The medical expense deduction — the items people with Parkinson's forget to count

Most households with Parkinson’s decide they will not clear the medical expense threshold, and stop adding things up. That decision is usually made after counting three items — insurance premiums, copays and prescriptions — and before counting the six or seven that actually push a return over the line.

This page is a checklist of what the IRS lets you count, drawn from Publication 502, checked in August 2026. It is not tax advice and it does not replace a preparer.

Two conditions, both of which must hold

The 7.5% floor. You can deduct medical and dental expenses only “to the extent they exceed 7.5% of your adjusted gross income for the year.” The first 7.5% is yours to pay.

You have to itemize. Medical expenses go on Schedule A (Form 1040). If your total itemized deductions come to less than the standard deduction, itemizing costs you money and the medical deduction is worth nothing. This is why the arithmetic below matters — a household with $9,000 of medical costs may not itemize, and the same household at $16,000 may.

A worked example. On an AGI of $60,000, the floor is $4,500. Count $10,200 of qualifying expenses and $5,700 is deductible. Whether that $5,700 is useful then depends on your other itemized deductions.

You can include expenses you paid for yourself, your spouse, and your dependents — so one return often carries the medical costs of two people.

The mileage nobody logs

Getting to medical care is a deductible medical expense, and with Parkinson’s you go a lot: neurology, physical therapy, occupational therapy, speech therapy, dentistry, blood tests, infusion appointments, device programming.

You can deduct either your out-of-pocket car costs, “such as the cost of gas and oil,” or the standard medical mileage rate. Parking fees and tolls are deductible on top, either way.

For 2026 the medical rate changed mid-year:

Fares count too — “bus, taxi, train, or plane fares or ambulance service.” So do the transportation expenses of a nurse or other person who has to travel to give you treatment, and of a parent who must accompany a child receiving care.

Lodging is includible when you have to travel for care: up to $50 a night per person, and because a companion can be included, “up to $100 per night.” The conditions are strict — the lodging must be “primarily for and essential to medical care,” provided in connection with care by a doctor in a licensed hospital or equivalent facility, not lavish, and with “no significant element of personal pleasure, recreation, or vacation.” Travelling to a specialist center for an assessment or a procedure is exactly the case this rule was written for. Meals in that situation are treated differently, so ask a preparer rather than assuming.

Keep the log as you go. A mileage record reconstructed in April from memory is both painful and weak. A note in your phone after each appointment — date, destination, round-trip miles, parking — takes ten seconds and is the difference between claiming and not.

Home modifications are the biggest single item

This is where the deduction can become substantial, and it works differently from everything else.

A capital improvement made for medical reasons is deductible to the extent its cost exceeds any increase in the value of the property. In other words, if a $20,000 improvement adds $8,000 to the home’s value, $12,000 is a medical expense.

Then comes the part that matters. Publication 502 lists improvements that “don’t usually increase the value of the home” — meaning the whole cost counts:

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

Read that against a house being adapted for someone whose balance is going. Ramp, wider doorway, bathroom rails, grab bars in the hallway, stair modification, better lighting switches — every one is on the list.

Two adjacent points. Costs of operating and maintaining a medical capital asset are also medical expenses. And if you rent rather than own, improvements you pay for in a rented property are handled under their own rules in Publication 502 — worth reading before you assume you are excluded.

Paid help at home

If you pay someone to help at home, the deductible share is the part that is care, not housekeeping.

You can include “wages and other amounts you pay for nursing services” — services of a kind generally performed by a nurse, such as giving medication and attending to the person. The helper does not have to be a nurse by profession.

When one person does both jobs, “amounts paid to the attendant must be divided between the time spent performing household and personal services and the time spent for nursing services.” So keep a simple time split. An attendant who spends two of four hours on medication, transfers and personal care gives you a 50% allocation, and a written record of that is what makes it defensible.

The overlooked extra: employment taxes count too. You can include the Social Security tax, Medicare tax, FUTA and state employment taxes you pay for that attendant, allocated the same way.

Long-term care, and what “chronically ill” means

Qualified long-term care services are deductible medical expenses. The definition has two parts, and both matter for Parkinson’s.

The services must be “necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, rehabilitative services, and maintenance and personal care services” required by a chronically ill individual, and provided pursuant to a plan of care prescribed by a licensed health care practitioner.

You count as chronically ill if, within the previous 12 months, a licensed health care practitioner has certified that you are either:

• unable to perform at least two activities of daily living without substantial assistance from another individual for at least 90 days, or
• requiring substantial supervision to be protected from threats to health and safety due to severe cognitive impairment.

Two practical consequences. The certification has to be renewed — it is a 12-month window, not a one-time event. And there has to be a plan of care written by a practitioner; personal care provided without one does not qualify under this heading.

Premiums for a qualified long-term care insurance policy are deductible up to an age-based cap that is adjusted each year. For tax year 2025 the caps were $480 at age 40 or under, $900 for 41–50, $1,800 for 51–60, $4,810 for 61–70 and $6,020 at 71 or over. Check the current year’s table in Publication 502 before you file.

Premiums, and the Medicare split

Medicare premiums are not all treated the same way.

Health insurance premiums generally count, but premiums paid with pre-tax dollars — through an employer plan, or from an HSA or FSA — cannot be counted again. Nor can any expense you were reimbursed for. The rule throughout is that you deduct what you actually bore.

Things that do not count

Publication 502 and Topic 502 rule these out, and they are the ones people include by mistake:

• Over-the-counter medicines other than insulin, unless prescribed
• Toiletries, cosmetics and general-purpose items
• Trips or programs “for the general improvement of health” rather than treatment of a specific condition
• Most cosmetic surgery
• Funeral expenses
• Non-prescription nicotine products

A gym membership, a supplement aisle, and a holiday your doctor thought would do you good are all in this column, however genuinely helpful.

Two other provisions worth raising with a preparer

Impairment-related work expenses. If you have a disability and you pay for attendant care at work, or for equipment and services that let you do your job, Publication 502 treats these separately from ordinary medical expenses — and they are not subject to the 7.5% floor. Because the treatment depends on your employment situation, this is one to put to a preparer rather than to work out alone. It can be worth more than everything else on this page.

The Credit for the Elderly or the Disabled. A credit, not a deduction — it reduces tax directly. You may qualify if you are 65 or older, or if you “retired on permanent and total disability and received taxable disability income for the tax year.” Publication 524 defines that phrase strictly:

You have a permanent and total disability if you can’t engage in any substantial gainful activity because of your physical or mental condition. A qualified physician must certify that the condition has lasted or can be expected to last continuously for 12 months or more, or that the condition can be expected to result in death.

The income limits are the reason most people do not qualify. From Publication 524:

Both tests apply. Checking still costs nothing — the IRS publishes an interactive eligibility tool alongside Publication 524.

ABLE accounts. The IRS describes these 529A accounts as a way for “eligible people with disabilities (designated beneficiaries)” to save, with distributions tax-free when used for qualified disability expenses. Eligibility rules and how a balance interacts with means-tested benefits are set out elsewhere, so ask a preparer or check the IRS page before opening one.

What to do this year

Free help exists: the IRS runs VITA and Tax Counseling for the Elderly, both free, and both listed on IRS.gov.

If this applies to you

This page summarizes IRS Publication 502 and is not tax advice. Rates, caps and thresholds change every year, and state income tax rules differ from federal ones. Confirm your own position with a tax professional or free IRS-sponsored assistance before filing.