IRS Tax Code Section 213(d) Eligible Medical Expenses

Eligible medical expenses under Section 213(d) of the Internal Revenue Code fall into four categories: amounts paid to diagnose, treat, or prevent disease (or to affect any structure or function of the body); transportation primarily for and essential to medical care; qualified long-term care services; and premiums for insurance covering medical care.¹ The same definition controls what you can deduct on Schedule A and what qualifies for tax-free reimbursement from an HSA, FSA, or HRA.²

Diagnosis, Treatment, and Prevention

The first and broadest category covers amounts paid to diagnose, treat, or prevent disease, and costs that affect any structure or function of the body.¹ The “structure or function” language is what pulls in procedures like LASIK and orthodontics even though they aren’t treating disease in the traditional sense.

Medical and Dental Services

Payments to physicians, surgeons, dentists, psychiatrists, psychologists, and other licensed practitioners qualify, along with hospital services, nursing care, and lab fees that are part of your medical care.³ Dental expenses include cleanings, fluoride treatments, X-rays, fillings, braces, extractions, and dentures. Teeth whitening is excluded.

Mental health care is fully covered. Fees for psychiatric care, psychoanalysis, and therapy count when received as medical treatment. One narrow exception: psychoanalysis that is part of required training to become a psychoanalyst does not qualify.³

Prescription Drugs, Vision, and Hearing

Prescription medications and insulin are deductible. A prescribed drug is one that requires a doctor’s prescription for use by an individual. Over-the-counter medications do not qualify, with the sole exception of insulin.³

Eyeglasses, prescription contact lenses, hearing aids, and guide dogs or other service animals for a person with visual, hearing, or physical disabilities all qualify.⁴ Eye surgery to correct defective vision, such as LASIK, is also deductible.³

Fertility, Reconstruction, and Substance Abuse Treatment

Procedures to overcome an inability to have children qualify, including in vitro fertilization, temporary storage of eggs or sperm, and surgery to reverse a prior sterilization. Breast reconstruction surgery and prostheses following a mastectomy for cancer also qualify.³

Inpatient treatment at a therapeutic center for alcohol or drug addiction qualifies, including the cost of meals and lodging at the facility during treatment.³

Transportation and Lodging

Section 213(d)(1)(B) separately covers transportation that is primarily for and essential to receiving medical care.¹ Qualifying costs include bus, taxi, train, or plane fares, ambulance services, parking, and tolls.³

If you drive your own car to a medical appointment, you can deduct actual out-of-pocket costs (gas and oil) or use the IRS standard medical mileage rate, which is 20.5 cents per mile for 2026.⁵ Parking and tolls are deductible on top of either method.⁴

Lodging while traveling away from home for medical care is capped at $50 per night per person. The cap applies to both the patient and a necessary companion, so a parent traveling with a sick child could deduct up to $100 per night total. Meals during medical travel are not deductible. The only exception is meals provided as part of inpatient care at a hospital or similar facility.³

Long-Term Care Services and Insurance Premiums

The remaining two categories cover long-term care services and insurance premiums.

Qualified Long-Term Care Services

Section 213(d) treats qualified long-term care services as medical care by cross-reference to Section 7702B(c).⁶ These are services needed by a chronically ill person under a plan of care prescribed by a licensed health care practitioner. Ongoing nursing care, personal care assistance, and similar services for a chronic illness or disability fall into this category.

Health Insurance Premiums

Premiums for insurance covering medical care are deductible. That includes policies covering hospitalization, surgical services, prescription drugs, dental care, and contact lens replacement, along with Medicare Part B and Part D premiums.³

Premiums for life insurance, disability insurance, or policies that pay a fixed amount upon illness without regard to actual expenses incurred are not medical care.

Long-Term Care Insurance Premium Caps

Premiums for qualified long-term care insurance are deductible, but subject to annual age-based caps. For 2025, those caps are:

Age 40 or under: $480
Age 41 to 50: $900
Age 51 to 60: $1,800
Age 61 to 70: $4,810
Over age 70: $6,020

The limits apply per person and adjust annually for inflation.⁷ The contract itself must meet the definition of a qualified long-term care insurance contract under Section 7702B(b), which requires among other things that the contract be guaranteed renewable and provide no cash surrender value.⁶

Medical Equipment and Home Modifications

Wheelchairs, crutches, oxygen equipment, and prosthetic limbs are fully deductible because their primary purpose is medical care. So are special vehicle modifications, such as hand controls for a person with a disability.³

Home improvements work differently. A medically necessary improvement is deductible only to the extent its cost exceeds any increase in your home’s fair market value.³ Install a $20,000 elevator that adds $8,000 to your home’s value, and $12,000 is deductible. A professional appraisal before and after is typically what supports that calculation.

Some improvements are treated as adding zero value to the home, so their full cost qualifies:

Constructing entrance ramps
Widening doorways and hallways
Installing grab bars in bathrooms
Modifying fire alarms, smoke detectors, or other warning systems for hearing-impaired individuals
Lowering kitchen cabinets or modifying electrical outlets and fixtures

Ongoing costs to operate and maintain a medically necessary capital improvement are also deductible. Electricity to run a medical elevator is a qualifying expense.³

What’s Excluded

The exclusions matter as much as the inclusions, because many common health-related costs fall outside the 213(d) definition.

Cosmetic Surgery

Any procedure directed at improving appearance that does not meaningfully promote the proper function of the body or treat illness is excluded.¹ An elective facelift or teeth whitening does not qualify. The exception is surgery necessary to correct a deformity arising from a congenital abnormality, an accidental injury, or a disfiguring disease. Breast reconstruction after a cancer mastectomy is the clearest example.³

General Health and Wellness

Expenses merely beneficial to general health do not qualify, even when a doctor recommends them. Health club memberships, swimming lessons, dance classes, vitamins, and nutritional supplements all fail the test unless a physician prescribes them for a specific diagnosed disease.²

Weight-loss programs sit on this line. A program undertaken for general health or appearance improvement does not qualify. The same program becomes deductible if a physician diagnoses obesity, hypertension, heart disease, or another specific condition and prescribes weight loss as treatment.³ The activity can be identical; the medical context around it decides the outcome.

Over-the-Counter Products

Non-prescription drugs other than insulin are not deductible. Vitamins, herbal supplements, and natural medicines qualify only if recommended by a medical practitioner as treatment for a specific condition diagnosed by a physician.³

Whose Expenses You Can Count

You can deduct medical costs you pay for yourself, for your spouse (as long as you were married at the time the services were provided or the expenses were paid), and for anyone who qualifies as your dependent.³

You can also deduct expenses for someone who would have been your dependent except that they earned too much gross income, filed a joint return, or you could be claimed as a dependent on someone else’s return. That catches a common situation: an aging parent whose Social Security income sits above the qualifying-relative threshold but whose medical bills you pay.

For divorced or separated parents, either parent can deduct the medical expenses they pay for a child if the child was in one or both parents’ custody for more than half the year and received more than half their support from the parents together. It doesn’t matter which parent claims the child as a dependent for other tax purposes.³

No Double-Dipping With HSAs, FSAs, and HRAs

The Section 213(d) definition is the same one that governs tax-free reimbursements from a Health Savings Account, Flexible Spending Arrangement, or Health Reimbursement Arrangement.² You cannot deduct an expense on Schedule A that has already been paid for or reimbursed through one of those accounts. Only your truly unreimbursed expenses count. Pay $15,000 in bills and get $3,000 back from an FSA, and $12,000 is what enters the deduction calculation.

The 7.5% AGI Floor

Even after you identify every qualifying expense, only the portion above 7.5% of your adjusted gross income is deductible, and only if you itemize on Schedule A.⁴ On an $80,000 AGI, the first $6,000 of medical expenses produces no deduction; only amounts above that count. And because itemizing means giving up the standard deduction, which is $16,100 for single filers and $32,200 for joint filers in 2026, your combined itemized deductions have to clear that threshold before the medical deduction produces any benefit.⁸ The eligibility rules described above still control what’s a “medical expense” for HSA, FSA, and HRA purposes even when the Schedule A math doesn’t work out.

1
Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses
2
Internal Revenue Service. Frequently Asked Questions About Medical Expenses Related to Nutrition, Wellness and General Health
3
Internal Revenue Service. Publication 502, Medical and Dental Expenses
4
Internal Revenue Service. Topic No. 502, Medical and Dental Expenses
5
Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate at 72.5 Cents Per Mile, Up 2.5 Cents
6
Office of the Law Revision Counsel. 26 USC 7702B – Treatment of Qualified Long-Term Care Insurance
7
Internal Revenue Service. Eligible Long-Term Care Premium Limits
8
Internal Revenue Service. IRS Releases Tax Inflation Adjustments for Tax Year 2026