Written by Olivia Cole

Long-Term Care Expenses: What Can You Deduct?

As we age, our families are often burdened with the ever-increasing long-term care expenses related to home health care services and nursing home care. When not covered by insurance, many of these expenses are eligible to be deducted on your personal income tax return as a medical expense. This article is an overview of the IRS tax rules for deducting long-term care expenses as well as the possibility as claiming a parent as a dependent.

Medical Expenses – In General

Qualified medical expenses are the cost of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body. Qualified medical expenses also include the premiums paid for health coverage and the amounts paid for transportation to get medical care.

Amounts paid for qualified medical care may be deducted on your personal income tax return as an itemized deduction on the Schedule A. The deductible amount is limited to any amounts paid that are more than 7.5% of your adjusted gross income (AGI) for the year. For example, if your AGI is $50,000 for the year and you spent $6,000 in medical care then the limit on what you can deduct is any expense over $3,750 ($50,000 x 7.5%). More specifically, $2,250 would be allowed as an itemized deduction ($6,000 – $3,750).

You can generally include qualified medical expenses you pay for yourself, as well as those you pay for your spouse and/or dependent.

Long-term Care Expenses & Nursing Homes

The costs of qualified long-term care, including nursing home care, are deductible as medical expenses. Qualified long-term care services are necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, rehabilitative services, and maintenance or personal-care services required by a chronically ill individual provided under a plan of care presented by a licensed health-care provider.

To qualify as chronically ill, an individual must be certified by a physician or other licensed health-care practitioner (e.g., nurse, social worker, etc.) as unable to perform, without substantial assistance, at least two activities of daily living (eating, toileting, transferring, bathing, dressing, and continence) for at least 90 days due to a loss of functional capacity, or as requiring substantial supervision for protection due to severe cognitive impairment (memory loss, disorientation, etc.).

The entire costs paid (including meals and lodging) to a nursing home, home for the aged, or similar institution, are fully deductible as a medical expense if the person is staying at the home primarily for medical care. However, if an individual is in the home primarily for non-medical reasons, then only the portion attributable to actual medical or nursing care, excluding meals and lodging, is deductible.

Long-term Care Insurance

Premiums paid for a qualified long-term care insurance contract are deductible as medical expenses (subject to an annual premium deduction limitation based on age, as explained below) to the extent they, along with other medical expenses, exceed 7.5% of AGI.

A qualified long-term care insurance contract is insurance that covers only qualified long-term care services, doesn’t pay costs that are covered by Medicare, is guaranteed renewable, and doesn’t have a cash surrender value. A policy isn’t disqualified merely because it pays benefits on a per diem or other periodic basis without regard to the expenses incurred.

For the tax years 2019 and 2020, qualified long-term care premiums are includible as medical expenses up to the following dollar amounts per individual:

Age Before End of Tax Year Limit – 2019 Limit -2020
40 or younger $420 $430
41 to 50 $790 $810
51 to 60 $1,580 $1,630
61 to 70 $4,220 $4,350
71 or older $5,270 $5,430

Claiming a Parent as a Dependent

If your parent qualifies as your dependent, you can include any medical expenses you incur for your parent along with your own when determining your medical deduction. If your parent doesn’t qualify as your dependent only because of the gross income or joint return test ((b) and (c), below), you can still include these medical costs with your own.

You may be able to claim your parent as a dependent, thus qualifying for an exemption, even though your parent is confined to a nursing home. The qualifying factors for claiming a parent as a dependent are:

(a) you must provide more than 50% of your parent’s support costs,

(b) your parent must not have gross income in excess of the exemption amount of $4,200 in 2019, (c) your parent must not file a joint return for the year, and

(d) your parent must be a U.S. citizen or a resident of the U.S., Canada, or Mexico.

Your parent can qualify as your dependent even though he or she doesn’t live with you, provided the support and other tests mentioned above are met. It is also important to note that gross income does not include Social Security payments, in most cases.

Amounts you pay for qualified long-term care services required by your parent and eligible long-term care insurance premiums, discussed above, as well as amounts you pay to the nursing home for your parent’s medical care, are included in the total support you provide. If the support test ((a) above) can only be met by a group (you and your brothers and sisters, for example, combining to support your parent), a multiple support form can be filed to grant one of you the exemption, subject to certain conditions.

Head of Household Status

If you aren’t married and you are entitled to claim a dependency exemption for your parent, you may qualify for the head-of-household filing status, which is more favorable than the single filing status. You may be eligible to file as head of household even if the parent for whom you claim an exemption doesn’t live with you. In order to qualify for head-of-household status, generally you must have paid more than half the cost of maintaining a home for yourself and a qualifying relative for more than half the year.

In the case of a parent, however, you may be eligible to file as head of household if you pay more than half the cost of maintaining a home that was the principal home for your parent for the entire year. Thus, if your parent is confined to a nursing home, you are considered to be maintaining a principal home for your parent if you pay more than half the cost of keeping your parent in the nursing home.

As the average age in America continues to climb, the need for medical care for the elderly continues to increase. With the increasing costs of medical care, it is important to understand the IRS rules for deducting these costs on your personal tax return. Please contact us with any questions you may have about these rules and we can provide additional guidance.