,500 − $7,500).
Taylor’s other itemized amounts (illustrative): SALT capped at $10,000, mortgage interest $12,000, charity $2,000. Itemized total = $28,000. If the standard deduction for Taylor’s filing status is $15,000 (placeholder—use the real IRS figure), itemizing wins. If Taylor were MFJ with a much higher standard deduction and thinner mortgage interest, the same $4,000 medical line might still leave itemizing behind the standard deduction—software at TurboTax, H&R Block, Free File, or a CPA/EA should compute both.
Tax savings from that $4,000 medical deduction depend on marginal rate (Tax bracket vs effective rate). At a 22% federal marginal rate, $4,000 of extra deduction is worth about $880 before state effects—not $4,000 cash back.
Timing and bunching tips
- Pay elective but qualified care in a year when you will already itemize (big mortgage interest, charity bunching, or a high medical year).
- Do not double-dip: HSA/FSA distributions for the same expense remove Schedule A eligibility for that dollar.
- Track mileage and lodging rules carefully when treatment requires travel.
- Premium tax credit reconciliation and marketplace premiums have separate rules—do not assume every health premium is Schedule A medical.
Checklist
- Confirm the AGI floor percentage for your tax year in IRS materials.
- Sum only unreimbursed, qualified expenses you actually paid.
- Subtract AGI × 7.5% before celebrating a “medical deduction.”
- Run standard vs itemized; the floor alone does not mean itemizing wins.
- Exclude HSA/FSA-paid amounts and insurance reimbursements.
- Keep receipts, EOBs, and mileage logs; ask a CPA/EA when surgery years or dependents complicate the file.
Educational only. Not tax, legal, or accounting advice. IRS thresholds, qualified-expense lists, and state conformity change by year. Confirm Publication 502 and consider a qualified professional before filing.