Department of the Treasury

Internal Revenue Service

Publication 502

Cat. No. 15002Q

Medical and Dental Expenses

(Including the Health Coverage Tax Credit)

For use in preparing

2021 Returns

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Jan 11, 2022

Contents

What's New. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

What Are Medical Expenses? . . . . . . . . . . . . . . . . . 2

What Expenses Can You Include This Year? . . . . . 2

How Much of the Expenses Can You Deduct? . . . . 3

Whose Medical Expenses Can You Include? . . . . . 3

What Medical Expenses Are Includible? . . . . . . . . 5

What Expenses Aren't Includible? . . . . . . . . . . . . 15

How Do You Treat Reimbursements?. . . . . . . . . 17

How Do You Figure and Report the Deduction

on Your Tax Return?. . . . . . . . . . . . . . . . . . . 19

Sale of Medical Equipment or Property . . . . . . . . 19

Damages for Personal Injuries . . . . . . . . . . . . . . . 20

Impairment-Related Work Expenses . . . . . . . . . . 21

Health Insurance Costs for Self-Employed

Persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Health Coverage Tax Credit . . . . . . . . . . . . . . . . . 22

How To Get Tax Help . . . . . . . . . . . . . . . . . . . . . . 22

Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Future Developments

For the latest information about developments related to Pub. 502, such as legislation enacted after it was published, go to IRS.gov/Pub502.

What's New

Standard mileage rate. The standard mileage rate al-lowed for operating expenses for a car when you use it for medical reasons is 16 cents a mile. See Transportation under What Medical Expenses Are Includible, later.

Reminders

Photographs of missing children. The IRS is a proud partner with the National Center for Missing & Exploited Children® (NCMEC) . Photographs of missing children se-lected by the Center may appear in this publication on pa-ges that would otherwise be blank. You can help bring these children home by looking at the photographs and calling 800-THE-LOST (800-843-5678) if you recognize a child.

Introduction

This publication explains the itemized deduction for medi-cal and dental expenses that you claim on Schedule A (Form 1040). It discusses what expenses, and whose ex-penses, you can and can't include in figuring the deduc-tion. It explains how to treat reimbursements and how to figure the deduction. It also tells you how to report the de-duction on your tax return and what to do if you sell medi-cal property or receive damages for a personal injury.

Medical expenses include dental expenses, and in this publication the term “medical expenses” is often used to refer to medical and dental expenses.

You can deduct on Schedule A (Form 1040) only the part of your medical and dental expenses that is more than 7.5% of your adjusted gross income (AGI).

This publication also explains how to treat impair-ment-related work expenses, health insurance premiums if you are self-employed, and the health coverage tax credit that is available to certain individuals.

Pub. 502 covers many common medical expenses but not every possible medical expense. If you can't find the expense you are looking for, refer to the definition of medi-cal expenses under What Are Medical Expenses, later.

See How To Get Tax Help near the end of this publica-tion for information about getting publications and forms.

Comments and suggestions. We welcome your com-ments about this publication and suggestions for future editions.

You can send us comments through IRS.gov/ FormComments. Or, you can write to the Internal Reve-nue Service, Tax Forms and Publications, 1111 Constitu-tion Ave. NW, IR-6526, Washington, DC 20224.

Although we can’t respond individually to each com-ment received, we do appreciate your feedback and will consider your comments and suggestions as we revise our tax forms, instructions, and publications. Don’t send tax questions, tax returns, or payments to the above ad-dress.

Getting answers to your tax questions. If you have a tax question not answered by this publication or the How To Get Tax Help section at the end of this publication, go to the IRS Interactive Tax Assistant page at IRS.gov/ Help/ITA where you can find topics by using the search feature or viewing the categories listed.

Getting tax forms, instructions, and publications. Go to IRS.gov/Forms to download current and prior-year forms, instructions, and publications.

Ordering tax forms, instructions, and publications. Go to IRS.gov/OrderForms to order current forms, instruc-tions, and publications; call 800-829-3676 to order prior-year forms and instructions. The IRS will process your order for forms and publications as soon as possible. Don’t resubmit requests you’ve already sent us. You can get forms and publications faster online.

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Useful Items

You may want to see:

Publication

969 Health Savings Accounts and Other Tax-Favored Health Plans

Forms (and Instructions)

1040 U.S. Individual Income Tax Return

1040-SR U.S. Tax Return for Seniors

Schedule A (Form 1040) Itemized Deductions

8885 Health Coverage Tax Credit

8962 Premium Tax Credit (PTC)

What Are Medical Expenses?

Medical expenses are the costs of diagnosis, cure, mitiga-tion, treatment, or prevention of disease, and for the pur-pose 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 equip-ment, supplies, and diagnostic devices needed for these purposes.

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 gen-eral health, such as vitamins or a vacation.

Medical expenses include the premiums you pay for in-surance 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.

What Expenses Can You Include This Year?

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 In-clude, later, for an exception.) This is not the rule for de-termining 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 finan-cial 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.

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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 Re-turn, to claim a refund for the year in which you over-looked 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'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.

Separate returns. If you and your spouse live in a non-community property state and file separate returns, each of you can include only the medical expenses each ac-tually 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.

Community property states. If you and your spouse live in a community property state and file separate re-turns 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 expen-ses are paid out of the separate funds of one individual, only the individual who paid the medical expenses can in-clude them. If you live in a community property state and aren't filing a joint return, see Pub. 555, Community Prop-erty.

How Much of the Expenses Can You Deduct?

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.

Whose Medical Expenses Can You Include?

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 differ-ent 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.

Spouse

You can include medical expenses you paid for your spouse. To include these expenses, you must have been

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married either at the time your spouse received the medi-cal services or at the time you paid the medical expenses.

Example 1. Mary received medical treatment before she married Bill. Bill paid for the treatment after they mar-ried. Bill can include these expenses in figuring his medi-cal expense deduction even if Bill and Mary file separate returns.

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

Example 2. 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 serv-ices, he can include those expenses in figuring his medi-cal expense deduction for this year.

Dependent

You can include medical expenses you paid for your de-pendent. 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.

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

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

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

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

2. He or she filed a joint return for 2021; or

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

Exception for adopted child. If you are a U.S. citizen or national and your adopted child lived with you as a mem-ber 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.

Qualifying Child

A qualifying child is a child who:

1. 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);

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2. Was:

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

b. Under age 24 at the end of 2021, a full-time stu-dent, and younger than you (or your spouse if fil-ing jointly), or

c. Any age and permanently and totally disabled;

3. Lived with you for more than half of 2021;

4. Didn't provide over half of his or her own support for 2021; and

5. Didn't file a joint return, other than to claim a refund.

Adopted child. 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 depend-ent 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 provi-ded 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 nego-tiations began, you can't include them as medical expen-ses.

You may be able to take a credit for other expen-TIP ses related to an adoption. See the Instructions for Form 8839, Qualified Adoption Expenses, for

more information.

Child of divorced or separated parents. For purposes of the medical and dental expenses deduction, a child of divorced or separated parents can be treated as a de-pendent 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:

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

2. The child receives over half of his or her support dur-ing the year from his or her parents; and

3. The child's parents:

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

b. Are separated under a written separation agree-ment, or

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

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

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Qualifying Relative

A qualifying relative is a person:

1. Who is your:

a. Son, daughter, stepchild, or foster child, or a de-scendant of any of them (for example, your grand-child),

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

c. Father, mother, or an ancestor or sibling of either of them (for example, your grandmother, grandfa-ther, aunt, or uncle),

d. Stepbrother, stepsister, stepfather, stepmother, son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, or sister-in-law, or

e. Any other person (other than your spouse) who lived with you all year as a member of your house-hold if your relationship didn't violate local law,

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

3. 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 Qualify-ing Relative in Pub. 501, Dependents, Standard De-duction, and Filing Information.

Support claimed under a multiple support agree-ment. If you are considered to have provided more than half of a qualifying relative's support under a multiple sup-port 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 per-son'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 unreim-bursed amount you paid for medical expenses.

Example. 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 de-pendent. 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.

Decedent

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

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includes expenses for the decedent's spouse and de-pendents as well as for the decedent.

The survivor or personal representative of a decedent can choose to treat certain expenses paid by the dece-dent's estate for the decedent's medical care as paid by the decedent at the time the medical services were provi-ded. 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 re-turn, Form 1040-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 CAUTION tax-free distribution from any Archer MSA, Medi-

care Advantage MSA, or health savings account.

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

Example. John properly filed his 2020 income tax re-turn. 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 rep-resentative 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.

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 1040) in the year paid, whether they are paid before or after the dece-dent's death. The expenses can be included if the person was your spouse or dependent either at the time the medi-cal services were provided or at the time you paid the ex-penses.

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.

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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 sup-port organization (for example, Alcoholics Anonymous) meetings in your community if the attendance is pursuant to medical advice that membership in Alcoholics Anony-mous 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 elec-tronic body scan.

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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 im-paired 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 in-clude 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 Cos-metic Surgery, later.

Capital Expenses

You can include in medical expenses amounts you pay for special equipment installed in a home, or for improve-ments, if their main purpose is medical care for you, your spouse, or your dependent. The cost of permanent im-provements 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 equip-ment.

Moving or modifying electrical outlets and fixtures.

Installing porch lifts and other forms of lifts (but eleva-tors 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 door-ways.

Grading the ground to provide access to the resi-dence.

Only reasonable costs to accommodate a home to your disabled condition are considered medical care. Addi-tional 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

Keep for Your Records

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

1. Enter the amount you paid for the home improvement . . . . . . . . . . . . . . . . . . . . . . . . . . 1.

2. Enter the value of your home immediately after the improvement . . . . . . . . . . . . . . . 2.

3. Enter the value of your home immediately before the improvement . . . . . . . . . . . . . . . 3.

4. Subtract line 3 from line 2. This is the increase in the value of your home due to the improvement . . . . . . . . . . . . . . . . . . . . . . . . . . 4.

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.

5. Subtract line 4 from line 1. These are your medical expenses due to the home improvement . . . . . . . . . . . . . . . . . . . . . . . . . . 5.

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 expen-ses.

Example. John has arthritis and a heart condition. He can't climb stairs or get into a bathtub. On his doctor's ad-vice, he installs a bathroom with a shower stall on the first floor of his two-story rented house. The landlord didn't pay

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any of the cost of buying and installing the special plumb-ing 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 hy-gienist or dentist for such procedures as teeth cleaning, the application of sealants, and fluoride treatments to pre-vent tooth decay. Treatment to alleviate dental disease in-cludes services of a dentist for procedures such as X-rays, fillings, braces, extractions, dentures, and other dental ailments. But see Teeth Whitening under What Ex-penses 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

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the cost of the blood sugar test kit in your medical expen-ses.

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 Depend-ent 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 rea-sons. 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 fol-lowing procedures performed on yourself, your spouse, or your dependent to overcome an inability to have children.

Procedures such as in vitro fertilization (including tem-porary storage of eggs or sperm).

Surgery, including an operation to reverse prior sur-gery that prevented the person operated on from hav-ing children.

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Founder's Fee

See Lifetime Care—Advance Payments, later.

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 ani-mal to assist a visually impaired or hearing disabled per-son, or a person with other physical disabilities. In gen-eral, this includes any costs, such as food, grooming, and veterinary care, incurred in maintaining the health and vi-tality 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 pre-scribed by a physician and the physician issues a state-ment that the treatment is necessary to alleviate a physi-cal 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 medi-cal 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 op-erate 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 in-clude in medical expenses insurance premiums that were paid and for which you are claiming a credit or deduction.

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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 medi-cal 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, reemploy-ment 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 cover-age 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 In-structions 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 in-surance 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 sal-ary. Because you are an employee whose insurance pre-miums are paid with money that is never included in your

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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 re-ported as wages on your Form W-2.

Retired public safety officers. If you are a retired pub-lic 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 re-tirement 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 ex-penses 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 Medi-care 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 ex-pense. Check the information you received from the So-cial 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 Medi-care Part D.

Prepaid Insurance Premiums

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

1. Payable in equal yearly installments or more often; and

2. 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 re-ceive 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 ex-pense.

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 in-clude 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 in-surance 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 pro-vider and these distributions would otherwise have been included in income.

Taxes imposed by any governmental unit, such as Medi-care taxes, aren't insurance premiums.

Coverage for nondependents. Generally, you can't de-duct any additional premium you pay as the result of in-cluding 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 be-cause of the rules for children of divorced or separa-ted 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

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claimed as a dependent on someone else's 2021 re-turn.

Also, if you had family coverage when you added this indi-vidual 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 disa-bled in a special home, not the home of a relative, on the recommendation of a psychiatrist to help the person ad-just 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.

Lactation Expenses

See Breast Pumps and Supplies, earlier.

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 crack-ing) 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 ex-penses. 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 ill-ness. 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 alloca-ble to medical care. The agreement must require that you pay a specific fee as a condition for the home's promise to

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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 medi-cal 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 be-come 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 sub-stantially beyond the end of the year. This rule doesn't ap-ply in situations where the future care is purchased in con-nection 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 institu-tion. You can include the cost of such lodging while away from home if all of the following requirements are met.

1. The lodging is primarily for and essential to medical care.

2. 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.

3. The lodging isn't lavish or extravagant under the cir-cumstances.

4. 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 lodg-ing 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 pa-rent 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.

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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 con-tracts.

Qualified Long-Term Care Services

Qualified long-term care services are necessary diagnos-tic, preventive, therapeutic, curing, treating, mitigating, re-habilitative services, and maintenance and personal care services (defined later) that are:

1. Required by a chronically ill individual, and

2. Provided pursuant to a plan of care prescribed by a li-censed 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.

1. He or she is unable to perform at least two activities of daily living without substantial assistance from an-other individual for at least 90 days, due to a loss of functional capacity. Activities of daily living are eating, toileting, transferring, bathing, dressing, and conti-nence.

2. He or she requires substantial supervision to be pro-tected from threats to health and safety due to severe cognitive impairment.

Maintenance and personal care services. Mainte-nance 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 (includ-ing protection from threats to health and safety due to se-vere cognitive impairment).

Qualified Long-Term Care Insurance Contracts

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

1. Be guaranteed renewable;

2. Not provide for a cash surrender value or other money that can be paid, assigned, pledged, or borrowed;

3. 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

4. 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 peri-odic payments without regard to expenses.

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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).

1. Qualified long-term care premiums up to the following amounts.

a. Age 40 or under—$450.

b. Age 41 to 50—$850.

c. Age 51 to 60—$1,690.

d. Age 61 to 70—$4,520.

e. Age 71 or over—$5,640.

2. 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 distribu-tions from a qualified retirement plan made directly to the insurance provider and these distributions would other-wise 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 be-ing 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 neces-sary to the medical care of you, your spouse, or your de-pendent. 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.
CAUTION

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 re-quest 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

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individual. You can also include amounts you pay for insu-lin. Except for insulin, you can't include in medical expen-ses amounts you pay for a drug that isn't prescribed.

Imported medicines and drugs. If you imported medi-cines 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 insti-tution, 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 rea-son 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 serv-ices 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 per-sonal and household services, amounts paid to the at-tendant must be divided between the time spent perform-ing household and personal services and the time spent for nursing services. For example, because of your medi-cal 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 med-ical expenses. The $30 (10% × $300) allocated to house-hold services can't be included. However, certain mainte-nance 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 indi-vidual 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.

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Employment taxes. You can include as a medical ex-pense 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 ex-pense only the amount of employment taxes paid for med-ical services, as explained earlier. For information on em-ployment 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 Cos-metic Surgery under What Expenses Aren't Includible, later.

Optometrist

See Eyeglasses, earlier.

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 prob-lems 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 pre-mium tax credit. You also can't include in medical expen-ses 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.

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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 premi-ums 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 repay-ment 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 al-lowed 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.

Prosthesis

See Artificial Limb and Breast Reconstruction Surgery, earlier.

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 psy-choanalysis. However, you can't include payments for psychoanalysis that is part of required training to be a psy-choanalyst.

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 disor-ders.

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 dis-abilities. Overcoming the learning disabilities must be the primary reason for attending the school, and any ordinary

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education received must be incidental to the special edu-cation 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 condi-tion caused by a birth defect.

You can't include in medical expenses the cost of send-ing a child with behavioral problems to a school where the course of study and the disciplinary methods have a ben-eficial 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 per-son 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 equip-ment 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 televi-sion that exceeds the cost of the same model regular tele-vision 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

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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 or-gan 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 treat-ment required by a patient who is traveling to get med-ical care and is unable to travel alone; and

Transportation expenses for regular visits to see a mentally ill dependent, if these visits are recommen-ded 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, insur-ance, 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 multi-plies 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 re-quires an unusual means of transportation.

Travel for purely personal reasons to another city for an operation or other medical care.

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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 in-cluded as a medical expense for lodging. Meals aren't in-cluded. 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, ear-lier.

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 diag-nosed by a physician (such as obesity, hypertension, or heart disease). This includes fees you pay for member-ship in a weight reduction group as well as fees for attend-ance 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

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nutritional needs. You can include the cost of special food in medical expenses only if:

1. The food doesn't satisfy normal nutritional needs,

2. The food alleviates or treats an illness, and

3. The need for the food is substantiated by a physician.

The amount you can include in medical expenses is limi-ted to the amount by which the cost of the special food ex-ceeds the cost of a normal diet. See also Weight-Loss Program under What Expenses Aren't Includible, later.

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.

What Expenses Aren't Includible?

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

Baby Sitting, Childcare, and Nursing Services for a Normal, Healthy Baby

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.

Controlled Substances

You can't include in medical expenses amounts you pay for controlled substances (such as marijuana, laetrile, etc.) that aren't legal under federal law, even if such sub-stances are legalized by state law.

Cosmetic Surgery

Generally, you can't include in medical expenses the amount you pay for cosmetic surgery. This includes any

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procedure that is directed at improving the patient's ap-pearance 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 de-formity arising from, or directly related to, a congenital ab-normality, a personal injury resulting from an accident or trauma, or a disfiguring disease.

Example. An individual undergoes surgery that re-moves a breast as part of treatment for cancer. She pays a surgeon to reconstruct the breast. The surgery to recon-struct the breast corrects a deformity directly related to the disease. The cost of the surgery is includible in her medi-cal expenses.

Dancing Lessons

You can't include in medical expenses the cost of dancing lessons, swimming lessons, etc., even if they are recom-mended by a doctor, if they are only for the improvement of general health.

Diaper Service

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.

Electrolysis or Hair Removal

See Cosmetic Surgery, earlier.

Flexible Spending Arrangement

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

Funeral Expenses

You can't include in medical expenses amounts you pay for funerals.

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, as explained under Lifetime Care—Advance Payments, or qualified long-term care insurance contracts, as explained under Long-Term Care, earlier.

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Hair Transplant

See Cosmetic Surgery, earlier.

Health Club Dues

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.

Health Coverage Tax Credit (HCTC)

You can't include in medical expenses amounts you pay for health insurance you use in figuring your health cover-age tax credit. For more information, see the Instructions for Form 8885.

Health Savings Accounts

You can’t include in medical expenses amounts you con-tribute to a health savings account. You can’t include ex-penses you pay for with a tax-free distribution from your health savings account. You also can’t use other funds equal to the amount of the distribution and include the ex-penses. For more information, see Pub. 969.

Household Help

You can't include in medical expenses the cost of house-hold 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. For more informa-tion, see Nursing Services, earlier, under What Medical Expenses Are Includible. Also, certain maintenance or personal care services provided for qualified long -term care can be included in medical expenses. For more infor-mation, see Long-Term Care, earlier, under What Medical Expenses Are Includible.

Illegal Operations and Treatments

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.

Insurance Premiums

See Insurance Premiums under What Medical Expenses Are Includible, earlier.

Maternity Clothes

You can't include in medical expenses amounts you pay for maternity clothes.

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Medical Savings Account (MSA)

You can't include in medical expenses amounts you con-tribute 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. For more informa-tion on Archer MSAs, see Pub. 969.

Medicines and Drugs From Other Countries

In general, you can't include in your medical expenses the cost of a prescribed drug brought in (or ordered and ship-ped) 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 indi-viduals.

You can include the cost of a prescribed drug you pur-chase and consume in another country if the drug is legal in both the other country and the United States.

Nonprescription Drugs and Medicines

Except for insulin, you can't include in medical expenses amounts you pay for a drug that isn't prescribed. A pre-scribed drug is one that requires a prescription by a doctor for its use by an individual.

Example. Your doctor recommends that you take as-pirin. Because aspirin is a drug that doesn't require a physician's prescription for its use by an individual, you can't include its cost in your medical expenses.

Nutritional Supplements

You can't include in medical expenses the cost of nutri-tional supplements, vitamins, herbal supplements, “natu-ral medicines,” etc., unless they are recommended by a medical practitioner as treatment for a specific medical condition diagnosed by a physician. These items are taken to maintain your ordinary good health and aren't for medical care.

Personal Use Items

You can't include in medical expenses the cost of an item ordinarily used for personal, living, or family purposes un-less 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 ex-pense.

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

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medical expense. See Braille Books and Magazines un-der What Medical Expenses Are Includible, earlier.

Premium Tax Credit

You can't include in medical expenses the amount of health insurance premiums paid by or through the pre-mium tax credit. You also can't include in medical expen-ses 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.

Swimming Lessons

See Dancing Lessons, earlier.

Teeth Whitening

You can't include in medical expenses amounts paid to whiten teeth. See Cosmetic Surgery, earlier.

Veterinary Fees

You generally can't include veterinary fees in your medical expenses, but see Guide Dog or Other Service Animal un-der What Medical Expenses Are Includible, earlier.

Weight-Loss Program

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, hy-pertension, 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'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 nutri-tional needs.

See Weight-Loss Program under What Medical Expen-ses Are Includible, earlier.

Insurance Reimbursement

You must reduce your total medical expenses for the year by all reimbursements for medical expenses that you re-ceive 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 re-ceive from that policy to reduce your total medical expen-ses, including those it doesn't reimburse.

Example. 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 deduc-tion, you must reduce the total amount you spent for medi-cal care by the total amount of insurance you received, even if the policies don't cover some of your medical ex-penses.

Health reimbursement arrangement (HRA). An HRA 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 in-cluded in your income.

Other reimbursements. Generally, you don't reduce medical expenses by payments you receive for:

Permanent loss or loss of use of a member or function of the body (loss of limb, sight, hearing, etc.) or disfig-urement to the extent the payment is based on the na-ture of the injury without regard to the amount of time lost from work, or

Loss of earnings.

You must, however, reduce your medical expenses by any part of these payments that is designated for medical costs. See How Do You Figure and Report the Deduction on Your Tax Return, later.

For how to treat damages received for personal injury or sickness, see Damages for Personal Injuries, later.

What if Your Insurance Reimbursement Is More Than Your Medical Expenses?

If you are reimbursed more than your medical expenses, you may have to include the excess in income. You may want to use Figure 1 to help you decide if any of your re-imbursement is taxable.

How Do You Treat

Reimbursements?

You can include in medical expenses only those amounts

paid during the tax year for which you received no insur-

ance or other reimbursement.

Publication 502 (2021)Page 17

Figure 1.Is Your Excess Medical

	Reimbursement Taxable?


Was any part of		No
your premiums

paid by your
employer?			▼
			NONE of the
	Yes
			excess

▼			reimbursement is
			taxable.

Were your


employer’s
		Yes
contributions to

your premiums
included in your
income?

	No
▼

Did you pay any		No	ALL of the excess
part of the			reimbursement is
premiums?			taxable.

	Yes

			PART of the
			excess
			reimbursement is
			taxable.*

*See Premiums paid by you and your employer.

Premiums paid by you. If you pay either the entire pre-mium for your medical insurance or all the costs of a plan similar to medical insurance and your insurance payments or other reimbursements are more than your total medical expenses for the year, you have excess reimbursement. Generally, you don't include the excess reimbursement in your gross income. However, gross income does include total payments in excess of $400 a day ($146,000 for 2021) for qualified long-term care services.

Premiums paid by you and your employer. If both you and your employer contribute to your medical insurance plan and your employer's contributions aren't included in your gross income, you must include in your gross income the part of your excess reimbursement that is from your employer's contribution.

If you aren't covered by more than one policy, you can figure the amount of the excess reimbursement you must include in gross income using Worksheet B. If you are covered under more than one policy, see More than one policy, later.

Worksheet B. Excess Reimbursement

Includible in Income

When You Have Only

One Policy

Keep for Your Records

Instructions: Use this worksheet to figure the amount of excess reimbursement you must include in income when both you and your employer contributed to your medical insurance and your employer's contributions aren't included in your gross income.

1. Enter the amount contributed to your medical insurance for the year by your employer . . . . . . . . . . . . . . . . . . . . . . . . 1.

2. Enter the total annual cost of the

policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.

3. Divide line 1 by line 2 . . . . . . . . . . . . . . . 3.

4. Enter the amount of excess

reimbursement . . . . . . . . . . . . . . . . . . . . 4.

5. Multiply line 3 by line 4. This is the amount of the excess reimburse-ment you must include as other income

on Form 1040 or 1040-SR . . . . . . . . . . . 5.

Premiums paid by your employer. If your employer or your former employer pays the total cost of your medical insurance plan and your employer's contributions aren't included in your income, you must report all of your ex-cess reimbursement as other income.

More than one policy. If you are covered under more than one policy, the cost of at least one of which is paid by both you and your employer, you must first divide the medical expenses among the policies to figure the excess reimbursement from each policy. Then divide the policy costs to figure the part of any excess reimbursement that is from your employer's contribution. Any excess reim-bursement that is due to your employer's contributions is includible in your income.

You can figure the part of the excess reimbursement that is from your employer's contribution by using Work-sheet C. Use Worksheet C only if both you and your em-ployer paid part of the cost of at least one policy. If you had more than one policy, but you didn't share in the cost of at least one policy, don't use Worksheet C.

Page 18Publication 502 (2021)

Worksheet C. Excess

Reimbursement

Includible in Income

When You Have More

Than One Policy

Keep for Your Records

Instructions: Use this worksheet to figure the amount of excess reimbursement you must include as income on your tax return when

(a) you are reimbursed under two or more health insurance policies,

(b) at least one of which is paid for by both you and your employer, and (c) your employer's contributions aren't included in your gross income. If you and your employer didn't share in the cost of at least one policy, don't use this worksheet.

1. Enter the reimbursement from your

employer's policy . . . . . . . . . . . . . . . . . . . .1.

2. Enter the reimbursement from your own

	policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	2.
3.	Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . .	3.
4.	Divide line 1 by line 3 . . . . . . . . . . . . . . . .	4.

5. Enter the total medical expenses you paid during the year. If this amount is at least as much as the amount on line 3, stop here because there is no excess

	reimbursement . . . . . . . . . . . . . . . . . . . . .	5.
6.	Multiply line 4 by line 5 . . . . . . . . . . . . . . .	6.
7.	Subtract line 6 from line 1 . . . . . . . . . . . . .	7.
8.	Enter employer's contribution to the
	annual cost of the employer's	8.
	policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9.	Enter total annual cost of the employer's	9.
	policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10.	Divide line 8 by line 9. This is the
	percentage of your total excess
	reimbursement you must report as other	10.
	income . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11.	Multiply line 7 by line 10. This is the
	amount of your total excess
	reimbursement you must report as other	11.
	income on Form 1040 or 1040-SR . . . . . .

What if You Receive Insurance Reimbursement in a Later Year?

If you are reimbursed in a later year for medical expenses you deducted in an earlier year, you must generally report the reimbursement as income up to the amount you previ-ously deducted as medical expenses.

However, don't report as income the amount of reim-bursement you received up to the amount of your medical deductions that didn't reduce your tax for the earlier year.

For more information about the recovery of an amount that you claimed as an itemized deduction in an earlier year, see Recoveries in Pub. 525, Taxable and Nontaxa-ble Income.

What if You Are Reimbursed for Medical Expenses You Didn't Deduct?

If you didn't deduct a medical expense in the year you paid it because your medical expenses weren't more than 7.5% of your AGI or because you didn't itemize deduc-tions, don't include the reimbursement, up to the amount of the expense, in income. However, if the reimbursement is more than the expense, see What if Your Insurance Re-imbursement Is More Than Your Medical Expenses, ear-lier.

How Do You Figure and Report the Deduction on Your Tax Return?

Once you have determined which medical expenses you can include, figure and report the deduction on your tax return.

What Tax Form Do You Use?

You report your medical expense deduction on Sched-ule A (Form 1040). See the Instructions for Schedule A (Form 1040) for more detailed information on figuring your medical and dental expense deduction.

Recordkeeping. You should keep records of your medical and dental expenses to support your RECORDS deduction. Don't send these records with your pa-

per return.

Sale of Medical Equipment or Property

If you deduct the cost of medical equipment or property in one year and sell it in a later year, you may have a taxable gain. The taxable gain is the amount of the selling price that is more than the adjusted basis of the equipment or property.

The adjusted basis is the portion of the cost of the equipment or property that you couldn't deduct because of the 7.5% or 10% AGI limit used to figure your medical deduction. Refer to your Schedule A for the year the cost was included to determine which limit applied to you. Use Worksheet D to figure the adjusted basis of the equipment or property.

Publication 502 (2021)Page 19

Worksheet D. Adjusted Basis of

Medical Equipment or

Property Sold

Keep for Your Records

Instructions: Use this worksheet if you deducted the cost of medical equipment or property in one year and sold the equipment or property in a later year. This worksheet will give you the adjusted basis of the equipment or property you sold.

1. Enter the cost of the equipment or

property . . . . . . . . . . . . . . . . . . . . . . .1.

2. Enter your total includible medical expenses for the year you included the cost in your medical

	expenses . . . . . . . . . . . . . . . . . . . . .	2.
3.	Divide line 1 by line 2 . . . . . . . . . . . .	3.
4.	Enter 7.5% or 10% of your AGI
	(whichever applies) for the year the
	cost was included in your medical	4.
	expenses . . . . . . . . . . . . . . . . . . . . .

5. Multiply line 3 by line 4. If your allowable itemized deductions for the year you purchased the equipment or property weren't more than your AGI for that year, stop here. This is the adjusted basis of the equipment or property. If your allowable itemized deductions for the year you purchased the equipment or property were more than your AGI for that year, complete lines 6 through

11 ............................	5.
6. Subtract line 5 from line 1 . . . . . . . .	6.

7. Enter your total allowable itemized deductions for the year the cost was included in your medical

expenses . . . . . . . . . . . . . . . . . . . . .	7.
8. Divide line 6 by line 7 . . . . . . . . . . . .	8.

9. Enter your AGI for the year the cost was included in your medical

	expenses . . . . . . . . . . . . . . . . . . . . .	9.
10.	Subtract line 9 from line 7 . . . . . . . .	10.
11.	Multiply line 8 by line 10 . . . . . . . . .	11.
12.	Add line 5 to line 11. If your allowable
	itemized deductions for the year you
	purchased the equipment or property
	were more than your AGI for that
	year, this is the adjusted basis of the	12.
	equipment or property . . . . . . . . . . .

Next, use Worksheet E to figure the total gain or loss on the sale of the medical equipment or property.

Page 20

Worksheet E. Gain or Loss on the

Sale of Medical

Equipment or Property

Keep for Your Records

Instructions: Use the following worksheet to figure total gain or loss on the sale of medical equipment or property that you deducted in an earlier year.

1. Enter the amount that the medical

equipment or property sold for . . . . . .

1.

2. Enter your selling expenses . . . . . . . . . 2.

3. Subtract line 2 from line 1 . . . . . . . . . . .

3.

4. Enter the adjusted basis of the equipment or property from Worksheet

D, line 5, or line 12, if applicable. . . . . 4.

5. Subtract line 4 from line 3. This is the total gain or loss from the sale of the

medical equipment or property . . . . . .

5.

If you have a loss, it isn't deductible. If you have a gain, it is includible in your income. The part of the gain that is a recovery of an amount you previously deducted is taxable as ordinary income. Enter it on Form 1040 or 1040-SR. Any part of the gain that is more than the recovery of an amount you previously deducted is taxable as a capital gain. Enter it on Form 8949, Sales and Other Dispositions of Capital Assets, and Schedule D (Form 1040), Capital Gains and Losses.

For more information about the recovery of an amount that you claimed as an itemized deduction in an earlier year, see Recoveries in Pub. 525.

Damages for Personal Injuries

If you receive an amount in settlement of a personal injury suit, part of that award may be for medical expenses that you deducted in an earlier year. If it is, you must include that part in your income in the year you receive it to the ex-tent it reduced your taxable income in the earlier year. See What if You Receive Insurance Reimbursement in a Later Year, discussed earlier under How Do You Treat Reim-bursements.

Example. You sued this year for injuries you suffered in an accident last year. You sought $10,000 for your inju-ries and didn't itemize your damages. Last year, you paid $500 for medical expenses for your injuries. You deducted those expenses on last year's tax return. This year you settled your lawsuit for $2,000. Your settlement didn't itemize or allocate the damages. The $2,000 is first pre-sumed to be for the medical expenses that you deducted. The $500 is includible in your income this year because you deducted the entire $500 as a medical expense de-duction last year.

Future medical expenses. If you receive an amount in settlement of a damage suit for personal injuries, part of

Publication 502 (2021)

that award may be for future medical expenses. If it is, you must reduce any future medical expenses for these inju-ries until the amount you received has been completely used.

Example. You were injured in an accident. You sued and sought a judgment of $50,000 for your injuries. You settled the suit for $45,000. The settlement provided that $10,000 of the $45,000 was for future medical expenses for your injuries. You can't include the first $10,000 that you pay for medical expenses for those injuries.

Workers' compensation. If you received workers' com-pensation and you deducted medical expenses related to that injury, you must include the workers' compensation in income up to the amount you deducted. If you received workers' compensation, but didn't deduct medical expen-ses related to that injury, don't include the workers' com-pensation in your income.

Impairment-Related Work Expenses

If you are a person with disabilities, you can take a busi-ness deduction for expenses that are necessary for you to be able to work. If you take a business deduction for these impairment-related work expenses, they aren't subject to the 7.5% limit that applies to medical expenses.

You have a disability if you have:

A physical or mental disability (for example, blindness or deafness) that functionally limits your being em-ployed; or

A physical or mental impairment (for example, a sight or hearing impairment) that substantially limits one or more of your major life activities, such as performing manual tasks, walking, speaking, breathing, learning, or working.

Impairment-related expenses defined. Impairment-re-lated expenses are those ordinary and necessary busi-ness expenses that are:

Necessary for you to do your work satisfactorily;

For goods and services not required or used, other than incidentally, in your personal activities; and

Not specifically covered under other income tax laws.

Where to report. If you are self-employed, deduct the business expenses on the appropriate form (Schedule C, E, or F) used to report your business income and expen-ses.

If you are an employee, complete Form 2106, Em-ployee Business Expenses. Enter on Schedule A (Form 1040) that part of the amount on Form 2106 that is related to your impairment.

Example. You are blind. You must use a reader to do your work. You use the reader both during your regular

Publication 502 (2021)

working hours at your place of work and outside your reg-ular working hours away from your place of work. The reader's services are only for your work. You can deduct your expenses for the reader as business expenses.

Health Insurance Costs for Self-Employed Persons

If you were self-employed and had a net profit for the year, you may be able to deduct, as an adjustment to income, amounts paid for medical and qualified long-term care in-surance on behalf of yourself, your spouse, your depend-ents, and your children who were under age 27 at the end of 2021. For this purpose, you were self-employed if you were a general partner (or a limited partner receiving guar-anteed payments) or you received wages from an S cor-poration in which you were more than a 2% shareholder. The insurance plan must be established under your trade or business and the deduction can't be more than your earned income from that trade or business.

You can't deduct payments for medical insurance for any month in which you were eligible to participate in a health plan subsidized by your employer, your spouse's employer, or an employer of your dependent, or your child under age 27, at the end of 2021. You can't deduct pay-ments for a qualified long-term care insurance contract for any month in which you were eligible to participate in a long-term care insurance plan subsidized by your em-ployer or your spouse's employer.

If you qualify to take the deduction, use the Self-Em-ployed Health Insurance Deduction Worksheet in the In-structions for Forms 1040 and 1040-SR to figure the amount you can deduct. But if any of the following applies, don't use that worksheet.

You had more than one source of income subject to self-employment tax.

You file Form 2555, Foreign Earned Income.

You are using amounts paid for qualified long-term care insurance to figure the deduction.

If you can't use the worksheet in the Instructions for Forms 1040 and 1040 -SR, use the worksheet in Pub. 535, Busi-ness Expenses, to figure your deduction.

If you were an eligible TAA recipient, ATAA recipient, RTAA recipient, or PBGC payee, see the Instructions for Form 8885 to figure the amount to enter on the worksheet.

Use Pub. 974, Premium Tax Credit, instead of the worksheet in the 2021 Instructions for Forms 1040 and 1040-SR if the insurance plan established, or considered to be established, under your business was obtained through the Health Insurance Marketplace and you are claiming the premium tax credit.

When figuring the amount you can deduct for insurance premiums, don't include amounts paid for health insur-ance coverage with retirement plan distributions that were tax free because you are a retired public safety officer.

Page 21

Where to report. You take this deduction on Form 1040 or 1040-SR. If you itemize your deductions and don't claim 100% of your self-employed health insurance costs on Form 1040 or 1040-SR, include any remaining premi-ums with all other medical expenses on Schedule A (Form 1040) subject to the 7.5% limit.

Child under age 27. If the insurance policy covers your nondependent child who was under age 27 at the end of 2021, you can claim the premiums for that coverage on Form 1040 or 1040-SR. If you can't claim 100% of your self-employed health insurance costs on Form 1040 or 1040-SR, any excess amounts attributable to that child aren't eligible to be claimed on Schedule A (Form 1040).

Generally, family health insurance premiums don't in-crease if coverage for an additional child is added. If this is the situation, no allocation would be necessary. If the premiums did increase (such as where coverage was ex-panded from single to family to add the nondependent child), you can allocate the amount on Form 1040 or 1040-SR to the nondependent child and any excess amounts not attributable to that child would be eligible to be claimed on Schedule A.

Example 1. Kate is self-employed in 2021 and has self-only coverage for health insurance. Her premium for that coverage was $5,000 for the year. She changes to family coverage only to add her 26-year-old nondepend-ent child to the plan. Her health insurance premium in-creases to $10,000 for the year. After completing the Self-Employed Health Insurance Deduction Worksheet in the Instructions for Forms 1040 and 1040-SR, she can only deduct $4,000 on Form 1040 or 1040-SR. The $4,000 is allocable to the nondependent child. On Sched-ule A, she can only claim the $5,000 allocable to her cov-erage. She can't claim the $1,000 excess premiums allo-cable to the nondependent child.

Example 2. The facts are the same as in Example 1, except that Kate had family coverage when she added her 26-year-old nondependent child to the policy. There was no increase in the $10,000 premium. In this case, she could claim $4,000 on Form 1040 or 1040 -SR and $6,000 on Schedule A.

More information. For more information, see Pub. 535.

Health Coverage Tax Credit

The health coverage tax credit (HCTC) is a tax credit that pays 72.5% of qualified health insurance premiums for eli-gible individuals and their families. The HCTC acts as par-tial reimbursement for premiums paid for qualified health insurance coverage.

You must elect the HCTC. Once you make the election to take the HCTC for an eligible coverage month, you can't take the premium tax credit for the same coverage in that coverage month and for all subsequent coverage months during your tax year in which you are eligible to take the HCTC.

Page 22

If you have qualified health insurance that covers any-one besides yourself and your qualifying family mem-ber(s), you may not be able to take into account all of your payments. You can't treat an amount as paid for insurance for yourself and qualifying family members unless all of the following requirements are met.

The charge for insurance for yourself and qualifying family members is either separately stated in the con-tract or furnished to you by the insurance company in a separate statement.

The amount you paid for insurance for yourself and qualifying family members isn't more than the charge that is stated in the contract or furnished by the insur-ance company.

The amount stated in the contract or furnished by the insurance company isn't unreasonably large in relation to the total charges under the contract.

For more information on who is eligible to take the HCTC, which plans are qualified health plans for the HCTC, how to figure your credit if advance payments of the premium tax credit were made, as well as other changes to the HCTC, go to IRS.gov/HCTC. Also, see the Instructions for Form 8885.

How To Get Tax Help

If you have questions about a tax issue; need help prepar-ing your tax return; or want to download free publications, forms, or instructions, go to IRS.gov to find resources that can help you right away.

Preparing and filing your tax return. After receiving all your wage and earnings statements (Forms W-2, W-2G, 1099-R, 1099-MISC, 1099-NEC, etc.); unemployment compensation statements (by mail or in a digital format) or other government payment statements (Form 1099-G); and interest, dividend, and retirement statements from banks and investment firms (Forms 1099), you have sev-eral options to choose from to prepare and file your tax re-turn. You can prepare the tax return yourself, see if you qualify for free tax preparation, or hire a tax professional to prepare your return.

For 2021, if you received an Economic Impact ! Payment (EIP), refer to your Notice 1444-C, Your CAUTION 2021 Economic Impact Payment. If you received Advance Child Tax Credit payments, refer to your Letter

6419.

Free options for tax preparation. Go to IRS.gov to see your options for preparing and filing your return online or in your local community, if you qualify, which include the following.

Free File. This program lets you prepare and file your federal individual income tax return for free using brand-name tax-preparation-and-filing software or Free File fillable forms. However, state tax preparation may not be available through Free File. Go to IRS.gov/

Publication 502 (2021)

FreeFile to see if you qualify for free online federal tax preparation, e-filing, and direct deposit or payment op-tions.

VITA. The Volunteer Income Tax Assistance (VITA) program offers free tax help to people with low-to-moderate incomes, persons with disabilities, and limited-English-speaking taxpayers who need help preparing their own tax returns. Go to IRS.gov/ VITA, download the free IRS2Go app, or call

800-906-9887 for information on free tax return prepa-ration.

TCE. The Tax Counseling for the Elderly (TCE) pro-gram offers free tax help for all taxpayers, particularly those who are 60 years of age and older. TCE volun-teers specialize in answering questions about pen-sions and retirement-related issues unique to seniors. Go to IRS.gov/TCE, download the free IRS2Go app, or call 888-227-7669 for information on free tax return preparation.

MilTax. Members of the U.S. Armed Forces and qualified veterans may use MilTax, a free tax service offered by the Department of Defense through Military OneSource. For more information go to MilitaryOneSource (MilitaryOneSource.mil/Tax).

Also, the IRS offers Free Fillable Forms, which can be completed online and then filed electronically re-gardless of income.

Using online tools to help prepare your return. Go to IRS.gov/Tools for the following.

The Earned Income Tax Credit Assistant (IRS.gov/ EITCAssistant) determines if you’re eligible for the earned income credit (EIC).

The Online EIN Application (IRS.gov/EIN) helps you get an employer identification number (EIN) at no cost.

The Tax Withholding Estimator (IRS.gov/W4app) makes it easier for everyone to pay the correct amount of tax during the year. The tool is a convenient, online way to check and tailor your withholding. It’s more user-friendly for taxpayers, including retirees and self-employed individuals. The features include the following.

– Easy to understand language.

– The ability to switch between screens, correct pre-vious entries, and skip screens that don’t apply.

– Tips and links to help you determine if you qualify for tax credits and deductions.

– A progress tracker.

– A self-employment tax feature.

– Automatic calculation of taxable social security ben-efits.

The First-Time Homebuyer Credit Account Look-up (IRS.gov/HomeBuyer) tool provides information on your repayments and account balance.

Publication 502 (2021)

The Sales Tax Deduction Calculator (IRS.gov/ SalesTax) figures the amount you can claim if you itemize deductions on Schedule A (Form 1040).

Getting answers to your tax questions. On IRS.gov, you can get up-to-date information on current events and changes in tax law.

IRS.gov/Help: A variety of tools to help you get an-swers to some of the most common tax questions.

IRS.gov/ITA: The Interactive Tax Assistant, a tool that will ask you questions and, based on your input, pro-vide answers on a number of tax law topics.

IRS.gov/Forms: Find forms, instructions, and publica-tions. You will find details on 2021 tax changes and hundreds of interactive links to help you find answers to your questions.

You may also be able to access tax law information in your electronic filing software.

Need someone to prepare your tax return? There are various types of tax return preparers, including tax prepar-ers, enrolled agents, certified public accountants (CPAs), attorneys, and many others who don’t have professional credentials. If you choose to have someone prepare your tax return, choose that preparer wisely. A paid tax pre-parer is:

Primarily responsible for the overall substantive accu-racy of your return,

Required to sign the return, and

Required to include their preparer tax identification number (PTIN).

Although the tax preparer always signs the return, you're ultimately responsible for providing all the informa-tion required for the preparer to accurately prepare your return. Anyone paid to prepare tax returns for others should have a thorough understanding of tax matters. For more information on how to choose a tax preparer, go to Tips for Choosing a Tax Preparer on IRS.gov.

Advance child tax credit payments. From July through December 2021, advance payments were sent automati-cally to taxpayers with qualifying children who met certain criteria. The advance child tax credit payments were early payments of up to 50% of the estimated child tax credit that taxpayers may properly claim on their 2021 returns. Go to IRS.gov/AdvCTC for more information about these payments and how they can affect your taxes.

Coronavirus. Go to IRS.gov/Coronavirus for links to in-formation on the impact of the coronavirus, as well as tax relief available for individuals and families, small and large businesses, and tax-exempt organizations.

Employers can register to use Business Services On-line. The Social Security Administration (SSA) offers on-line service at SSA.gov/employer for fast, free, and secure online W-2 filing options to CPAs, accountants, enrolled agents, and individuals who process Form W-2, Wage

Page 23

and Tax Statement, and Form W-2c, Corrected Wage and Tax Statement.

IRS social media. Go to IRS.gov/SocialMedia to see the various social media tools the IRS uses to share the latest information on tax changes, scam alerts, initiatives, prod-ucts, and services. At the IRS, privacy and security are our highest priority. We use these tools to share public in-formation with you. Don’t post your social security number (SSN) or other confidential information on social media sites. Always protect your identity when using any social networking site.

The following IRS YouTube channels provide short, in-formative videos on various tax-related topics in English, Spanish, and ASL.

Youtube.com/irsvideos.

Youtube.com/irsvideosmultilingua.

Youtube.com/irsvideosASL.

Watching IRS videos. The IRS Video portal (IRSVideos.gov) contains video and audio presentations for individuals, small businesses, and tax professionals.

Online tax information in other languages. You can find information on IRS.gov/MyLanguage if English isn’t your native language.

Free Over-the-Phone Interpreter (OPI) Service. The IRS is committed to serving our multilingual customers by offering OPI services. The OPI service is a federally fun-ded program and is available at Taxpayer Assistance Centers (TACs), other IRS offices, and every VITA/TCE return site. OPI service is accessible in more than 350 lan-guages.

Accessibility Helpline available for taxpayers with disabilities. Taxpayers who need information about ac-cessibility services can call 833-690-0598. The Accessi-bility Helpline can answer questions related to current and future accessibility products and services available in al-ternative media formats (for example, braille, large print, audio, etc.).

Getting tax forms and publications. Go to IRS.gov/ Forms to view, download, or print all of the forms, instruc-tions, and publications you may need. Or, you can go to IRS.gov/OrderForms to place an order.

Getting tax publications and instructions in eBook format. You can also download and view popular tax publications and instructions (including the Instructions for Form 1040) on mobile devices as eBooks at IRS.gov/ eBooks.

Note. IRS eBooks have been tested using Apple's iBooks for iPad. Our eBooks haven’t been tested on other dedicated eBook readers, and eBook functionality may not operate as intended.

Page 24

Access your online account (individual taxpayers only). Go to IRS.gov/Account to securely access infor-mation about your federal tax account.

View the amount you owe and a breakdown by tax year.

See payment plan details or apply for a new payment plan.

Make a payment or view 5 years of payment history and any pending or scheduled payments.

Access your tax records, including key data from your most recent tax return, your EIP amounts, and tran-scripts.

View digital copies of select notices from the IRS.

Approve or reject authorization requests from tax pro-fessionals.

View your address on file or manage your communi-cation preferences.

Tax Pro Account. This tool lets your tax professional submit an authorization request to access your individual taxpayer IRS online account. For more information, go to IRS.gov/TaxProAccount.

Using direct deposit. The fastest way to receive a tax refund is to file electronically and choose direct deposit, which securely and electronically transfers your refund di-rectly into your financial account. Direct deposit also avoids the possibility that your check could be lost, stolen, or returned undeliverable to the IRS. Eight in 10 taxpayers use direct deposit to receive their refunds. If you don’t have a bank account, go to IRS.gov/DirectDeposit for more information on where to find a bank or credit union that can open an account online.

Getting a transcript of your return. The quickest way to get a copy of your tax transcript is to go to IRS.gov/ Transcripts. Click on either “Get Transcript Online” or “Get Transcript by Mail” to order a free copy of your transcript. If you prefer, you can order your transcript by calling 800-908-9946.

Reporting and resolving your tax-related identity theft issues.

Tax-related identity theft happens when someone steals your personal information to commit tax fraud. Your taxes can be affected if your SSN is used to file a fraudulent return or to claim a refund or credit.

The IRS doesn’t initiate contact with taxpayers by email, text messages, telephone calls, or social media channels to request personal or financial information. This includes requests for personal identification num-bers (PINs), passwords, or similar information for credit cards, banks, or other financial accounts.

Go to IRS.gov/IdentityTheft, the IRS Identity Theft Central webpage, for information on identity theft and data security protection for taxpayers, tax professio-nals, and businesses. If your SSN has been lost or stolen or you suspect you’re a victim of tax-related

Publication 502 (2021)

identity theft, you can learn what steps you should take.

Get an Identity Protection PIN (IP PIN). IP PINs are six-digit numbers assigned to taxpayers to help pre-vent the misuse of their SSNs on fraudulent federal in-come tax returns. When you have an IP PIN, it pre-vents someone else from filing a tax return with your SSN. To learn more, go to IRS.gov/IPPIN.

Ways to check on the status of your refund.

Go to IRS.gov/Refunds.

Download the official IRS2Go app to your mobile de-vice to check your refund status.

Call the automated refund hotline at 800-829-1954.

Note. The IRS can’t issue refunds before mid-Febru-ary 2022 for returns that claimed the EIC or the additional child tax credit (ACTC). This applies to the entire refund, not just the portion associated with these credits.

Making a tax payment. Go to IRS.gov/Payments for in-formation on how to make a payment using any of the fol-lowing options.

IRS Direct Pay: Pay your individual tax bill or estima-ted tax payment directly from your checking or sav-ings account at no cost to you.

Debit or Credit Card: Choose an approved payment processor to pay online or by phone.

Electronic Funds Withdrawal: Schedule a payment when filing your federal taxes using tax return prepara-tion software or through a tax professional.

Electronic Federal Tax Payment System: Best option for businesses. Enrollment is required.

Check or Money Order: Mail your payment to the ad-dress listed on the notice or instructions.

Cash: You may be able to pay your taxes with cash at a participating retail store.

Same-Day Wire: You may be able to do same-day wire from your financial institution. Contact your finan-cial institution for availability, cost, and time frames.

Note. The IRS uses the latest encryption technology to ensure that the electronic payments you make online, by phone, or from a mobile device using the IRS2Go app are safe and secure. Paying electronically is quick, easy, and faster than mailing in a check or money order.

What if I can’t pay now? Go to IRS.gov/Payments for more information about your options.

Apply for an online payment agreement (IRS.gov/ OPA) to meet your tax obligation in monthly install-ments if you can’t pay your taxes in full today. Once you complete the online process, you will receive im-mediate notification of whether your agreement has been approved.

Use the Offer in Compromise Pre-Qualifier to see if you can settle your tax debt for less than the full

Publication 502 (2021)

amount you owe. For more information on the Offer in Compromise program, go to IRS.gov/OIC.

Filing an amended return. You can now file Form 1040 -X electronically with tax filing software to amend 2019 or 2020 Forms 1040 and 1040-SR. To do so, you must have e -filed your original 2019 or 2020 return. Amen-ded returns for all prior years must be mailed. Go to IRS.gov/Form1040X for information and updates.

Checking the status of your amended return. Go to IRS.gov/WMAR to track the status of Form 1040-X amen-ded returns.

Note. It can take up to 3 weeks from the date you filed your amended return for it to show up in our system, and processing it can take up to 16 weeks.

Understanding an IRS notice or letter you’ve re-ceived. Go to IRS.gov/Notices to find additional informa-tion about responding to an IRS notice or letter.

You can use Schedule LEP, Request for Change in Language Preference, to state a preference to receive no-tices, letters, or other written communications from the IRS in an alternative language, when these are available. Once your Schedule LEP is processed, the IRS will deter-mine your translation needs and provide you translations when available. If you have a disability requiring notices in an accessible format, see Form 9000.

Contacting your local IRS office. Keep in mind, many questions can be answered on IRS.gov without visiting an IRS TAC. Go to IRS.gov/LetUsHelp for the topics people ask about most. If you still need help, IRS TACs provide tax help when a tax issue can’t be handled online or by phone. All TACs now provide service by appointment, so you’ll know in advance that you can get the service you need without long wait times. Before you visit, go to IRS.gov/TACLocator to find the nearest TAC and to check hours, available services, and appointment options. Or, on the IRS2Go app, under the Stay Connected tab, choose the Contact Us option and click on “Local Offices.”

The Taxpayer Advocate Service (TAS) Is Here To Help You

What Is TAS?

TAS is an independent organization within the IRS that helps taxpayers and protects taxpayer rights. Their job is to ensure that every taxpayer is treated fairly and that you know and understand your rights under the Taxpayer Bill of Rights.

How Can You Learn About Your Taxpayer Rights?

The Taxpayer Bill of Rights describes 10 basic rights that all taxpayers have when dealing with the IRS. Go to TaxpayerAdvocate.IRS.gov to help you understand what these rights mean to you and how they apply. These are your rights. Know them. Use them.

Page 25

What Can TAS Do for You?

TAS can help you resolve problems that you can’t resolve with the IRS. And their service is free. If you qualify for their assistance, you will be assigned to one advocate who will work with you throughout the process and will do everything possible to resolve your issue. TAS can help you if:

Your problem is causing financial difficulty for you, your family, or your business;

You face (or your business is facing) an immediate threat of adverse action; or

You’ve tried repeatedly to contact the IRS but no one has responded, or the IRS hasn’t responded by the date promised.

How Can You Reach TAS?

TAS has offices in every state, the District of Columbia, and Puerto Rico . Your local advocate’s number is in your local directory and at TaxpayerAdvocate.IRS.gov/ Contact-Us. You can also call them at 877-777-4778.

TAS for Tax Professionals

TAS can provide a variety of information for tax professio-nals, including tax law updates and guidance, TAS pro-grams, and ways to let TAS know about systemic prob-lems you’ve seen in your practice.

Low Income Taxpayer Clinics (LITCs)

LITCs are independent from the IRS. LITCs represent in-dividuals whose income is below a certain level and need to resolve tax problems with the IRS, such as audits, ap-peals, and tax collection disputes. In addition, LITCs can provide information about taxpayer rights and responsibili-ties in different languages for individuals who speak Eng-lish as a second language. Services are offered for free or a small fee for eligible taxpayers. To find an LITC near you, go to TaxpayerAdvocate.IRS.gov/about-us/Low-Income-Taxpayer-Clinics-LITC or see IRS Pub. 4134, Low Income Taxpayer Clinic List.

How Else Does TAS Help Taxpayers?

TAS works to resolve large-scale problems that affect

many taxpayers. If you know of one of these broad issues,

report it to them at IRS.gov/SAMS.

	To help us develop a more useful index, please let us know if you have ideas for index entries.

Index
	See “Comments and Suggestions” in the “Introduction” for the ways you can reach us.

A

Abortion 5

Acupuncture 5

Adopted child's medical expenses 4

AGI limitation 2, 3

Alcoholism 5

Ambulances 5

Archer MSAs:

Medical expenses paid for decedent from 5

Artificial limbs 5

Artificial teeth 5

Aspirin 16

Assistance (See Tax help)

Assisted living homes 12

Athletic club dues 16

Automobiles (See Cars)

B

Baby sitting 15

Bandages 5

Basis:

Medical equipment or property (Worksheet D) 20

Birth control pills 5 Page 26

Body scan 5

Braille books and magazines 6

Breast pumps and supplies 6

Breast reconstruction surgery 6

C

Calculation of deduction 19 Capital expenses 6

Improvements to rented property 6 Operation and upkeep 6 Worksheet A 6

Cars 7

Out-of-pocket expenses 14 Standard medical mileage rates 14

Child care 15

Children's medical expenses: Adopted child 4 Dependents 3

Chiropractor 7

Christian Scientist practitioner 7

Chronically ill persons 11

Community property states 3

Computer banks to track medical information 11

Contact lenses 7

Controlled substances 15

Cosmetic surgery 15

Crutches 7

D

Dancing lessons 15

Decedent's medical expenses 4, 5

Deductible amount 3

Deductible expenses 3–15

Definition of medical expenses:

Doctor 2

Physician 2

Dental treatment 7

Artificial teeth 5

Teeth whitening 17

Dentures 5

Dependent's medical expenses:

Adopted child 4

Multiple support agreement 4

Qualifying child 3

Qualifying relative 3

Dependents:

Disabled dependent care 7, 10 Diagnostic devices 7

Diaper services 15

Disabilities, persons with:

Dependent care expenses 7, 10

Improvements to rented property 6

Special education 13

Publication 502 (2021)

Divorced taxpayers:

Medical expenses of child 4 Drug addiction 7

Drugs (See Medicines)

Dues:

Health club 16

E

Education, special 13 Electrolysis 15

Employer-sponsored health insurance plans 8

Employment taxes 12

Excluded expenses:

Insurance premiums 9

Eye exam 7

Eyeglasses 7

Eye surgery 7

F

Fertility enhancement:

Eggs, temporary storage of 7 Fertility 7

In vitro fertilization 7 Figuring the deduction 19

Final return for decedent: Medical expenses paid 4

Flexible spending arrangement 15 Food (See Weight-loss programs)

Form 1040, Schedule A:

Impairment-related work

expenses 21

Medical and dental expenses 2, 19 Self-employed persons, health

insurance costs 21

Form 1040, Schedule C:

Impairment-related work

expenses 21

Form 1040, Schedule E:

Impairment-related work

expenses 21

Form 1040, Schedule F:

Impairment-related work

expenses 21

Form 1040 or 1040-SR:

Self-employed persons, health

insurance costs 21

Form 1040-X: Amended return 3 Deceased taxpayer 5

Form 2106:

Impairment-related work

expenses 21

Form 2555:

Self-employed persons, health insurance costs 21

Founder's fee (See Lifetime care, advance payments)

Funeral expenses 15 Future medical care 10, 15

G

Glasses 7

Guide dog or other animal 8

H

Hair:

Removal 15

Transplants 15

Wigs 15

Health club dues 16

Health Coverage Tax Credit 8

Health coverage tax credit:

Alternative TAA recipient 22

Children of divorced parents 22

Insurance that covers other

individuals 22

TAA recipient 22

Health institutes 8

Health insurance: Employer-sponsored plan 8 Pension Benefit Guaranty

Corporation (PBGC) recipient 21

Premiums:

Deductible 8

Nondeductible 9

Paid by employer 18

Paid by employer and you 18 Paid by you 18

Prepaid 9

Unused sick leave used to pay 9 Reimbursements (See Reimbursem

ents)

Self-employed persons 21

Health maintenance organizations (HMOs) 8

Health reimbursement arrangements (HRAs) 17

Health savings accounts (HSAs):

Payments from 16

Hearing aids 8

Hearing-impaired persons:

Guide dog or other animal for 8

HMOs (Health maintenance organizations) 8

Home care (See Nursing services) Home improvements (See Capital

expenses:)

Hospital services 8

Hotels 10

Household help 16

HRAs (Health reimbursement arrangements) 17

I

Illegal operations and treatments 16

Illegal substances 15

Impairment-related work expenses 21 Reporting of 21

Insulin 16

Insurance (See Health insurance)

Intellectually and developmentally disabled persons:

Mentally disabled 10 Special homes for 10

L

Laboratory fees 10

Lactation expenses (See Breast pumps and supplies)

Laser eye surgery 7

Lead-based paint removal 10

Learning disabilities 13

Legal fees 10

Lessons, dancing and swimming 15

Lifetime care:

Advance payments for 10 Lodging 10, 14

(See also Trips)

Long-term care 11

Chronically ill individuals 11 Maintenance and personal care

services 11

Qualified insurance contracts 11 Qualified services 11

M

Maintenance and personal care services 11

Maternity clothes 16 Meals 11, 14

(See also Weight-loss programs) Medical conferences 11

Medical equipment or property:

Adjusted basis (Worksheet D) 20

Medical expense records 19 Medical information plans 11

Medical savings accounts (MSAs) 16

Medicare:

Medicare Part A, deductible expense 9

Medicare Part B, deductible expense 9

Medicare Part D, deductible expense 9

Medicines 11 Imported 12, 16 Nonprescription drugs and

medicines 16

Missing children, photographs of in IRS publications 1

Multiple support agreement 4

Publication 502 (2021)Page 27

N

Nondeductible expenses 15–17

Nonprescription drugs and medicines 16

Nursing homes 12 Nursing services 12, 15

Chronically ill individuals 11

Nutritional supplements:

Natural medicines 16

O

Operations 12

Cosmetic surgery 15

Illegal operations and

treatments 16

Optometrist 12

Organ donors 13

Osteopath 12

Oxygen 12

P

Parking fees and tolls 14 Personal injury damages 20 Personal use items 16 Physical examination 12 Physical therapy 13 Plastic surgery 15 Pregnancy test kit 12 Premiums (See Health insurance) Premium Tax Credit 12 Prepaid insurance premiums 9 Prosthesis 5

Psychiatric care 13 Psychoanalysis 13 Psychologists 13 Publications (See Tax help)

R

Radial keratotomy 7 Recordkeeping 19 Rehabilitation facilities 12 Reimbursements 17–19

Excess includible in income:

More than one policy (Worksheet C) 19

One policy (Worksheet B) 18 Excess may be taxable (Figure

1) 17

Health Reimbursement Arrangement (HRA) 17

Insurance 17

Medical expenses not deducted 19

More than one policy 18

Received in later year 19

Rental property:

Improvements to 6

Reporting:

Impairment-related work

expenses 21

Medical and dental expenses 19 Medical deduction (See Form 1040,

Schedule A)

Self-employed persons, health

insurance costs 21

S

Sale of medical equipment or property 19

Adjusted basis (Worksheet D) 20 Schedules (See Form 1040 or

1040-SR)

Seeing-eye dogs 8

Self-employed persons:

Health insurance costs 21

Senior housing 12

Separated taxpayers:

Medical expenses of child 4

Separate returns:

Community property states 3 Medical and dental expenses 3

Service animals 8

Sick leave:

Used to pay health insurance premiums 9

Special education 13 Spouse's medical expenses 3

Deceased spouse 5 Sterilization 13 Stop-smoking programs 13 Surgery (See Operations) Swimming lessons 15

T

Tables and figures:

Medical equipment or property:

Adjusted basis (Worksheet

D) 20

Reimbursements, excess includible in income:

More than one policy (Worksheet C) 19

One policy (Worksheet B) 18 Reimbursements, excess may be

taxable (Figure 1) 17 Tax help 22

Teeth:

Artificial 5

Dental treatment 7

Whitening 17

Telephone 13

Television 13

Therapy 13

Transplants 13

Travel and transportation expenses 14

Car expenses 14

Includible expenses 14

Parking fees and tolls 14

Trips 14

Tuition 14

V

Vasectomy 14

Veterinary fees 17

Vision correction surgery 7

Visually impaired persons:

Guide dog or other animal for 8

Vitamins or minerals 16

W

Weight-loss programs 14, 17

What's new:

Standard medical mileage rate 1 Wheelchairs 15

Wigs 15

Workers' compensation 21

Work expenses:

Disabled dependent care 7 Impairment-related 21

Worksheets:

Capital expenses (Worksheet A) 6

Medical equipment or property:

Adjusted basis (Worksheet D) 20

Reimbursements, excess includible in income:

More than one policy (Worksheet C) 19

One policy (Worksheet B) 18

Page 28Publication 502 (2021)

IRS Releases Publication 502 (2021), Medical and Dental Expenses