Managing healthcare costs is one of the biggest financial hurdles in retirement. According to AARP, the average Medicare beneficiary spends roughly $7,295 annually on out-of-pocket medical care. But there may be ways to save.
One way is through your federal tax return. By utilizing the medical expense deduction, you can deduct qualifying, unreimbursed medical expenses that exceed 7.5% of your adjusted gross income (AGI). While this strategy requires electing to itemize rather than claiming the standard deduction, heavy medical bills might justify the extra paperwork.
Plus, more than just standard doctor visits or hospital stays may qualify for the deduction. For instance, you might be able to deduct the cost of your weight-loss program or service animal on your federal return.
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But because the IRS heavily scrutinizes unconventional claims, navigating these deductions requires ample preparation. So carefully consider whether or not you are eligible for these five unusual write-offs before claiming them on your 2026 federal return.
This list focuses exclusively on federal tax deductions. You may qualify for other tax breaks on your state income taxes. Also, the article does not constitute legal or financial advice. Always consult a qualified tax professional before filing.
The medical expense deduction: Ground rules
To be eligible to claim any of the medical tax deductions listed below, you must first meet the specific criteria for the medical expense deduction. This includes:
- Itemizing your deductions on Schedule A (Form 1040) instead of claiming the standard deduction.
- Filing your itemized deductions under the medical expense deduction (which is technically available to taxpayers of any age, but is heavily utilized by older adults).
- Exceeding the adjusted gross income (AGI) threshold. You can only deduct the portion of your total qualifying medical expenses that exceeds 7.5% of your AGI. (For example, if your AGI is $100,000, the first $7,500 of your medical expenses won’t count; only the amounts above that are deductible.)
Also, you can’t deduct an expense on your federal return if it was already covered by your insurance, health savings account (HSA), or flexible spending account (FSA).
Additionally, the IRS recommends that you maintain all applicable tax records for qualifying medical expenses for at least three years (though most tax experts advise six or more years). This covers the IRS’s tax audit period.
1. Home modifications for medical care
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- What qualifies. The modification must directly treat or accommodate a diagnosed condition. A formal letter of medical necessity from a doctor is typically necessary.
- Documentation needed. Keep your doctor’s letter, a home appraisal from before and after the project (to document changes in property value), all itemized contractor receipts, and any other applicable tax records.
- Value calculation. You can only deduct the amount by which the cost of the improvement exceeds the increase in your home’s market value.
The last bullet point might sound confusing. But here’s an example:
- Say you install a home elevator for $35,000 to accommodate a mobility issue.
- A licensed appraiser determines that it increases your home’s total property value by $25,000.
- Thus, your potentially deductible medical expense is the difference between the two: $10,000.
(Note: If an upgrade increases your home’s value by more than it costs to build, the potential deduction drops to $0).
The IRS also explicitly states in its Medical and Dental Expenses Guide that certain standard accessibility modifications are presumed not to increase a home’s market value, and are thus 100% potentially deductible. These include adding ramps, widening doorways, modifying stairways, etc.
For more information, check out Kiplinger’s report, Tax-Deductible Home Improvements for Retirement.
2. Guide dogs and service animals
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Service animals trained to assist with physical disabilities (like visual impairments or mobility limitations) or medical alerts may qualify for the medical expense deduction. Typical qualifying expenses include the total cost of purchasing, training, and maintaining the animal.
- What qualifies. The animal must be individually trained to perform tasks for a person with a disability. Emotional support animals (ESAs) or general family pets are not tax-deductible and do not qualify.
- Documentation needed. You must retain training invoices, veterinary bills, grocery/supply receipts, and other applicable tax records.
- Value calculation. You may write off the vet care, grooming, food, and specialized training supplies associated with your service animal.
3. Prescribed swimming pools
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This is a highly scrutinized deduction by the IRS, but it may be medically necessary under special circumstances.
If a doctor explicitly prescribes hydrotherapy to treat a severe, specific medical condition (like advanced arthritis), the cost of installing and operating a home pool might be eligible for a medical expense deduction.
- What qualifies. You can deduct not only the qualifying home pool installation fees but also the ongoing operational costs — like heating, chemicals, and electricity — only for the portion of the year the pool is used strictly for medical treatment.
- Documentation needed. You will need a letter of medical necessity, appraisal documents, and utility bills to prove your operation costs.
- Value calculation. Like home modifications, the installation cost is deductible only to the extent it exceeds the value the pool adds to your real estate. So, if a pool costs $50,000 to build but adds $20,000 to your home’s equity, you can potentially claim only $30,000 as a medical expense.
Special note: Because the IRS looks closely at pool deductions, it is very rare to claim this home improvement as a tax deduction. However, if a pool is medically necessary, you can consult with a tax professional to see if it would qualify for a potential write-off.
4. Prescription weight-loss programs
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If you’re enrolled in a weight-loss program to manage or mitigate a specific diagnosed health condition — like type 2 diabetes, heart disease, or severe hypertension — the enrollment and attendance fees may be tax-deductible as a medical expense deduction.
- What qualifies. Only fees related to your prescribed diagnosis. The IRS strictly prohibits deductions for programs designed for general health, well-being, or cosmetic appearance.
- Documentation needed. A written diagnosis from your physician stating the specific disease being treated, along with itemized monthly statement receipts from the program.
- Value calculation. You generally cannot deduct the cost of specialty diet foods, nutritional supplements, or standard gym memberships. All qualifying healthcare expenses related to your program are potentially deductible under the medical expense deduction.
5. Oral and facial physical therapy
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In a landmark IRS ruling, a parent successfully argued that clarinet lessons for their child were deductible because an orthodontist formally prescribed them to correct a severe overbite.
For older adults, the equivalent is specialized physical therapy for the mouth and jaw muscles, like treatment for Temporomandibular Joint (TMJ) disorders or myofunctional therapy.
- What qualifies. As with other qualifying expenses on this list, you can only claim out-of-pocket expenses that were not otherwise covered or reimbursed by your insurance, HSA, or FSA.
- Documentation needed. A formal referral and script from a dentist, orthodontist, or primary physician, alongside detailed treatment logs specifying the dates of service and itemized payment receipts.
- Value calculation. Any qualifying medical expenses above the 7.5% AGI limit may be potentially deductible under this federal tax deduction.
For more information on what qualifies as AGI, check out Kiplinger’s report, How to Calculate Your Adjusted Gross Income — and What It Means.
