Publication 502 (2017), Medical and Dental Expenses

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FREQUENTLY ASKED QUESTIONS - MEMBERS
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. Often used to cover a specific need such as covering medical bills and burial or paying off a home mortgage. The premiums for long-term care insurance item 1 that you can treat as qualified medical expenses are subject to limits based on age and are adjusted annually. The key is you have to work with your HSA provider and tell them you want to follow the special procedures to withdraw excess contributions. You cannot claim this credit for premiums that you pay with a tax-free distribution from your Archer MSA. However, you can't include payments for psychoanalysis that is part of required training to be a psychoanalyst. Medical expenses that are not defined as eligible under your employer's plan; Medical expenses that do not meet IRS section d requirements e.

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This is true whether the payments were made directly to you, to the patient, or to the provider of the medical services. 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.

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. 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. 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. 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. If Mary had paid the expenses, Bill couldn't include Mary's expenses in his separate return.

Mary would include the amounts she paid during the year in 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.

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. 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. The person was a qualifying child defined later or a qualifying relative defined later , and. The person was a U. If your qualifying child was adopted, see Exception for adopted child , later.

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 return. If you are a U. 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 ,.

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

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

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.

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. You may be able to take a credit for other expenses related to an adoption. 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: The child is in the custody of one or both parents for more than half the year,.

The child receives over half of his or her support during the year from his or her parents, and. Are divorced or legally separated under a decree of divorce or separate maintenance,. This doesn't apply if the child's exemption is being claimed under a multiple support agreement discussed later.

Son, daughter, stepchild, or foster child, or a descendant of any of them for example, your grandchild ,. Father, mother, or an ancestor or sibling of either of them for example, your grandmother, grandfather, aunt, or uncle ,. Stepbrother, stepsister, stepfather, stepmother, son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, or sister-in-law, or. 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,.

Who wasn't a qualifying child see Qualifying Child , earlier of any taxpayer for , and. For whom you provided over half of the support in 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. 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. 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. 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. 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.

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 or the decedent's amended return, Form X saying that the expenses haven't been and won't be claimed on the estate tax return. 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.

What if the decedent's return had been filed and the medical expenses weren't included? Form X can be filed for the year or years the expenses are treated as paid, unless the period for filing an amended return for that year has passed.

Generally, an amended return 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. John properly filed his income tax return. What if you pay medical expenses of a deceased spouse or dependent?

If you paid medical expenses for your deceased spouse or dependent, include them as medical expenses on your Schedule A Form 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. 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. 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 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 alcoholic liquors.

See Physical Examination , later. You can include in medical expenses the amount you pay for birth control pills prescribed by a doctor. 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.

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. 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. Installing porch lifts and other forms of lifts but elevators generally add value to the house. Only reasonable costs to accommodate a home to a disabled condition are considered medical care. Additional costs for personal motives, such as for architectural or aesthetic reasons, aren't medical expenses.

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

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

The includible costs of using a car for medical reasons are explained under Transportation , later. You can include in medical expenses fees you pay to Christian Science practitioners for medical care. 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. 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. You can include in medical expenses the cost of devices used in diagnosing and treating illness and disease. 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. 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. 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 at the center during treatment. See Medicines , later.

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.

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.

You can include in medical expenses the cost of the following procedures 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.

See Lifetime Care—Advance Payments , later. 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. 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.

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. You can include in medical expenses the cost of a hearing aid and batteries, repairs, and maintenance needed to operate it. See Nursing Services , later. See Capital Expenses , earlier.

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.

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:.

Long-term care subject to additional limitations. 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.

When figuring the amount of insurance premiums you can deduct on Schedule A, don't include any of the following. Any qualified health insurance coverage premiums you paid to "U. Treasury—HCTC" for eligible coverage months for which you received the benefit of the advance monthly payment program, or. 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 to see how to figure your credit.

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 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.

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 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. If you have medical expenses that are reimbursed by a health reimbursement arrangement, you can't include those expenses in your medical expenses. This is because an HRA is funded solely by the employer. If you are covered under social security or if you are a government employee who paid Medicare tax , you are enrolled in Medicare A.

The payroll tax paid for Medicare 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 A. In this situation you can include the premiums you paid for Medicare A as a medical expense.

Medicare B is a supplemental medical insurance. Premiums you pay for Medicare B are a medical expense. Check the information you received from the Social Security Administration to find out your premium. Medicare D is a voluntary prescription drug insurance program for persons with Medicare A or B.

You can include as a medical expense premiums you pay for Medicare D. 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:. You must include in gross income cash payments you receive at the time of retirement for unused sick leave. You also must 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. 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. 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 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 except that you, or your spouse if filing jointly, can be claimed as a dependent on someone else's 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 the full amount of your medical and dental insurance premiums.

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.

You can include in medical expenses the amounts you pay for laboratory fees that are part of medical care. See Breast Pumps and Supplies , earlier. 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. Don't include the cost of painting the wallboard as a medical expense. See Special Education , later. 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.

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. 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. 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.

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 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. There is no significant element of personal pleasure, recreation, or vacation in the travel away from home. You can include lodging for a person traveling with the person receiving the medical care.

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

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:.

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 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.

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

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. 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. 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.

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. 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. 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.

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. 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.

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. You can include in medical expenses amounts you pay for legal operations that aren't for unnecessary cosmetic surgery. See Eyeglasses , earlier. See Transplants , later. You can include in medical expenses amounts you pay for oxygen and oxygen equipment to relieve breathing problems caused by a medical condition. 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. You can include in medical expenses the amount you pay to purchase a pregnancy test kit to determine if you are pregnant. 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.

Amy is under age 65 and unmarried. 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. 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.

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.

For expenses to be deductible, a doctor must recommend that the child attend the school. Overcoming the learning disabilities must be a principal reason for attending the school, and any ordinary education received must be incidental to the special education provided. 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.

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. 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.

See Operations , earlier. 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. You can also include the cost of repairing the equipment. 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 also may be the part of the cost of a specially equipped television that exceeds the cost of the same model regular television set. 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. You can include any expenses you pay for the medical care of a donor in connection with the donating of an organ.

You can include in medical expenses amounts paid for transportation primarily for, and essential to, medical care. 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. 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 , you can use the standard medical mileage rate of 17 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.

In , Bill Jones drove 2, miles for medical reasons. 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 then figures the standard mileage amount. 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. The costs of operating a specially equipped car for other than medical reasons. 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.

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. 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.

See Eye Surgery , earlier. 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 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. 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.

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. Following is a list of some items that you can't include in figuring your medical expense deduction.

You can't include in medical expenses amounts you pay for the care of children, even if the expenses enable you, your spouse, or your dependent to get medical or dental treatment. Also, any expense allowed as a childcare credit can't be treated as an expense paid for medical care.

You can't include in medical expenses amounts you pay for controlled substances such as marijuana, laetrile, etc. Generally, you can't include in medical expenses the amount you pay for unnecessary cosmetic surgery. This includes any procedure that is directed at improving the patient's appearance and doesn't meaningfully promote the proper function of the body or prevent or treat illness or disease. You generally can't include in medical expenses the amount you pay for procedures such as face lifts, hair transplants, hair removal electrolysis , and liposuction.

You can include in medical expenses the amount you pay for cosmetic surgery if it is necessary to improve a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease.

An individual undergoes surgery that removes a breast as part of treatment for cancer. She pays a surgeon to reconstruct the breast.

The surgery to reconstruct the breast corrects a deformity directly related to the disease. The cost of the surgery is includible in her medical expenses. You can't include in medical expenses the cost of dancing lessons, swimming lessons, etc. You can't include in medical expenses the amount you pay for diapers or diaper services, unless they are needed to relieve the effects of a particular disease.

See Cosmetic Surgery , earlier. You can't include in medical expenses amounts for which you are fully reimbursed by your flexible spending account if you contribute a part of your income on a pre-tax basis to pay for the qualified benefit.

This rule doesn't apply in situations where the future care is purchased in connection with obtaining lifetime care, as explained under Lifetime Care—Advance Payments , or qualified long-term care insurance contracts, as explained under Long-Term Care , earlier.

You can't include in medical expenses health club dues or amounts paid to improve one's general health or to relieve physical or mental discomfort not related to a particular medical condition. You can't include in medical expenses the cost of membership in any club organized for business, pleasure, recreation, or other social purpose.

You can't include in medical expenses amounts you pay for health insurance you use in figuring your health coverage tax credit. For more information, see the Instructions for Form You can't include in medical expenses any payment or distribution for medical expenses out of a health savings account. Contributions to health savings accounts are deducted separately.

You can't include in medical expenses the cost of household help, even if such help is recommended by a doctor. This is a personal expense that isn't deductible. However, you may be able to include certain expenses paid to a person providing nursing-type services. Also, certain maintenance or personal care services provided for qualified long-term care can be included in medical expenses. You can't include in medical expenses amounts you pay for illegal operations, treatments, or controlled substances whether rendered or prescribed by licensed or unlicensed practitioners.

You can't include in medical expenses amounts you contribute to an Archer MSA. You can't include expenses you pay for with a tax-free distribution from your Archer MSA. You also can't use other funds equal to the amount of the distribution and include the expenses.

In general, you can't include in your medical expenses the cost of a prescribed drug brought in or ordered shipped from another country. You can only include the cost of a drug that was imported legally. For example, you can include the cost of a prescribed drug the Food and Drug Administration announces can be legally imported by individuals. You can include the cost of a prescribed drug you purchase and consume in another country if the drug is legal in both the other country and the United States.

Your doctor recommends that you take aspirin. Because aspirin is a drug that doesn't require a physician's prescription, you can't include its cost in your medical expenses. You can't include in medical expenses the cost of nutritional supplements, vitamins, herbal supplements, "natural medicines," etc.

These items are taken to maintain your ordinary good health and aren't for medical care. You can't include in medical expenses the cost of an item ordinarily used for personal, living, or family purposes unless it is used primarily to prevent or alleviate a physical or mental disability or illness. For example, the cost of a toothbrush and toothpaste is a nondeductible personal expense. In order to accommodate an individual with a physical disability, you may have to purchase an item ordinarily used as a personal, living, or family item in a special form.

You can include the excess of the cost of the item in a special form over the cost of the item in normal form as a medical expense. See Dancing Lessons , earlier. You can't include in medical expenses amounts paid to whiten teeth. You can't include in medical expenses the cost of a weight-loss program if the purpose of the weight loss is the improvement of appearance, general health, or sense of well-being.

You can't include amounts you pay to lose weight unless the weight loss is a treatment for a specific disease diagnosed by a physician such as obesity, hypertension, or heart disease. If the weight-loss treatment isn't for a specific disease diagnosed by a physician, you can't include either the fees you pay for membership in a weight reduction group or fees for attendance at periodic meetings.

Also, you can't include membership dues in a gym, health club, or spa. You can include in medical expenses only those amounts paid during the tax year for which you received no insurance or other reimbursement. You must reduce your total medical expenses for the year by all reimbursements for medical expenses that you receive from insurance or other sources during the year.

This includes payments from Medicare. Even if a policy provides reimbursement only for certain specific medical expenses, you must use amounts you receive from that policy to reduce your total medical expenses, including those it doesn't reimburse. You have insurance policies that cover your hospital and doctors' bills but not your nursing bills.

The insurance you receive for the hospital and doctors' bills is more than their charges. In figuring your medical deduction, you must reduce the total amount you spent for medical care by the total amount of insurance you received, even if the policies don't cover some of your medical expenses. A health reimbursement arrangement is an employer-funded plan that reimburses employees for medical care expenses and allows unused amounts to be carried forward.

An HRA is funded solely by the employer and the reimbursements for medical expenses, up to a maximum dollar amount for a coverage period, aren't included in your income.

Generally, you don't reduce medical expenses by payments you receive for: You can receive tax-free distributions from your HSA to pay or be reimbursed for qualified medical expenses you incur after you establish the HSA. If you are no longer an eligible individual, you can still receive tax-free distributions to pay or reimburse your qualified medical expenses. Generally, a distribution is money you get from your HSA.

Your total distributions include amounts paid with a debit card that restricts payments to health care and amounts withdrawn from the HSA by other individuals that you have designated. Qualified medical expenses are those expenses that generally would qualify for the medical and dental expenses deduction.

These are explained in Pub. A medicine or drug will be a qualified medical expense for HSA purposes only if the medicine or drug: Is available without a prescription an over-the-counter medicine or drug and you get a prescription for it, or.

State law determines when an HSA is established. If, under the last-month rule, you are considered to be an eligible individual for the entire year for determining the contribution amount, only those expenses incurred after you actually establish your HSA are qualified medical expenses.

Qualified medical expenses are those incurred by the following persons. Any person you could have claimed as a dependent on your return except that: You, or your spouse if filing jointly, could be claimed as a dependent on someone else's return. For this purpose, a child of parents that are divorced, separated, or living apart for the last 6 months of the calendar year is treated as the dependent of both parents whether or not the custodial parent releases the claim to the child's exemption.

Health care coverage while receiving unemployment compensation under federal or state law. Medicare and other health care coverage if you were 65 or older other than premiums for a Medicare supplemental policy, such as Medigap. The premiums for long-term care insurance item 1 that you can treat as qualified medical expenses are subject to limits based on age and are adjusted annually.

See Limit on long-term care premiums you can deduct in the instructions for Schedule A Form Items 2 and 3 can be for your spouse or a dependent meeting the requirement for that type of coverage. The following situations result in deemed taxable distributions from your HSA.

You engaged in any transaction prohibited by section with respect to any of your HSAs, at any time in Your account ceases to be an HSA as of January 1, , and you must include the fair market value of all assets in the account as of January 1, , on Form You used any portion of any of your HSAs as security for a loan at any time in You must include the fair market value of the assets used as security for the loan as income on Form or Form NR.

Furnishing goods, services, or facilities between you and the HSA; and. Transfer to or use by you, or for your benefit, of any assets of the HSA. You must keep records sufficient to show that:. How you report your distributions depends on whether or not you use the distribution for qualified medical expenses defined earlier.

However, the distribution of an excess contribution taken out after the due date, including extensions, of your return is subject to tax even if used for qualified medical expenses. Follow the instructions for the form and file it with your Form or Form NR. There is no additional tax on distributions made after the date you are disabled, reach age 65, or die.

An HSA is generally exempt from tax. You are permitted to take a distribution from your HSA at any time; however, only those amounts used exclusively to pay for qualified medical expenses are tax free. Amounts that remain at the end of the year are generally carried over to the next year see Excess contributions , earlier. You should choose a beneficiary when you set up your HSA.

What happens to that HSA when you die depends on whom you designate as the beneficiary. The fair market value of the HSA becomes taxable to the beneficiary in the year in which you die. If your estate is the beneficiary, the value is included on your final income tax return.

The amount taxable to a beneficiary other than the estate is reduced by any qualified medical expenses for the decedent that are paid by the beneficiary within 1 year after the date of death.

You must file Form with your Form or Form NR if you or your spouse, if married filing jointly had any activity in your HSA during the year. You must file the form even if only your employer or your spouse's employer made contributions to the HSA.

Enter "statement" at the top of each Form and complete the form as instructed. Next, complete a controlling Form combining the amounts shown on each of the statement Forms Attach the statements to your tax return after the controlling Form This section contains the rules that employers must follow if they decide to make HSAs available to their employees. Unlike the previous discussions, "you" refers to the employer and not to the employee.

You can provide no additional coverage other than those exceptions listed previously under Other health coverage. You can make contributions to your employees' HSAs.

You deduct the contributions on your business income tax return for the year in which you make the contributions. If the contribution is allocated to the prior year, you still deduct it in the year in which you made the contribution. For more information on employer contributions, see Notice , I. If you decide to make contributions, you must make comparable contributions to all comparable participating employees' HSAs. Your contributions are comparable if they are either: The same percentage of the annual deductible limit under the HDHP covering the employees.

Have the same category of coverage either self-only or family coverage , and. Have the same category of employment part-time, full-time, or former employees.

To meet the comparability requirements for eligible employees who have neither established an HSA by December 31 nor notified you that they have an HSA, you must meet a notice requirement and a contribution requirement. You will meet the notice requirement if by January 15 of the following calendar year you provide a written notice to all such employees.

The notice must state that each eligible employee who, by the last day of February, establishes an HSA and notifies you that he or she has established an HSA will receive a comparable contribution to the HSA for the prior year. For a sample of the notice, see Regulations section For purposes of making contributions to HSAs of non-highly compensated employees, highly compensated employees shall not be treated as comparable participating employees.

You must report the contributions in box 12 of the Form W-2 you file for each employee. This includes the amounts the employee elected to contribute through a cafeteria plan. Enter code "W" in box Archer MSAs were created to help self-employed individuals and employees of certain small employers meet the medical care costs of the account holder, the account holder's spouse, or the account holder's dependent s.

You became an active participant for a tax year ending after , by reason of coverage under a high deductible health plan HDHP of an Archer MSA participating employer. The interest or other earnings on the assets in your Archer MSA are tax free.

The contributions remain in your Archer MSA from year to year until you use them. An Archer MSA is "portable" so it stays with you if you change employers or leave the work force. An employee or the spouse of an employee of a small employer defined later that maintains a self-only or family HDHP for you or your spouse.

A self-employed person or the spouse of a self-employed person who maintains a self-only or family HDHP. You can have no other health or Medicare coverage except what is permitted under Other health coverage , later. You must be an eligible individual on the first day of a given month to get an Archer MSA deduction for that month. A small employer is generally an employer who had an average of 50 or fewer employees during either of the last 2 calendar years.

The definition of small employer is modified for new employers and growing employers. The employer will continue to meet the requirement for small employers if he or she: Made a contribution that was excludable or deductible as an Archer MSA for the last year he or she had 50 or fewer employees, and.

If you change employers, your Archer MSA moves with you. However, you may not make additional contributions unless you are otherwise eligible. A maximum limit on the annual out-of-pocket medical expenses that you must pay for covered expenses.

The following table shows the limits for annual deductibles and the maximum out-of-pocket expenses for HDHPs for However, you can have additional insurance that provides benefits only for the following items.

Liabilities incurred under workers' compensation laws, torts, or ownership or use of property. Contributions to an Archer MSA must be made in cash. If you are an employee, your employer may make contributions to your Archer MSA. You must have the HDHP all year to contribute the full amount. You have an HDHP for your family all year in If you and your spouse each have a family plan, you are treated as having family coverage with the lower annual deductible of the two health plans. The contribution limit is split equally between the two of you unless you agree on a different division.

This is your income from self-employment minus expenses including the deductible part of self-employment tax. Westley Lawrence is self-employed. He had an HDHP for his family for the entire year in You should include all contributions you or your employer made for , including those made from January 1, through April 17, , that are designated for Follow the instructions for Form and complete the Line 3 Limitation Chart and Worksheet in the instructions.

You will have excess contributions if the contributions to your Archer MSA for the year are greater than the limits discussed earlier.

You withdraw the excess contributions by the due date, including extensions, of your tax return. You may be able to deduct excess contributions for previous years that are still in your Archer MSA.

The excess contribution you can deduct in the current year is the lesser of the following two amounts. The total excess contributions in your Archer MSA at the beginning of the year. Any excess contributions remaining at the end of a tax year are subject to the excise tax. You can receive tax-free distributions from your Archer MSA to pay for qualified medical expenses discussed later. If you no longer qualify to make contributions, you can still receive tax-free distributions to pay or reimburse your qualified medical expenses.

A distribution is money you get from your Archer MSA. A medicine or drug will be a qualified medical expense for MSA purposes only if the medicine or drug: You can, however, treat premiums for long-term care coverage, health care coverage while you receive unemployment benefits, or health care continuation coverage required under any federal law as qualified medical expenses for Archer MSAs.

You cannot claim this credit for premiums that you pay with a tax-free distribution from your Archer MSA. The following situations result in deemed taxable distributions from your Archer MSA. You engaged in any transaction prohibited by section with respect to any of your Archer MSAs at any time in Your account ceases to be an Archer MSA as of January 1, , and you must include the fair market value of all assets in the account as of January 1, , on Form You used any portion of any of your Archer MSAs as security for a loan at any time in Sale, exchange, or leasing of property between you and the Archer MSA;.

Furnishing goods, services, or facilities between you and the Archer MSA; and. Transfer to or use by you, or for your benefit, of any assets of the Archer MSA. How you report your distributions depends on whether or not you use the distribution for qualified medical expenses, defined earlier. See the Form instructions for more information. Report the additional tax in the total on Form or Form NR.

An Archer MSA is generally exempt from tax. You are permitted to take a distribution from your Archer MSA at any time; however, only those amounts used exclusively to pay for qualified medical expenses are tax free.

You should choose a beneficiary when you set up your Archer MSA. What happens to that Archer MSA when you die depends on whom you designate as the beneficiary. The fair market value of the Archer MSA becomes taxable to the beneficiary in the year in which you die. If your estate is the beneficiary, the fair market value of the Archer MSA will be included on your final income tax return. You must file the form even if only your employer or your spouse's employer made contributions to the Archer MSA.

This section contains the rules that employers must follow if they decide to make Archer MSAs available to their employees. You can make contributions to your employees' Archer MSAs and deduct them for the year in which you make them. If you decide to make contributions, you must make comparable contributions to all comparable participating employees' Archer MSAs. Have the same category of employment either part-time or full-time. Enter code "R" in box A Medicare Advantage MSA is a tax-exempt trust or custodial savings account that you set up with a financial institution such as a bank or an insurance company in which the Medicare program can deposit money for qualified medical expenses.

An HDHP is a special health insurance policy that has a high deductible. However, the policy must be approved by the Medicare program. You can get information by calling Medicare or through the Internet at Medicare.

FSAs are usually funded through voluntary salary reduction agreements with your employer. No employment or federal income taxes are deducted from your contribution. The employer also may contribute.

Contributions made by your employer can be excluded from your gross income. No employment or federal income taxes are deducted from the contributions. Withdrawals may be tax free if you pay qualified medical expenses. Health FSAs are employer-established benefit plans. These may be offered in conjunction with other employer-provided benefits as part of a cafeteria plan. Employers have complete flexibility to offer various combinations of benefits in designing their plan.

You contribute to your FSA by electing an amount to be voluntarily withheld from your pay by your employer. This is sometimes called a salary reduction agreement. The employer also may contribute to your FSA if specified in the plan. However, contributions made by your employer to provide coverage for long-term care insurance must be included in income.

At the beginning of the plan year, you must designate how much you want to contribute. Then, your employer will deduct amounts periodically generally, every payday in accordance with your annual election. You can change or revoke your election only if there is a change in your employment or family status that is specified by the plan. This amount is indexed for inflation and may change from year to year. However, see Balance in an FSA , later, for possible exceptions. For this reason, it is important to base your contribution on an estimate of the qualifying expenses you will have during the year.

Generally, distributions from a health FSA must be paid only to reimburse you for qualified medical expenses you incurred during the period of coverage. You must be able to receive the maximum amount of reimbursement the amount you have elected to contribute for the year at any time during the coverage period, regardless of the amount you have actually contributed.

The maximum amount you can receive tax free is the total amount you elected to contribute to the health FSA for the year. You must provide the health FSA with a written statement from an independent third party stating that the medical expense has been incurred and the amount of the expense.

Debit cards, credit cards, and stored value cards given to you by your employer can be used to reimburse participants in a health FSA. If the use of these cards meets certain substantiation methods, you may not have to provide additional information to the health FSA. Qualified medical expenses are those specified in the plan that generally would qualify for the medical and dental expenses deduction. A medicine or drug will be a qualified medical expense for FSA purposes only if the medicine or drug: A special rule allows amounts in a health FSA to be distributed to reservists ordered or called to active duty.

This rule applies to distributions made after June 17, , if the plan has been amended to allow these distributions. Your employer must report the distribution as wages on your Form W-2 for the year in which the distribution is made. The distribution is subject to employment taxes and is included in your gross income. A qualified reservist distribution is allowed if you were because you were in the reserves ordered or called to active duty for a period of more than days or for an indefinite period, and the distribution is made during the period beginning on the date of the order or call and ending on the last date that reimbursements could otherwise be made for the plan year that includes the date of the order or call.

Flexible spending arrangements are generally "use-it-or-lose-it" plans. However, the plan can provide for either a grace period or a carryover. If there is a grace period, any qualified medical expenses incurred in that period can be paid from any amounts left in the account at the end of the previous year.

See Qualified reservist distribution , earlier. The plan may specify a lower dollar amount as the maximum carryover amount. If the plan permits a carryover, any unused amounts in excess of the carryover amount are forfeited.

For the health FSA to maintain tax-qualified status, employers must comply with certain requirements that apply to cafeteria plans. For example, there are restrictions for plans that cover highly compensated employees and key employees. The plans also must comply with rules applicable to other accident and health plans. Chapters 1 and 2 of Pub. Employees are reimbursed tax free for qualified medical expenses up to a maximum dollar amount for a coverage period.

Reimbursements may be tax free if you pay qualified medical expenses. Any unused amounts in the HRA can be carried forward for reimbursements in later years. HRAs are employer-established benefit plans. These may be offered in conjunction with other employer-provided health benefits. HRAs are funded solely through employer contributions and may not be funded through employee salary deferrals under a cafeteria plan. There is no limit on the amount of money your employer can contribute to the accounts.

Additionally, the maximum reimbursement amount credited under the HRA in the future may be increased or decreased by amounts not previously used. See Balance in an HRA , later. Generally, distributions from an HRA must be paid to reimburse you for qualified medical expenses you have incurred. The expense must have been incurred on or after the date you are enrolled in the HRA.

Debit cards, credit cards, and stored value cards given to you by your employer can be used to reimburse participants in an HRA. If the use of these cards meets certain substantiation methods, you may not have to provide additional information to the HRA. If any distribution is, or can be, made for other than the reimbursement of qualified medical expenses, any distribution including reimbursement of qualified medical expenses made in the current tax year is included in gross income.

For example, if an unused reimbursement is payable to you in cash at the end of the year, or upon termination of your employment, any distribution from the HRA is included in your income.

This also applies if any unused amount upon your death is payable in cash to your beneficiary or estate, or if the HRA provides an option for you to transfer any unused reimbursement at the end of the year to a retirement plan. If the plan permits amounts to be paid as medical benefits to a designated beneficiary other than the employee's spouse or dependents , any distribution from the HRA is included in income.

A medicine or drug will be a qualified medical expense for HRA purposes only if the medicine or drug: Amounts that remain at the end of the year generally can be carried over to the next year. These amounts may never be used for anything but reimbursements for qualified medical expenses.

For an HRA to maintain tax-qualified status, employers must comply with certain requirements that apply to other accident and health plans.

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