The floor is the whole mechanism, and it is often described as a threshold. A threshold would mean that clearing 7.5% makes everything deductible. A floor means only the part above it counts, so the deduction is always smaller than the bills, and for most households it is zero. The 7.5% figure is fixed in the statute rather than adjusted for inflation, and it has been at that level permanently since the Consolidated Appropriations Act, 2021 removed the scheduled return to 10%. The number that moves is adjusted gross income, which is why the same medical bills produce a deduction in a low-income year and nothing in a high-income one.
There are two hurdles and people usually see one. Clearing the floor produces an itemized deduction, and an itemized deduction is worth nothing unless the total of every itemized deduction beats the standard deduction. A household with substantial medical costs and no mortgage and modest state taxes can clear the 7.5% floor and still take the standard deduction, in which case the medical bills changed nothing. That comparison belongs to the itemized deductions page; what belongs here is that the floor is not the last test.
Reimbursement is netted, and the statute says so. Only expenses "not compensated for by insurance or otherwise" count, so a bill your insurer paid directly never enters the calculation, and a reimbursement received in the same year reduces that year's expenses. A reimbursement received in a later year for a bill deducted earlier does not reduce the later year's expenses; instead, where the earlier deduction reduced tax, the reimbursement is reported as income in the year received. The same logic bars the most common double claim: money spent from a health savings account or a health flexible spending arrangement was never taxed, so deducting it would be taking the same benefit twice.
Whose expenses count is broader than your dependent list. Section 213(a) reaches the taxpayer, their spouse, and a dependent as defined in section 152 "determined without regard to subsections (b)(1), (b)(2), and (d)(1)(B) thereof". Those three modifications matter in practice. Dropping the gross income test means you can deduct bills you paid for a parent who earned too much to be your dependent. Dropping the joint return rule means a married child who filed jointly is not disqualified. And dropping section 152(b)(1) means you can still deduct even where you yourself can be claimed on somebody else's return. Section 213(d)(5) adds a fourth: a child covered by the divorced parents rule in section 152(e) is treated as a dependent of both parents for this section, so either parent can deduct what they actually paid.
A handful of rules apply only to the deduction and not to account reimbursement. Section 213(b) still requires that a medicine or drug be a prescribed drug or insulin, so over-the-counter medicine is not deductible even though it has been reimbursable from an account since 2020. Lodging away from home for medical care is capped by section 213(d)(2) at $50 a night per person, and only where the care is provided by a physician in a licensed hospital or its equivalent and there is no significant element of pleasure, recreation or vacation in the travel. Travel by car is deductible at a standard medical mileage rate the IRS sets each year, plus parking and tolls. Cosmetic surgery is excluded from the definition of medical care itself, unless it corrects a congenital abnormality, an injury from an accident or trauma, or a disfiguring disease.
Premiums are deductible, with two limits worth knowing. Insurance covering medical care is medical care under section 213(d)(1)(D), so premiums count, including Medicare Part B and Part D and, for someone 65 or older who is not entitled to Social Security, voluntarily paid Part A premiums. Two restrictions apply. Premiums paid pre-tax through an employer's cafeteria plan are already excluded from income and cannot be deducted again. And premiums for a qualified long-term care insurance contract count only up to an age-banded limit under section 213(d)(10), which is adjusted annually and rises in five bands with the insured's attained age. A different rule applies where long-term care coverage rides on a life insurance or annuity contract and is paid for by a charge against the contract's cash value: section 7702B(e)(2) denies any section 213 deduction for that charge, so it is not a premium that has been capped, it is a payment that never qualifies.
Timing is by payment, with one exception. The deduction is for expenses "paid during the taxable year", so a bill incurred in December and paid in January belongs to the later year, and paying by credit card counts as payment when the charge is made. The exception is for a decedent: section 213(c)(1) treats medical expenses paid out of an estate during the one-year period beginning the day after death as paid by the taxpayer when incurred, so they can go on the final return, provided the same amounts are not also deducted under section 2053 in computing the taxable estate.
The taxes that are not medical expenses. The Schedule A instructions exclude the Medicare tax on wages and tips, and the Medicare component of self-employment tax and household employment taxes, from medical expenses. They are taxes, and they are not deductible here or under the state and local taxes section either.
