Is mental health therapy tax deductible

The cost of going to therapy is tax deductible for both clients and for therapists attending therapy sessions themselves.

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If you’re a client, there are particular requirements you need to meet so you can deduct therapy on your tax return. If you’re a therapist paying for therapy, you need to meet fewer requirements.

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However, since you’re deducting therapy as a business expense, you should follow best practices to ensure you don’t run afoul of the IRS.

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First, we’ll look at how therapy deductions differ between private individuals and therapists. Then, we’ll cover what you need to know to make sure your therapy sessions qualify as tax deductions, and how you can list them on your return.

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The difference between personal and professional therapy tax deductions

Whether you’re a private individual paying for therapy, or a professional therapist, you may only deduct the cost of therapy from your taxes if you pay for it out of pocket. Therapy covered by medical insurance is not eligible.

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However, that’s where the similarities end.

Deducting the cost of therapy as a private individual (non-therapist)

Private individuals are only able to deduct the cost of therapy from their taxes if the total cost of therapy for the year exceeds 7.5% of their adjusted gross income (AGI).

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The therapy must also be part of a medical treatment, though the IRS is pretty vague about what that means. Rule of thumb: if the therapy is necessary, and deals with specific issues that negatively impact one’s life, it’s probably deductible.

Deducting the cost of therapy as a professional therapist

As a self-employed therapist, you do not need to meet the same minimum threshold as individuals (7.5% of AGI) in order to deduct the cost of therapy.

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And any form of treatment that helps you do your job well, and allows you to continue doing it well, is considered valid for the purposes of tax deductions.

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You may see a therapist to help you navigate job-related issues: the emotional burden of supporting your clients, work-life balance, or even ethical dilemmas you face in your work.

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You may also see a therapist in order—at least partly—to keep you grounded in the client experience, so you never lose touch with how it feels to occupy “the other chair.”

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Finally, you may see a therapist in order to navigate your own, personal challenges: anxiety and stress, difficult relationships, or trauma.

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At the end of the day, your practice’s number one asset is you. Any kind of therapy that helps you stay healthy and function well as a human being benefits your business. That’s why it’s a valid business expense, and tax deductible.

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Finally, if you need to travel in order to attend therapy, you can deduct it on your taxes as a business travel expense.

Best practices for deducting the cost of therapy

If you’re planning to deduct the cost of therapy as a business expense, there are a few best practices you should follow in order to accurately file your taxes and avoid running into trouble with the IRS.

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‍Enter the expense in your books

Since therapy is a business expense, it needs to be entered in your general ledger—either by you (if you do your own bookkeeping) or by your bookkeeper. You may have a specific “Therapy” account in your chart of accounts, or you may include it under a different account.

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This not only ensures your bookkeeping is accurate, it will make it easier during tax time for you or your accountant to calculate the total amount your business spent on therapy for the year.

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‍Keep your receipts

As with all deductible business expenses, you’ll need to provide evidence in the case of an audit. Receipts are that evidence. For any therapy sessions you deduct on your tax return, plan to hold on to receipts for at least six years (the maximum statute of limitations on tax returns).

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‍When in doubt, check with your accountant‍

To reiterate: just about any type of psychotherapy that helps you do your job well qualifies as a business expense. But if you have doubts about a particular course of therapy, double check with a qualified accountant or tax advisor. They can give you the final word on whether your therapy counts as a business expense.
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How to deduct therapy on your tax return (Form 1040 or Form 1120S)

How you deduct therapy on your tax return varies according to whether your business is a sole proprietorship or an S corporation.

Deducting therapy expenses as a sole proprietor

To deduct the cost of therapy as a sole proprietor, list it as an expense on Schedule C of IRS Form 1040.

Deducting therapy expenses as an S corporation

On IRS Form 1120S, enter the total amount of “Other Deductions” (which includes therapy) on Line 19. In a separate, attached statement, include a breakdown of all these “Other Deductions,” including your therapy expense.

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You should identify your therapy expense on this attached statement as “Code S.” If this is your first year filing as an S corporation, it’s a good idea to get help from a qualified accountant.
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The cost of therapy is just one of many expenses therapists tend to overlook while filing their taxes. For a complete rundown of all the deductions you can take advantage of this tax season, get Heard’s Complete Guide to Tax Deduction for Therapists.‍

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This post is to be used for informational purposes only and does not constitute legal, business, or tax advice. Each person should consult his or her own attorney, business advisor, or tax advisor with respect to matters referenced in this post.

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Bryce Warnes is a West Coast writer specializing in small business finances.

Medical expenses include the premiums you pay for insurance that covers the expenses of medical care, and the amounts you pay for transportation to get medical care. Medical expenses also include amounts paid for qualified long-term care services and limited amounts paid for any qualified long-term care insurance contract.

Medical care expenses must be primarily to alleviate or prevent a physical or mental disability or illness. They don’t include expenses that are merely beneficial to general health, such as vitamins or a vacation.

Medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and for the purpose of affecting any part or function of the body. These expenses include payments for legal medical services rendered by physicians, surgeons, dentists, and other medical practitioners. They include the costs of equipment, supplies, and diagnostic devices needed for these purposes.

If you and your spouse live in a community property state and file separate returns or are registered domestic partners in Nevada, Washington, or California, any medical expenses paid out of community funds are divided equally. Generally, each of you should include half the expenses. If medical expenses are paid out of the separate funds of one individual, only the individual who paid the medical expenses can include them. If you live in a community property state and aren’t filing a joint return, see Pub. 555, Community Property.

If you and your spouse live in a noncommunity property state and file separate returns, each of you can include only the medical expenses each actually paid. Any medical expenses paid out of a joint checking account in which you and your spouse have the same interest are considered to have been paid equally by each of you, unless you can show otherwise.

You can’t include medical expenses that were paid by insurance companies or other sources. This is true whether the payments were made directly to you, to the patient, or to the provider of the medical services.

If you didn’t claim a medical or dental expense that would have been deductible in an earlier year, you can file Form 1040-X, Amended U.S. Individual Income Tax Return, to claim a refund for the year in which you overlooked the expense. Don’t claim the expense on this year’s return. Generally, a claim for refund must be filed within 3 years from the date the original return was filed or within 2 years from the time the tax was paid, whichever is later.

You can include only the medical and dental expenses you paid this year, but generally not payments for medical or dental care you will receive in a future year. (But see Decedent under Whose Medical Expenses Can You Include, later, for an exception.) This is not the rule for determining whether an expense can be reimbursed by a flexible spending arrangement (FSA). If you pay medical expenses by check, the day you mail or deliver the check is generally the date of payment. If you use a “pay-by-phone” or “online” account to pay your medical expenses, the date reported on the statement of the financial institution showing when payment was made is the date of payment. If you use a credit card, include medical expenses you charge to your credit card in the year the charge is made, not when you actually pay the amount charged.

Generally, you can deduct on Schedule A (Form 1040) only the amount of your medical and dental expenses that is more than 7.5% of your AGI.

If you paid medical expenses for your deceased spouse or dependent, include them as medical expenses on your Schedule A (Form 1040) in the year paid, whether they are paid before or after the decedent’s death. The expenses can be included if the person was your spouse or dependent either at the time the medical services were provided or at the time you paid the expenses.

What if you pay medical expenses of a deceased spouse or dependent?

John properly filed his 2020 income tax return. He died in 2021 with unpaid medical expenses of $1,500 from 2020 and $1,800 in 2021. If the expenses are paid within the 1-year period, his survivor or personal representative can file an amended return for 2020 claiming a deduction based on the $1,500 medical expenses. The $1,800 of medical expenses from 2021 can be included on the decedent’s final return for 2021.

Form 1040-X can be filed for the year or years the expenses are treated as paid, unless the period for claiming a refund has passed. Generally, a claim for refund must be filed within 3 years of the date the original return was filed, or within 2 years from the time the tax was paid, whichever date is later.

What if the decedent’s return had been filed and the medical expenses weren’t included?

. Qualified medical expenses paid before death by the decedent aren’t deductible if paid with a tax-free distribution from any Archer MSA, Medicare Advantage MSA, or health savings account. .

The survivor or personal representative of a decedent can choose to treat certain expenses paid by the decedent’s estate for the decedent’s medical care as paid by the decedent at the time the medical services were provided. The expenses must be paid within the 1-year period beginning with the day after the date of death. If you are the survivor or personal representative making this choice, you must attach a statement to the decedent’s Form 1040 or 1040-SR (or the decedent’s amended return, Form 1040-X) saying that the expenses haven’t been and won’t be claimed on the estate tax return.

Medical expenses paid before death by the decedent are included in figuring any deduction for medical and dental expenses on the decedent’s final income tax return. This includes expenses for the decedent’s spouse and dependents as well as for the decedent.

You and your three brothers each provide one-fourth of your mother’s total support. Under a multiple support agreement, you treat your mother as your dependent. You paid all of her medical expenses. Your brothers repaid you for three-fourths of these expenses. In figuring your medical expense deduction, you can include only one-fourth of your mother’s medical expenses. Your brothers can’t include any part of the expenses. However, if you and your brothers share the nonmedical support items and you separately pay all of your mother’s medical expenses, you can include the unreimbursed amount you paid for her medical expenses in your medical expenses.

Any medical expenses paid by others who joined you in the agreement can’t be included as medical expenses by anyone. However, you can include the entire unreimbursed amount you paid for medical expenses.

If you are considered to have provided more than half of a qualifying relative’s support under a multiple support agreement, you can include medical expenses you pay for that person. A multiple support agreement is used when two or more people provide more than half of a person’s support, but no one alone provides more than half.

For whom you provided over half of the support in 2021. But see Child of divorced or separated parents , earlier, Support claimed under a multiple support agreement next, and Kidnapped child under Qualifying Relative in Pub. 501, Dependents, Standard Deduction, and Filing Information.

Who wasn’t a qualifying child (see Qualifying Child , earlier) of any taxpayer for 2021, and

Any other person (other than your spouse) who lived with you all year as a member of your household if your relationship didn’t violate local law,

Father, mother, or an ancestor or sibling of either of them (for example, your grandmother, grandfather, aunt, or uncle),

Brother, sister, half brother, half sister, or a son or daughter of any of them,

Son, daughter, stepchild, or foster child, or a descendant of any of them (for example, your grandchild),

This doesn’t apply if the child’s exemption is being claimed under a multiple support agreement (discussed later).

Live apart at all times during the last 6 months of the year.

Are divorced or legally separated under a decree of divorce or separate maintenance,

The child receives over half of his or her support during the year from his or her parents; and

The child is in the custody of one or both parents for more than half the year;

For purposes of the medical and dental expenses deduction, a child of divorced or separated parents can be treated as a dependent of both parents. Each parent can include the medical expenses he or she pays for the child, even if the other parent claims the child’s dependency exemption, if:

. You may be able to take a credit for other expenses related to an adoption. See the Instructions for Form 8839, Qualified Adoption Expenses, for more information..

But if you pay the agency or other person for medical care that was provided and paid for before adoption negotiations began, you can’t include them as medical expenses.

If you pay back an adoption agency or other persons for medical expenses they paid under an agreement with you, you are treated as having paid those expenses provided you clearly substantiate that the payment is directly attributable to the medical care of the child.

You can include medical expenses that you paid for a child before adoption if the child qualified as your dependent when the medical services were provided or when the expenses were paid.

A legally adopted child is treated as your own child. This child includes a child lawfully placed with you for legal adoption.

Didn’t provide over half of his or her own support for 2021; and

Lived with you for more than half of 2021;

Under age 24 at the end of 2021, a full-time student, and younger than you (or your spouse if filing jointly), or

Under age 19 at the end of 2021 and younger than you (or your spouse if filing jointly),

Is your son, daughter, stepchild, foster child, brother, sister, stepbrother, stepsister, half brother, half sister, or a descendant of any of them (for example, your grandchild, niece, or nephew);

If you are a U.S. citizen or national and your adopted child lived with you as a member of your household for 2021, that child doesn’t have to be a U.S. citizen or national, or a resident of the United States, Canada, or Mexico.

You can include medical expenses you paid for an individual that would have been your dependent except that:

You, or your spouse if filing jointly, could be claimed as a dependent on someone else’s 2021 return.

He or she filed a joint return for 2021; or

He or she received gross income of $4,300 or more in 2021;

The person was a U.S. citizen or national or a resident of the United States, Canada, or Mexico. If your qualifying child was adopted, see Exception for adopted child , later.

The person was a qualifying child (defined later) or a qualifying relative (defined later).

You can include medical expenses you paid for your dependent. For you to include these expenses, the person must have been your dependent either at the time the medical services were provided or at the time you paid the expenses. A person generally qualifies as your dependent for purposes of the medical expense deduction if both of the following requirements are met.

This year, John paid medical expenses for his wife Louise, who died last year. John married Belle this year and they file a joint return. Because John was married to Louise when she received the medical services, he can include those expenses in figuring his medical expense deduction for this year.

If Mary had paid the expenses, Bill couldn’t include Mary’s expenses on his separate return. Mary would include the amounts she paid during the year on her separate return. If they filed a joint return, the medical expenses both paid during the year would be used to figure their medical expense deduction.

Mary received medical treatment before she married Bill. Bill paid for the treatment after they married. Bill can include these expenses in figuring his medical expense deduction even if Bill and Mary file separate returns.

You can include medical expenses you paid for your spouse. To include these expenses, you must have been married either at the time your spouse received the medical services or at the time you paid the medical expenses.

You can generally include medical expenses you pay for yourself, as well as those you pay for someone who was your spouse or your dependent either when the services were provided or when you paid for them. There are different rules for decedents and for individuals who are the subject of multiple support agreements. See Support claimed under a multiple support agreement , later, under Qualifying Relative.

What Medical Expenses Are Includible?

Following is a list of items that you can include in figuring your medical expense deduction. The items are listed in alphabetical order.

This list doesn’t include all possible medical expenses. To determine if an expense not listed can be included in figuring your medical expense deduction, see What Are Medical Expenses, earlier.

Abortion

You can include in medical expenses the amount you pay for a legal abortion.

Acupuncture

You can include in medical expenses the amount you pay for acupuncture.

Alcoholism

You can include in medical expenses amounts you pay for an inpatient’s treatment at a therapeutic center for alcohol addiction. This includes meals and lodging provided by the center during treatment.

You can also include in medical expenses amounts you pay for transportation to and from alcohol recovery support organization (for example, Alcoholics Anonymous) meetings in your community if the attendance is pursuant to medical advice that membership in Alcoholics Anonymous is necessary for the treatment of a disease involving the excessive use of alcohol.

Ambulance

You can include in medical expenses amounts you pay for ambulance service.

Annual Physical Examination

See Physical Examination, later.

Artificial Limb

You can include in medical expenses the amount you pay for an artificial limb.

Artificial Teeth

You can include in medical expenses the amount you pay for artificial teeth.

Bandages

You can include in medical expenses the cost of medical supplies such as bandages.

Birth Control Pills

You can include in medical expenses the amount you pay for birth control pills prescribed by a doctor.

Body Scan

You can include in medical expenses the cost of an electronic body scan.

Braille Books and Magazines

You can include in medical expenses the part of the cost of Braille books and magazines for use by a visually impaired person that is more than the cost of regular printed editions.

Breast Pumps and Supplies

You can include in medical expenses the cost of breast pumps and supplies that assist lactation. This doesn’t include the costs of excess bottles for food storage.

Breast Reconstruction Surgery

You can include in medical expenses the amounts you pay for breast reconstruction surgery, as well as breast prosthesis, following a mastectomy for cancer. See Cosmetic Surgery, later.

Capital Expenses

You can include in medical expenses amounts you pay for special equipment installed in a home, or for improvements, if their main purpose is medical care for you, your spouse, or your dependent. The cost of permanent improvements that increase the value of your property may be partly included as a medical expense. The cost of the improvement is reduced by the increase in the value of your property. The difference is a medical expense. If the value of your property isn’t increased by the improvement, the entire cost is included as a medical expense.

Certain improvements made to accommodate a home to your disabled condition, or that of your spouse or your dependents who live with you, don’t usually increase the value of the home and the cost can be included in full as medical expenses. These improvements include, but aren’t limited to, the following items.

Constructing entrance or exit ramps for your home.
Widening doorways at entrances or exits to your home.
Widening or otherwise modifying hallways and interior doorways.
Installing railings, support bars, or other modifications to bathrooms.
Lowering or modifying kitchen cabinets and equipment.
Moving or modifying electrical outlets and fixtures.
Installing porch lifts and other forms of lifts (but elevators generally add value to the house).
Modifying fire alarms, smoke detectors, and other warning systems.
Modifying stairways.
Adding handrails or grab bars anywhere (whether or not in bathrooms).
Modifying hardware on doors.
Modifying areas in front of entrance and exit doorways.
Grading the ground to provide access to the residence.

Only reasonable costs to accommodate a home to your disabled condition are considered medical care. Additional costs for personal motives, such as for architectural or aesthetic reasons, aren’t medical expenses.

Capital expense worksheet.

Use Worksheet A to figure the amount of your capital expense to include in your medical expenses.

Worksheet A. Capital Expense Worksheet

Instructions:

Use this worksheet to figure the amount, if any, of your medical expenses due to a home improvement.

Enter the amount you paid for the home improvement

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Enter the value of your home immediately after the improvement

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Enter the value of your home immediately before the improvement

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Subtract line 3 from line 2. This is the increase in the value of your home due to the improvement

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• If line 4 is more than or equal to line 1, you have no medical expenses due to the home improvement; stop here.

• If line 4 is less than line 1, go to line 5.

Subtract line 4 from line 1. These are your medical expenses due to the home improvement

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Operation and upkeep.

Amounts you pay for operation and upkeep of a capital asset qualify as medical expenses as long as the main reason for them is medical care. This rule applies even if none or only part of the original cost of the capital asset qualified as a medical care expense.

Improvements to property rented by a person with a disability.

Amounts paid to buy and install special plumbing fixtures for a person with a disability, mainly for medical reasons, in a rented house are medical expenses.

Example.

John has arthritis and a heart condition. He can’t climb stairs or get into a bathtub. On his doctor’s advice, he installs a bathroom with a shower stall on the first floor of his two-story rented house. The landlord didn’t pay any of the cost of buying and installing the special plumbing and didn’t lower the rent. John can include in medical expenses the entire amount he paid.

Car

You can include in medical expenses the cost of special hand controls and other special equipment installed in a car for the use of a person with a disability.

Special design.

You can include in medical expenses the difference between the cost of a regular car and a car specially designed to hold a wheelchair.

Cost of operation.

The includible costs of using a car for medical reasons are explained under Transportation, later.

Chiropractor

You can include in medical expenses fees you pay to a chiropractor for medical care.

Christian Science Practitioner

You can include in medical expenses fees you pay to Christian Science practitioners for medical care.

Contact Lenses

You can include in medical expenses amounts you pay for contact lenses needed for medical reasons. You can also include the cost of equipment and materials required for using contact lenses, such as saline solution and enzyme cleaner. See Eyeglasses and Eye Surgery, later.

Crutches

You can include in medical expenses the amount you pay to buy or rent crutches.

Dental Treatment

You can include in medical expenses the amounts you pay for the prevention and alleviation of dental disease. Preventive treatment includes the services of a dental hygienist or dentist for such procedures as teeth cleaning, the application of sealants, and fluoride treatments to prevent tooth decay. Treatment to alleviate dental disease includes services of a dentist for procedures such as X-rays, fillings, braces, extractions, dentures, and other dental ailments. But see Teeth Whitening under What Expenses Aren’t Includible, later.

Diagnostic Devices

You can include in medical expenses the cost of devices used in diagnosing and treating illness and disease.

Example.

You have diabetes and use a blood sugar test kit to monitor your blood sugar level. You can include the cost of the blood sugar test kit in your medical expenses.

Disabled Dependent Care Expenses

Some disabled dependent care expenses may qualify as either:

Medical expenses, or
Work-related expenses for purposes of taking a credit for dependent care. See Pub. 503, Child and Dependent Care Expenses.

You can choose to apply them either way as long as you don’t use the same expenses to claim both a credit and a medical expense deduction.

Drug Addiction

You can include in medical expenses amounts you pay for an inpatient’s treatment at a therapeutic center for drug addiction. This includes meals and lodging provided by the center during treatment.

You can also include in medical expenses amounts you pay for transportaion to and from drug treatment meetings in your community if the attendance is pursuant to medical advice that the membership is necessary for the treatment of a disease involving the excessive use of drugs.

Drugs

See Medicines, later.

Eye Exam

You can include in medical expenses the amount you pay for eye examinations.

Eyeglasses

You can include in medical expenses amounts you pay for eyeglasses and contact lenses needed for medical reasons. See Contact Lenses, earlier, for more information.

Eye Surgery

You can include in medical expenses the amount you pay for eye surgery to treat defective vision, such as laser eye surgery or radial keratotomy.

Fertility Enhancement

You can include in medical expenses the cost of the following procedures performed on yourself, your spouse, or your dependent to overcome an inability to have children.

Procedures such as in vitro fertilization (including temporary storage of eggs or sperm).
Surgery, including an operation to reverse prior surgery that prevented the person operated on from having children.

Guide Dog or Other Service Animal

You can include in medical expenses the costs of buying, training, and maintaining a guide dog or other service animal to assist a visually impaired or hearing disabled person, or a person with other physical disabilities. In general, this includes any costs, such as food, grooming, and veterinary care, incurred in maintaining the health and vitality of the service animal so that it may perform its duties.

Health Institute

You can include in medical expenses fees you pay for treatment at a health institute only if the treatment is prescribed by a physician and the physician issues a statement that the treatment is necessary to alleviate a physical or mental disability or illness of the individual receiving the treatment.

Health Maintenance Organization (HMO)

You can include in medical expenses amounts you pay to entitle you, your spouse, or a dependent to receive medical care from an HMO. These amounts are treated as medical insurance premiums. See Insurance Premiums, later.

Hearing Aids

You can include in medical expenses the cost of a hearing aid and batteries, repairs, and maintenance needed to operate it.

Home Care

See Nursing Services, later.

Home Improvements

See Capital Expenses, earlier.

Hospital Services

You can include in medical expenses amounts you pay for the cost of inpatient care at a hospital or similar institution if a principal reason for being there is to receive medical care. This includes amounts paid for meals and lodging. Also see Lodging, later.

Insurance Premiums

You can include in medical expenses insurance premiums you pay for policies that cover medical care. You can’t include in medical expenses insurance premiums that were paid and for which you are claiming a credit or deduction. Medical care policies can provide payment for treatment that includes:

Hospitalization, surgical services, X-rays;
Prescription drugs and insulin;
Dental care;
Replacement of lost or damaged contact lenses; and
Long-term care (subject to additional limitations). See Qualified Long-Term Care Insurance Contracts under Long-Term Care, later.

If you have a policy that provides payments for other than medical care, you can include the premiums for the medical care part of the policy if the charge for the medical part is reasonable. The cost of the medical part must be separately stated in the insurance contract or given to you in a separate statement.

Health Coverage Tax Credit (HCTC)

If you were an eligible trade adjustment assistance (TAA) recipient, an alternative TAA (ATAA) recipient, reemployment TAA (RTAA) recipient, or Pension Benefit Guaranty Corporation (PBGC) payee, you must complete Form 8885 before completing Schedule A, line 1. When figuring the amount of insurance premiums you can deduct on Schedule A, don’t include any of the following.

Any amounts you included on Form 8885, line 4, or on Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request, to receive a reimbursement of the HCTC during the year.
Any qualified health insurance coverage premiums you paid to “U.S. Treasury–HCTC” for eligible coverage months for which you received the benefit of the advance monthly payment program.
Any advance monthly payments from your health plan administrator received from the IRS, as shown on Form 1099-H, Health Coverage Tax Credit (HCTC) Advance Payments.

If advance payments of the premium tax credit were made or you are eligible for both the premium tax credit and the HCTC and elect to take the HCTC, see the Instructions for Form 8885 to see how to figure your credit.

Employer-Sponsored Health Insurance Plan

Don’t include in your medical and dental expenses any insurance premiums paid by an employer-sponsored health insurance plan unless the premiums are included on your Form W-2, Wage and Tax Statement. Also, don’t include any other medical and dental expenses paid by the plan unless the amount paid is included on your Form W-2.

Example.

You are a federal employee participating in the premium conversion plan of the Federal Employee Health Benefits (FEHB) program. Your share of the FEHB premium is paid by making a pre-tax reduction in your salary. Because you are an employee whose insurance premiums are paid with money that is never included in your gross income, you can’t deduct the premiums paid with that money.

Long-term care services.

Contributions made by your employer to provide coverage for qualified long-term care services under a flexible spending or similar arrangement must be included in your income. This amount will be reported as wages on your Form W-2.

Retired public safety officers.

If you are a retired public safety officer, don’t include as medical expenses any health or long-term care insurance premiums that you elected to have paid with tax-free distributions from a retirement plan. This applies only to distributions that would otherwise be included in income.

Health reimbursement arrangement (HRA).

If you have medical expenses that are reimbursed by a health reimbursement arrangement, you can’t include those expenses in your medical expenses.

Medicare Part A

If you are covered under social security (or if you are a government employee who paid Medicare tax), you are enrolled in Medicare Part A. The payroll tax paid for Medicare Part A isn’t a medical expense.

If you aren’t covered under social security (or weren’t a government employee who paid Medicare tax), you can voluntarily enroll in Medicare Part A. In this situation, you can include the premiums you paid for Medicare Part A as a medical expense.

Medicare Part B

Medicare Part B is a supplemental medical insurance. Premiums you pay for Medicare Part B are a medical expense. Check the information you received from the Social Security Administration to find out your premium.

Medicare Part D

Medicare Part D is a voluntary prescription drug insurance program for persons with Medicare Part A or B. You can include as a medical expense premiums you pay for Medicare Part D.

Prepaid Insurance Premiums

Premiums you pay before you are age 65 for insurance for medical care for yourself, your spouse, or your dependents after you reach age 65 are medical care expenses in the year paid if they are:

Payable in equal yearly installments or more often; and
Payable for at least 10 years, or until you reach age 65 (but not for less than 5 years).

Unused Sick Leave Used To Pay Premiums

You must include in gross income cash payments you receive at the time of retirement for unused sick leave. You must also include in gross income the value of unused sick leave that, at your option, your employer applies to the cost of your continuing participation in your employer’s health plan after you retire. You can include this cost of continuing participation in the health plan as a medical expense.

If you participate in a health plan where your employer automatically applies the value of unused sick leave to the cost of your continuing participation in the health plan (and you don’t have the option to receive cash), don’t include the value of the unused sick leave in gross income. You can’t include this cost of continuing participation in that health plan as a medical expense.

Insurance Premiums You Can’t Include

You can’t include premiums you pay for:

Life insurance policies;
Policies providing payment for loss of earnings;
Policies for loss of life, limb, sight, etc.;
Policies that pay you a guaranteed amount each week for a stated number of weeks if you are hospitalized for sickness or injury;
The part of your car insurance that provides medical insurance coverage for all persons injured in or by your car because the part of the premium providing insurance for you, your spouse, and your dependents isn’t stated separately from the part of the premium providing insurance for medical care for others; or
Health or long-term care insurance if you elected to pay these premiums with tax-free distributions from a retirement plan made directly to the insurance provider and these distributions would otherwise have been included in income.

Taxes imposed by any governmental unit, such as Medicare taxes, aren’t insurance premiums.

Coverage for nondependents.

Generally, you can’t deduct any additional premium you pay as the result of including on your policy someone who isn’t your spouse or dependent, even if that person is your child under age 27. However, you can deduct the additional premium if that person is:

Your child whom you don’t claim as a dependent because of the rules for children of divorced or separated parents;
Any person you could have claimed as a dependent on your return except that person received $4,300 or more of gross income or filed a joint return; or
Any person you could have claimed as a dependent except that you, or your spouse if filing jointly, can be claimed as a dependent on someone else’s 2021 return.

Also, if you had family coverage when you added this individual to your policy and your premiums didn’t increase, you can enter on Schedule A (Form 1040) the full amount of your medical and dental insurance premiums.

Intellectually and Developmentally Disabled, Special Home for

You can include in medical expenses the cost of keeping a person who is intellectually and developmentally disabled in a special home, not the home of a relative, on the recommendation of a psychiatrist to help the person adjust from life in a mental hospital to community living.

Laboratory Fees

You can include in medical expenses the amounts you pay for laboratory fees that are part of medical care.

Lead-Based Paint Removal

You can include in medical expenses the cost of removing lead-based paints from surfaces in your home to prevent a child who has or had lead poisoning from eating the paint. These surfaces must be in poor repair (peeling or cracking) or within the child’s reach. The cost of repainting the scraped area isn’t a medical expense.

If, instead of removing the paint, you cover the area with wallboard or paneling, treat these items as capital expenses. See Capital Expenses, earlier. Don’t include the cost of painting the wallboard as a medical expense.

Learning Disability

See Special Education, later.

Legal Fees

You can include in medical expenses legal fees you paid that are necessary to authorize treatment for mental illness. However, you can’t include in medical expenses fees for the management of a guardianship estate, fees for conducting the affairs of the person being treated, or other fees that aren’t necessary for medical care.

Lifetime Care—Advance Payments

You can include in medical expenses a part of a life-care fee or “founder’s fee” you pay either monthly or as a lump sum under an agreement with a retirement home. The part of the payment you include is the amount properly allocable to medical care. The agreement must require that you pay a specific fee as a condition for the home’s promise to provide lifetime care that includes medical care. You can use a statement from the retirement home to prove the amount properly allocable to medical care. The statement must be based either on the home’s prior experience or on information from a comparable home.

Dependents with disabilities.

You can include in medical expenses advance payments to a private institution for lifetime care, treatment, and training of your physically or mentally impaired child upon your death or when you become unable to provide care. The payments must be a condition for the institution’s future acceptance of your child and must not be refundable.

Payments for future medical care.

Generally, you can’t include in medical expenses current payments for medical care (including medical insurance) to be provided substantially beyond the end of the year. This rule doesn’t apply in situations where the future care is purchased in connection with obtaining lifetime care of the type described earlier.

Lodging

You can include in medical expenses the cost of meals and lodging at a hospital or similar institution if a principal reason for being there is to receive medical care. See Nursing Home, later.

You may be able to include in medical expenses the cost of lodging not provided in a hospital or similar institution. You can include the cost of such lodging while away from home if all of the following requirements are met.

The lodging is primarily for and essential to medical care.
The medical care is provided by a doctor in a licensed hospital or in a medical care facility related to, or the equivalent of, a licensed hospital.
The lodging isn’t lavish or extravagant under the circumstances.
There is no significant element of personal pleasure, recreation, or vacation in the travel away from home.

The amount you include in medical expenses for lodging can’t be more than $50 for each night for each person. You can include lodging for a person traveling with the person receiving the medical care. For example, if a parent is traveling with a sick child, up to $100 per night can be included as a medical expense for lodging. Meals aren’t included.

Don’t include the cost of lodging while away from home for medical treatment if that treatment isn’t received from a doctor in a licensed hospital or in a medical care facility related to, or the equivalent of, a licensed hospital or if that lodging isn’t primarily for or essential to the medical care received.

Long-Term Care

You can include in medical expenses amounts paid for qualified long-term care services and certain amounts of premiums paid for qualified long-term care insurance contracts.

Qualified Long-Term Care Services

Qualified long-term care services are necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, rehabilitative services, and maintenance and personal care services (defined later) that are:

Required by a chronically ill individual, and
Provided pursuant to a plan of care prescribed by a licensed health care practitioner.

Chronically ill individual.

An individual is chronically ill if, within the previous 12 months, a licensed health care practitioner has certified that the individual meets either of the following descriptions.

He or she is unable to perform at least two activities of daily living without substantial assistance from another individual for at least 90 days, due to a loss of functional capacity. Activities of daily living are eating, toileting, transferring, bathing, dressing, and continence.
He or she requires substantial supervision to be protected from threats to health and safety due to severe cognitive impairment.

Maintenance and personal care services.

Maintenance or personal care services is care which has as its primary purpose the providing of a chronically ill individual with needed assistance with his or her disabilities (including protection from threats to health and safety due to severe cognitive impairment).

Qualified Long-Term Care Insurance Contracts

A qualified long-term care insurance contract is an insurance contract that provides only coverage of qualified long-term care services. The contract must:

Be guaranteed renewable;
Not provide for a cash surrender value or other money that can be paid, assigned, pledged, or borrowed;
Provide that refunds, other than refunds on the death of the insured or complete surrender or cancellation of the contract, and dividends under the contract must be used only to reduce future premiums or increase future benefits; and
Generally not pay or reimburse expenses incurred for services or items that would be reimbursed under Medicare, except where Medicare is a secondary payer, or the contract makes per diem or other periodic payments without regard to expenses.

The amount of qualified long-term care premiums you can include is limited. You can include the following as medical expenses on Schedule A (Form 1040).

Qualified long-term care premiums up to the following amounts.
1. Age 40 or under—$450.
2. Age 41 to 50—$850.
3. Age 51 to 60—$1,690.
4. Age 61 to 70—$4,520.
5. Age 71 or over—$5,640.
Unreimbursed expenses for qualified long-term care services.

Note.

The limit on premiums is for each person.

Also, if you are an eligible retired public safety officer, you can’t include premiums for long-term care insurance if you elected to pay these premiums with tax-free distributions from a qualified retirement plan made directly to the insurance provider and these distributions would otherwise have been included in your income.

Meals

You can include in medical expenses the cost of meals at a hospital or similar institution if a principal reason for being there is to get medical care.

You can’t include in medical expenses the cost of meals that aren’t part of inpatient care. Also see Weight-Loss Program and Nutritional Supplements, later.

Medical Conferences

You can include in medical expenses amounts paid for admission and transportation to a medical conference if the medical conference concerns the chronic illness of yourself, your spouse, or your dependent. The costs of the medical conference must be primarily for and necessary to the medical care of you, your spouse, or your dependent. The majority of the time spent at the conference must be spent attending sessions on medical information.

.The cost of meals and lodging while attending the conference isn’t deductible as a medical expense..

Medical Information Plan

You can include in medical expenses amounts paid to a plan that keeps medical information in a computer data bank and retrieves and furnishes the information upon request to an attending physician.

Medicines

You can include in medical expenses amounts you pay for prescribed medicines and drugs. A prescribed drug is one that requires a prescription by a doctor for its use by an individual. You can also include amounts you pay for insulin. Except for insulin, you can’t include in medical expenses amounts you pay for a drug that isn’t prescribed.

Imported medicines and drugs.

If you imported medicines or drugs from other countries, see Medicines and Drugs From Other Countries under What Expenses Aren’t Includible, later.

Nursing Home

You can include in medical expenses the cost of medical care in a nursing home, home for the aged, or similar institution, for yourself, your spouse, or your dependents. This includes the cost of meals and lodging in the home if a principal reason for being there is to get medical care.

Don’t include the cost of meals and lodging if the reason for being in the home is personal. You can, however, include in medical expenses the part of the cost that is for medical or nursing care.

Nursing Services

You can include in medical expenses wages and other amounts you pay for nursing services. The services need not be performed by a nurse as long as the services are of a kind generally performed by a nurse. This includes services connected with caring for the patient’s condition, such as giving medication or changing dressings, as well as bathing and grooming the patient. These services can be provided in your home or another care facility.

Generally, only the amount spent for nursing services is a medical expense. If the attendant also provides personal and household services, amounts paid to the attendant must be divided between the time spent performing household and personal services and the time spent for nursing services. For example, because of your medical condition, you pay a visiting nurse $300 per week for medical and household services. She spends 10% of her time doing household services such as washing dishes and laundry. You can include only $270 per week as medical expenses. The $30 (10% × $300) allocated to household services can’t be included. However, certain maintenance or personal care services provided for qualified long-term care can be included in medical expenses. See Maintenance and personal care services under Long-Term Care, earlier. Additionally, certain expenses for household services or for the care of a qualifying individual incurred to allow you to work may qualify for the child and dependent care credit. See Pub. 503.

You can also include in medical expenses part of the amount you pay for that attendant’s meals. Divide the food expense among the household members to find the cost of the attendant’s food. Then divide that cost in the same manner as in the preceding paragraph. If you had to pay additional amounts for household upkeep because of the attendant, you can include the extra amounts with your medical expenses. This includes extra rent or utilities you pay because you moved to a larger apartment to provide space for the attendant.

Employment taxes.

You can include as a medical expense social security tax, FUTA, Medicare tax, and state employment taxes you pay for an attendant who provides medical care. If the attendant also provides personal and household services, you can include as a medical expense only the amount of employment taxes paid for medical services, as explained earlier. For information on employment tax responsibilities of household employers, see Pub. 926.

Operations

You can include in medical expenses amounts you pay for legal operations that aren’t for cosmetic surgery. See Cosmetic Surgery under What Expenses Aren’t Includible, later.

Organ Donors

See Transplants, later.

Osteopath

You can include in medical expenses amounts you pay to an osteopath for medical care.

Oxygen

You can include in medical expenses amounts you pay for oxygen and oxygen equipment to relieve breathing problems caused by a medical condition.

Physical Examination

You can include in medical expenses the amount you pay for an annual physical examination and diagnostic tests by a physician. You don’t have to be ill at the time of the examination.

Pregnancy Test Kit

You can include in medical expenses the amount you pay to purchase a pregnancy test kit to determine if you are pregnant.

Premium Tax Credit

You can’t include in medical expenses the amount of health insurance premiums paid by or through the premium tax credit. You also can’t include in medical expenses any amount of advance payments of the premium tax credit made that you did not have to pay back. However, any amount of advance payments of the premium tax credit that you did have to pay back can be included in medical expenses.

Example 1.

Amy is under age 65 and unmarried. The cost of her health insurance premiums in 2021 is $8,700. Advance payments of the premium tax credit of $4,200 are made to the insurance company and Amy pays premiums of $4,500. On her 2021 tax return, Amy is allowed a premium tax credit of $3,600 and must repay $600 excess advance credit payments (which is less than the repayment limitation). Amy is treated as paying $5,100 ($8,700 less the allowed premium tax credit of $3,600) for health insurance premiums in 2021. When Amy fills out her Schedule A, she enters $5,100 on line 1.

Example 2.

The facts are the same as in Example 1, except Amy is allowed a premium tax credit of $4,900 on her tax return and receives a net premium tax credit of $700. Amy is treated as paying $3,800 ($8,700 less the allowed premium tax credit of $4,900) for health insurance premiums in 2021. When Amy fills out her Schedule A, she enters $3,800 on line 1.

Psychiatric Care

You can include in medical expenses amounts you pay for psychiatric care. This includes the cost of supporting a mentally ill dependent at a specially equipped medical center where the dependent receives medical care. See Psychoanalysis next and Transportation, later.

Psychoanalysis

You can include in medical expenses payments for psychoanalysis. However, you can’t include payments for psychoanalysis that is part of required training to be a psychoanalyst.

Psychologist

You can include in medical expenses amounts you pay to a psychologist for medical care.

Special Education

You can include in medical expenses fees you pay on a doctor’s recommendation for a child’s tutoring by a teacher who is specially trained and qualified to work with children who have learning disabilities caused by mental or physical impairments, including nervous system disorders.

You can include in medical expenses the cost (tuition, meals, and lodging) of attending a school that furnishes special education to help a child to overcome learning disabilities. Overcoming the learning disabilities must be the primary reason for attending the school, and any ordinary education received must be incidental to the special education provided. Special education includes:

Teaching Braille to a visually impaired person,
Teaching lip reading to a hearing disabled person, or
Giving remedial language training to correct a condition caused by a birth defect.

You can’t include in medical expenses the cost of sending a child with behavioral problems to a school where the course of study and the disciplinary methods have a beneficial effect on the child’s attitude if the availability of medical care in the school isn’t a principal reason for sending the student there.

Sterilization

You can include in medical expenses the cost of a legal sterilization (a legally performed operation to make a person unable to have children). Also see Vasectomy, later.

Stop-Smoking Programs

You can include in medical expenses amounts you pay for a program to stop smoking. However, you can’t include in medical expenses amounts you pay for drugs that don’t require a prescription, such as nicotine gum or patches, that are designed to help stop smoking.

Surgery

See Operations, earlier.

Telephone

You can include in medical expenses the cost of special telephone equipment that lets a person who is deaf, hard of hearing, or has a speech disability communicate over a regular telephone. This includes teletypewriter (TTY) and telecommunications device for the deaf (TDD) equipment. You can also include the cost of repairing the equipment.

Television

You can include in medical expenses the cost of equipment that displays the audio part of television programs as subtitles for persons with a hearing disability. This may be the cost of an adapter that attaches to a regular set. It may also be the part of the cost of a specially equipped television that exceeds the cost of the same model regular television set.

Therapy

You can include in medical expenses amounts you pay for therapy received as medical treatment.

Transplants

You can include in medical expenses amounts paid for medical care you receive because you are a donor or a possible donor of a kidney or other organ. This includes transportation.

You can include any expenses you pay for the medical care of a donor in connection with the donation of an organ to you, your spouse, or dependent. This includes transportation.

Transportation

You can include in medical expenses amounts paid for transportation primarily for, and essential to, medical care.

You can include:

Bus, taxi, train, or plane fares or ambulance service;
Transportation expenses of a parent who must go with a child who needs medical care;
Transportation expenses of a nurse or other person who can give injections, medications, or other treatment required by a patient who is traveling to get medical care and is unable to travel alone; and
Transportation expenses for regular visits to see a mentally ill dependent, if these visits are recommended as a part of treatment.

Car expenses.

You can include out-of-pocket expenses, such as the cost of gas and oil, when you use a car for medical reasons. You can’t include depreciation, insurance, general repair, or maintenance expenses.

If you don’t want to use your actual expenses for 2021, you can use the standard medical mileage rate of 16 cents a mile.

You can also include parking fees and tolls. You can add these fees and tolls to your medical expenses whether you use actual expenses or the standard mileage rate.

Example.

In 2021, Bill Jones drove 2,800 miles for medical reasons. He spent $400 for gas, $30 for oil, and $100 for tolls and parking. He wants to figure the amount he can include in medical expenses both ways to see which gives him the greater deduction.

He figures the actual expenses first. He adds the $400 for gas, the $30 for oil, and the $100 for tolls and parking for a total of $530.

He then figures the standard mileage amount. He multiplies 2,800 miles by 16 cents a mile for a total of $448. He then adds the $100 tolls and parking for a total of $548.

Bill includes the $548 of car expenses with his other medical expenses for the year because the $548 is more than the $530 he figured using actual expenses.

Transportation expenses you can’t include.

You can’t include in medical expenses the cost of transportation in the following situations.

Going to and from work, even if your condition requires an unusual means of transportation.
Travel for purely personal reasons to another city for an operation or other medical care.
Travel that is merely for the general improvement of one’s health.
The costs of operating a specially equipped car for other than medical reasons.

Trips

You can include in medical expenses amounts you pay for transportation to another city if the trip is primarily for, and essential to, receiving medical services. You may be able to include up to $50 for each night for each person. You can include lodging for a person traveling with the person receiving the medical care. For example, if a parent is traveling with a sick child, up to $100 per night can be included as a medical expense for lodging. Meals aren’t included. See Lodging, earlier.

You can’t include in medical expenses a trip or vacation taken merely for a change in environment, improvement of morale, or general improvement of health, even if the trip is made on the advice of a doctor. However, see Medical Conferences, earlier.

Tuition

Under special circumstances, you can include charges for tuition in medical expenses. See Special Education, earlier.

A lump-sum fee which includes education, board, and medical care—without distinguishing which part of the fee results from medical care—is not considered an amount payable for medical care. However, you can include charges for a health plan included in a lump-sum tuition fee if the charges are separately stated or can easily be obtained from the school.

Vasectomy

You can include in medical expenses the amount you pay for a vasectomy.

Vision Correction Surgery

See Eye Surgery, earlier.

Weight-Loss Program

You can include in medical expenses amounts you pay to lose weight if it is a treatment for a specific disease diagnosed by a physician (such as obesity, hypertension, or heart disease). This includes fees you pay for membership in a weight reduction group as well as fees for attendance at periodic meetings. You can’t include membership dues in a gym, health club, or spa as medical expenses, but you can include separate fees charged there for weight loss activities.

You can’t include the cost of diet food or beverages in medical expenses because the diet food and beverages substitute for what is normally consumed to satisfy nutritional needs. You can include the cost of special food in medical expenses only if:

The food doesn’t satisfy normal nutritional needs,
The food alleviates or treats an illness, and
The need for the food is substantiated by a physician.

What Expenses Aren’t Includible,

later.

The amount you can include in medical expenses is limited to the amount by which the cost of the special food exceeds the cost of a normal diet. See also

Weight-Loss Program

underlater.

Wheelchair

You can include in medical expenses the amounts you pay for a wheelchair used for the relief of a sickness or disability. The cost of operating and maintaining the wheelchair is also a medical expense.

Wig

You can include in medical expenses the cost of a wig purchased upon the advice of a physician for the mental health of a patient who has lost all of his or her hair from disease.

X-ray

You can include in medical expenses amounts you pay for X-rays for medical reasons.