Tax-Deductible Medical Expenses for Seniors: Premiums and Long-Term Care

Seniors can claim a deduction for unreimbursed medical and dental costs that exceed 7.5% of adjusted gross income, but only by itemizing on Schedule A.¹ Tax-deductible medical expenses for seniors cover a wide range of costs, from Medicare premiums and prescription drugs to long-term care, hearing aids, and travel to appointments. The practical question is whether your total itemized deductions clear the standard deduction, which is now substantially larger for people 65 and older.

The 7.5% AGI Floor

Only the portion of your medical spending above 7.5% of your adjusted gross income counts.² Anything below that floor is non-deductible. The costs must be unreimbursed by insurance or any other source, and they can be for you, your spouse, or a dependent.

With an AGI of $50,000, the first $3,750 in medical costs doesn’t count. With an AGI of $80,000, the floor is $6,000. Lower-income seniors reach the threshold sooner, but they also need fewer total deductions before itemizing becomes worthwhile.

Is Itemizing Worth It for Seniors

The medical deduction only helps if your itemized deductions beat the standard deduction. For 2026, the base standard deduction is $16,100 for single filers and $32,200 for joint filers.³ Taxpayers 65 and older add another $2,050 (single) or $1,650 per qualifying spouse (joint).

From 2025 through 2028, seniors also qualify for a new enhanced deduction of $6,000 per person, or $12,000 for a couple where both spouses are 65 or older. It phases out above $75,000 modified AGI for single filers and $150,000 for joint filers, and it applies whether you itemize or take the standard deduction.⁴

Stacked together, a single senior under the income limit sees roughly $24,150 in standard deductions. A qualifying couple approaches $47,700. Beating those numbers through itemizing usually requires a big medical year (major surgery, a nursing home stay, extensive dental work) combined with other deductions like state taxes, mortgage interest, and charitable gifts.

What Counts as a Deductible Medical Expense

The IRS treats a medical expense as anything primarily for diagnosing, treating, or preventing disease, or affecting a structure or function of the body.² The categories most relevant to older adults include:

Fees paid to doctors, surgeons, dentists, chiropractors, psychiatrists, psychologists, and other licensed providers.
Inpatient hospital care, lab work, and nursing services provided at a facility or in the home.
Prescription drugs and insulin. Over-the-counter medications generally do not qualify.
Hearing aids (including batteries, repairs, and maintenance), wheelchairs, walkers, crutches, prescription eyeglasses, and contact lenses.
Dental fillings, extractions, dentures, and braces; eye exams and corrective procedures.
The cost of buying, training, and maintaining a service animal, including food, grooming, and vet care.

Special diet costs sit in a narrow exception. Medically prescribed food is deductible only when it doesn’t meet normal nutritional needs, treats or alleviates an illness, and is substantiated by a physician, and even then only the amount above what you’d normally spend on food.⁵ Vitamins and supplements taken for general health don’t qualify.

Medicare and Other Insurance Premiums

Most Medicare premiums are deductible. The standard Part B premium is $202.90 per month in 2026, or $2,434.80 for the year.⁶ Part D, Medicare Advantage, and Medigap premiums also qualify.² Premiums paid with pre-tax money (typically through payroll before retirement) are not deductible, because you never paid tax on those dollars. Premiums deducted from your Social Security check are paid with after-tax money and do qualify.

Long-Term Care Services and Insurance

Qualified long-term care services are deductible when a licensed healthcare provider prescribes them for a chronically ill person. Covered care includes rehabilitation, therapy, and personal care such as help with bathing, dressing, and eating.²

Premiums for a qualified long-term care insurance policy are also deductible, but only up to an age-based annual cap. For 2026:

Age 40 or under: $500
Age 41 to 50: $930
Age 51 to 60: $1,860
Age 61 to 70: $4,960
Age 71 or older: $6,200

The caps are per person, so spouses each apply their own bracket. The eligible premium then joins your other medical costs and the combined total is subject to the 7.5% floor.¹ Long-term care premiums do not bypass the threshold, despite a common misconception.

Nursing Homes and Assisted Living

Whether residential care is deductible depends on why the person is there. If the primary reason is medical care, the entire cost of the facility (including room and board) is deductible, less any insurance reimbursement. If the primary reason is non-medical, only the portion attributable to actual medical services counts; room, board, and non-medical charges don’t.⁷

For assisted living, a physician’s certification that the resident is chronically ill and needs the level of care the facility provides makes the full cost more likely to be fully deductible. Without that certification, expect to deduct only the clearly medical line items, like skilled nursing or physical therapy. Ask the facility for an itemized breakdown of medical versus non-medical charges each year.

Home Modifications and Medical Equipment

Improvements made for a medical reason are deductible only to the extent they don’t increase your home’s value. Spend $10,000 on a wheelchair ramp that raises the appraised value by $6,000, and $4,000 is deductible as a medical expense.² Grab bars, widened doorways, stairway lifts, and lowered cabinets often add little or nothing to market value, so the full cost may qualify.

Operating and maintaining medically necessary equipment or modifications is deductible too. An air filtration system prescribed for a medical condition that adds $40 a month to your electric bill produces a $480 annual medical expense, even if the installation itself wasn’t fully deductible.

Travel to Medical Care

Transportation for medical care is deductible. That covers bus, taxi, train, plane, and ambulance fares. If you drive, you can deduct actual gas and oil costs or use the 2026 standard medical mileage rate of 20.5 cents per mile, plus parking and tolls either way.⁸²

Overnight lodging tied to out-of-town treatment is deductible up to $50 per night per person, and the cap applies separately to a necessary companion. The stay must be primarily for care at a licensed hospital or equivalent facility, with no significant vacation element. Meals during medical travel are not deductible.¹ A companion’s transportation qualifies when they provide medical assistance such as giving injections or administering medication.

What Does Not Qualify

Several categories of spending feel medical but are excluded:

Cosmetic surgery or treatments that improve appearance without treating disease or correcting a deformity from illness, injury, or a congenital abnormality.
Over-the-counter drugs other than insulin, including pain relievers, cold medicine, and allergy pills.
Vitamins and supplements taken for general health, unless a physician prescribes them for a diagnosed condition.²
Gym memberships and fitness programs, even when a doctor recommends exercise.
Toiletries and personal-care items like toothpaste and sunscreen.
Funeral and burial costs, regardless of cause of death.

Timing and Records

Medical expenses are deductible in the year you pay them, not the year you get the care.² A credit card charge counts in the year you swipe the card, not the year you pay the statement. That opens a genuine planning move: if you’re close to the 7.5% floor as the year ends, paying for elective work like dental implants or hearing aids before December 31 can push you over the threshold. Splitting those same costs across two years may leave neither year deductible.

Keep receipts, billing statements, and Explanation of Benefits forms. The IRS can examine a return for up to three years after filing, and undocumented deductions get disallowed.⁹ EOBs matter especially, because they show exactly how much of a bill went unreimbursed.

1
Office of the Law Revision Counsel. 26 U.S. Code 213 – Medical, Dental, Etc., Expenses
2
Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses
3
Internal Revenue Service. IRS Releases Tax Inflation Adjustments for Tax Year 2026, Including Amendments From the One, Big, Beautiful Bill
4
Internal Revenue Service. One, Big, Beautiful Bill Act: Tax Deductions for Working Americans and Seniors
5
Internal Revenue Service. Frequently Asked Questions About Medical Expenses Related to Nutrition, Wellness and General Health
6
Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
7
Internal Revenue Service. Medical, Nursing Home, Special Care Expenses
8
Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate
9
Internal Revenue Service. Topic No. 305, Recordkeeping