Blog · 16 October 2026

Medical Expense Deduction for Caregivers: In-Home Care for a Parent, §213 Rules, the 7.5% AGI Floor and What US CPA Firms Should Check

By Keshav Bansal, CA

The medical expense deduction is often the largest tax lever a caregiver has when they pay for in-home care for a parent — but only if the return clears three gates: the client itemizes on Schedule A, the care recipient is a person whose expenses count under §213, and the care itself qualifies as medical care. Caregiver Economics (Marcus Delacroix-Webb, September 22, 2026) walked families through those gates; this guide restates them for US CPA firms against the IRS’s own text in Publication 502, Tax Topic 502 and Rev. Proc. 2025-32.

The 7.5%-of-AGI floor and the itemizing test

Section 213(a) allows a deduction for medical care expenses “not compensated for by insurance or otherwise” for the taxpayer, spouse or a dependent, to the extent they exceed 7.5 percent of adjusted gross income. Tax Topic 502 (reviewed October 9, 2026) repeats that the deduction is available only if the taxpayer itemizes on Schedule A (Form 1040).

That makes the standard deduction the real benchmark. For 2026, Rev. Proc. 2025-32 sets it at $32,200 for married filing jointly and surviving spouses, $24,150 for heads of household and $16,100 for single and married filing separately, plus an additional $1,650 for the aged or blind ($2,050 if unmarried and not a surviving spouse). A year of paid home care can push medical expenses past the floor on its own, but the comparison is always total itemized deductions versus the standard deduction, so model both early.

Whose expenses count: dependents and “near-dependents”

A parent can be a qualifying relative. Pub. 501 lists four tests — not a qualifying child, relationship or member of household, gross income and support — and a parent is among the “relatives who don’t have to live with you.” The support test requires the caregiver to provide more than half of the parent’s total support for the year. The gross income test uses the §152(d)(1)(B) amount, which Rev. Proc. 2025-32 sets at $5,300 for 2026 (Pub. 502 and Pub. 501 for 2025 use $5,200). Pub. 501 counts only taxable Social Security benefits in gross income, so a parent living mainly on Social Security may still pass.

The more valuable rule for caregivers is the near-dependent exception. Section 213(a) defines dependent “without regard to” §152(b)(1), (b)(2) and (d)(1)(B), and Pub. 502 spells out the result: you can include medical expenses for someone who would have been your dependent except that they had too much gross income, filed a joint return, or you (or your spouse, if filing jointly) could be claimed as a dependent by someone else. The support test still applies. Where siblings share support, a multiple support agreement controls who can deduct what.

In-home care: chronically ill certification and plan of care

Ordinary nursing-type services — giving medication, changing dressings, bathing and grooming — are medical expenses under Pub. 502 even when the attendant is not a nurse. Personal care beyond that is deductible as qualified long-term care services only if two conditions in §7702B(c) are met:

• Chronically ill. A licensed health care practitioner has certified, within the preceding 12-month period, that the person cannot perform at least 2 of 6 activities of daily living (eating, toileting, transferring, bathing, dressing, continence) without substantial assistance for at least 90 days due to loss of functional capacity, or needs substantial supervision because of severe cognitive impairment (§7702B(c)(2)).
• Plan of care. The services are provided under a plan of care prescribed by a licensed health care practitioner (§7702B(c)(1)).

One trap the source article does not stress: §213(d)(11) treats amounts paid for qualified long-term care services as not paid for medical care if a spouse or relative provides them, unless that person is a licensed professional for the service. Paying a sibling or adult grandchild to provide personal care usually does not create a deduction.

Split housekeeping from care on every invoice

Pub. 502 is blunt: household help is a personal expense, “even if such help is recommended by a doctor.” When one attendant does both, the payment must be divided by time. The IRS example: a $300-per-week visiting nurse spends 10% of the time on dishes and laundry, so only $270 per week counts. A proportional share of the attendant’s meals can be included, and so can employer Social Security, Medicare, FUTA and state employment taxes — but only the portion tied to medical services. When the family hires the aide directly, household-employer rules apply; see our nanny tax and household employment taxes guide. Ask agencies for invoices that separate personal-care hours from homemaker hours.

Home modifications

Under Pub. 502’s capital expense rules, improvements whose main purpose is medical care are deductible to the extent cost exceeds any increase in home value (Worksheet A). Many accessibility changes — entrance or exit ramps, widened doorways, grab bars and railings, lowered cabinets, porch lifts, modified stairways — don’t usually raise value, so the full reasonable cost can be included. Elevators generally do add value, and costs for architectural or aesthetic reasons are not medical care.

2026 long-term care premium limits

Premiums on a qualified long-term care contract count only up to the §213(d)(10) age-based limits. For 2026, Rev. Proc. 2025-32 sets them, per person, by attained age before year-end: 40 or less $500; 41–50 $930; 51–60 $1,860; 61–70 $4,960; more than 70 $6,200 (2025 per Pub. 502: $480, $900, $1,800, $4,810, $6,020). The 2026 per diem limit for qualified LTC benefits under §7702B(d)(4) is $430.

No double benefit

Reduce medical expenses by insurance and Medicare reimbursements. Pub. 502 excludes amounts reimbursed by an FSA funded with pre-tax pay, amounts contributed to an HSA, and expenses paid with tax-free HSA distributions (see our HSA eligibility guide). Under §213(e), any expense claimed for the child and dependent care credit cannot also be a medical expense — relevant when care for a parent also lets the caregiver work; compare our dependent care FSA and credit guide. If a qualifying expense was overlooked, Pub. 502 points to Form 1040-X, generally within 3 years from the date the original return was filed or 2 years from the time the tax was paid, whichever is later.

Preparer checklist

• Run itemized versus standard deduction before chasing receipts.
• Document support: who paid what, including the parent’s own funds and taxable Social Security.
• Obtain the dated practitioner certification and written plan of care.
• Confirm the caregiver is not a relative (unless licensed) for personal care.
• Split care from housekeeping hours; keep logs or itemized agency invoices.
• Gather before-and-after values for any value-adding modification.
• Cap LTC premiums by age; strip out HSA, FSA, insurance and dependent care credit amounts.

Where Tax Brew fits

Caregiver returns are document-heavy: agency invoices, support schedules, payroll for household aides and Schedule A worksheets. Tax Brew provides bookkeeping, cleanup and tax prep support for US CPA firms, with the first 20 hours free for qualifying engagements, while your team keeps the review, advice and sign-off. See our services, or email info@taxbrewglobal.com.

Sources: IRS Publication 502 (2025), Medical and Dental Expenses; IRS Tax Topic 502 (reviewed Oct. 9, 2026); IRS Publication 501 (2025); Rev. Proc. 2025-32; 26 U.S.C. §213 and §7702B (Cornell LII); Caregiver Economics, Marcus Delacroix-Webb (Sept. 22, 2026). General information, not tax or legal advice.