IRS Publication 502 is the official guide issued by the Internal Revenue Service to help taxpayers understand which medical and dental expenses are deductible on their federal income tax return. This publication plays a crucial role for anyone looking to itemize deductions on Schedule A of Form 1040. Each year, the IRS updates this document to reflect inflation adjustments, legislative changes, and updated definitions of qualifying expenses. The 2025 version includes some notable changes and clarifications that taxpayers should be aware of before filing their return.
What Is IRS Publication 502?
Publication 502 is titled “Medical and Dental Expenses” and is primarily used by individuals who plan to itemize deductions on their federal income tax return. The document outlines what types of medical expenses are deductible, explains who qualifies as a dependent for medical deduction purposes, and provides detailed rules for calculating and claiming these deductions on Schedule A.
This publication does not apply to medical expenses reimbursed by insurance or paid with pre-tax dollars through Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs). It is also different from Publication 969, which covers HSAs, MSAs, and related accounts.
Key Updates in IRS Publication 502 for 2025
The 2025 edition of Publication 502 includes several updates and clarifications that reflect changes in tax laws, inflation adjustments, and interpretations issued by the IRS. Below are the most important revisions to note for this tax year:
1. Inflation-Adjusted Thresholds for Long-Term Care Insurance
One of the most important changes in 2025 relates to the deduction limits for long-term care insurance premiums. These limits are adjusted annually based on age. For 2025, the maximum amounts you can deduct (subject to the 7.5% AGI rule) have increased slightly due to inflation:
- Age 40 or under: $470
- Age 41–50: $880
- Age 51–60: $1,770
- Age 61–70: $4,720
- Age 71 and over: $5,960
These limits apply per person and only to policies that qualify as tax-advantaged under federal guidelines.
2. Mileage Rate for Medical Transportation
Publication 502 confirms that for 2025, the standard mileage rate for medical travel remains at 21 cents per mile. This applies to personal vehicles used to travel to and from medical appointments, hospitals, pharmacies, or other qualified healthcare locations.
3. Updated List of Deductible Medical Expenses
While the core list of deductible medical expenses remains largely the same, the 2025 publication includes additional clarifications and specific mentions of modern healthcare costs. Notable mentions include:
- COVID-19 at-home test kits and vaccination expenses (if unreimbursed)
- Telehealth and virtual doctor consultation fees
- Genetic testing costs when prescribed as part of a treatment plan
- Medical-grade air purifiers when prescribed by a healthcare provider
These clarifications ensure that evolving medical practices are adequately addressed for deduction eligibility.
4. Clarification on Cosmetic Surgery Rules
Publication 502 reiterates that cosmetic procedures are not deductible unless they are necessary to improve a deformity arising from or directly related to a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease. The 2025 update specifically mentions gender-affirming procedures as potentially deductible when prescribed and deemed medically necessary.
5. Expanded Guidance on Fertility Treatments
The IRS has added expanded guidance around fertility-related expenses. These include egg retrieval, in vitro fertilization (IVF), hormone treatments, and temporary storage of reproductive material if they are part of a diagnosed treatment plan. Expenses solely for elective preservation purposes without an immediate medical condition remain non-deductible.
6. Enhanced Focus on Mental Health Services
With the increasing recognition of mental health treatment, the 2025 version of Publication 502 now includes broader language encompassing therapy, psychiatric treatment, substance use disorder programs, and treatment centers as deductible expenses. This also includes online or app-based therapy platforms when professionally licensed.
What Has Not Changed?
Some core principles of Publication 502 have remained consistent in 2025. These include:
- Medical expenses are only deductible to the extent they exceed 7.5% of your AGI.
- Only unreimbursed expenses paid during the tax year qualify.
- Pre-tax or employer-reimbursed expenses (such as those paid via HSAs or FSAs) are not deductible again.
- You must itemize your deductions using Schedule A to claim medical expenses.
Common Examples of Deductible Medical Expenses in 2025
According to the updated IRS Publication 502, the following expenses remain deductible if unreimbursed and not covered by insurance:
- Doctor and dentist visits
- Prescription drugs and insulin
- Health insurance premiums (if paid out of pocket)
- Psychologist and psychiatrist services
- Chiropractor treatments
- Smoking cessation programs
- Weight loss programs (if part of a medical treatment)
- Hearing aids, eyeglasses, contact lenses
- Hospital services, lab fees, and imaging
- Medical equipment like wheelchairs, crutches, and prosthetics
Recordkeeping Tips
To ensure that your medical deductions are accepted in the event of an audit, keep the following documents on file:
- Receipts and invoices from all healthcare providers
- Cancelled checks or credit card statements proving payment
- Prescription notes from a licensed physician if required
- Mileage logs or transportation receipts for medical travel
Who Should Use Publication 502?
Taxpayers who meet any of the following criteria should review Publication 502 in 2025:
- Those with significant out-of-pocket medical or dental expenses
- Seniors or individuals paying for long-term care insurance or services
- Self-employed individuals paying for their own health insurance
- Taxpayers with dependents who have special medical needs
Even if you typically claim the standard deduction, it may be worth comparing your total itemized deductions (including medical expenses) to see if you would benefit from itemizing instead.
Where to Access Publication 502
You can download the latest IRS Publication 502 for the 2025 tax year directly from the IRS website at www.irs.gov. It is updated annually and typically released in early January for the prior tax year. Make sure you are referring to the correct version (i.e., “2025” for returns filed in early 2026).
Conclusion
IRS Publication 502 remains a vital resource for understanding what medical expenses are deductible and how to report them accurately on your tax return. The 2025 edition includes timely updates on modern healthcare needs, expanded mental health care, fertility treatment rules, and new clarifications on previously gray areas. Whether you are an individual filer, caregiver, or self-employed taxpayer, staying informed about these changes can help you reduce your tax liability and ensure compliance. Always consult a qualified tax professional if you are unsure about a specific expense or deduction.
