You can deduct as medical expenses only those amounts paid during the taxable year for which you received no insurance or other reimbursement.

Insurance Reimbursement

You must reduce your total medical expenses for the year by all reimbursements for medical expenses that you receive from insurance or other sources during the year. This includes payments from Medicare.

Generally, you do not reduce medical expenses by payments you receive for:

• Permanent loss or loss of use of a member or function of the body (loss of limb, sight, hearing, etc.) or disfigurement that is based on the nature of the injury without regard to the amount of time lost from work,
• Loss of earnings, or
• Damages for personal injury or sickness.

You must, however, reduce your medical expenses by any part of these payments that is designated for medical costs. See How Do You Figure Your Deduction, later.

What If Your Insurance Reimbursement Is More Than Your Medical Expenses?

If you are reimbursed more than your medical expenses, you may have to include the excess in income.

Premiums paid by you. If you pay the entire premium for your medical insurance or all the costs of a plan similar to medical insurance, and your insurance payments or other reimbursements are more than your total medical expenses for the year, you have excess reimbursement. Generally, you do not include the excess reimbursement in your gross income. However, gross income does include total payments in excess of the per diem limit for qualified long-term care insurance. See Periodic Payments Not Taxed, under What Medical Expenses Are Deductible, earlier, for the per diem amounts.

Figure 1. Is Your Excess Medical Reimbursement Taxable?

Premiums paid by you and your employer. If both you and your employer contribute to your medical insurance plan and your employer's contributions are not included in your gross income, you must include in your gross income the part of your excess reimbursement that is from your employer's contribution.

Example. You are covered by your employer's medical insurance policy. The annual premium is $2,000. Your employer pays $600 of that amount and the balance of $1,400 is taken out of your wages. The part of any excess reimbursement you receive under the policy that is from your employer's contributions is figured like this:

Total annual cost of policy	$2,000
Amount paid by employer	600
Employer's contribution in relation to the total annual cost of the policy ($600 x $2,000)	30%

You must include in your gross income 30% of any excess reimbursement you received for medical expenses under the policy.

Premiums paid by your employer. If your employer or your former employer pays the total cost of your medical insurance plan and your employer's contributions are not included in your income, you must report all of your excess reimbursement as other income.

More than one policy. If you are covered under more than one policy, the costs of which are paid by both you and your employer, you must first divide the medical expense among the policies to figure the excess reimbursement from each policy. Then divide the policy costs to figure the part of any excess reimbursement that is from your employer's contribution.

Example. You are covered by your employer's health insurance policy. The annual premium is $1,200. Your employer pays $300, and the balance of $900 is deducted from your wages. You also paid the entire premium ($250) for a personal health insurance policy.

During the year, you paid medical expenses of $3,600. In the same year, you were reimbursed $2,500 under your employer's policy and $1,500 under your personal policy.

You figure the part of the excess reimbursement that is from your employer's contribution like this:

Step 1.
Reimbursement from employer's policy	$2,500
Reimbursement from your policy	1,500
Total reimbursement	$4,000
Amount of medical expenses from your policy [($1,500 x $4,000) x $3,600 total medical expenses]	$1,350
Amount of medical expenses from your employer's policy [($2,500 x $4,000) x $3,600 total medical expenses]	2,250
Total medical expenses	$3,600
Excess reimbursement from your employer's policy ($2,500 - $2,250)	$250
Step 2.
Because both you and your employer contributed to the cost of this policy, you must divide the cost to determine the excess reimbursement from your employer's contribution.
Employer's contribution in relation to the annual cost of the policy ($300 x $1,200)	25%
Amount to report as other income on line 21, Form 1040 (25% x $250)	$62.50

What If You Receive Insurance Reimbursement in a Later Year?

If you are reimbursed in a later year for medical expenses you deducted in an earlier year, you must report the reimbursement as income up to the amount you previously deducted as medical expenses. However, do not report as income the amount of reimbursement you received up to the amount of your medical deductions that did not reduce your tax for the earlier year.

Example. You are single. Your adjusted gross income last year was $20,000. During that year you paid medical insurance premiums of $500 and other medical expenses of $1,900. You deducted $900, figured like this:

Step 1.
Medical expenses	$1,900
Insurance premiums	500
Total	$2,400
Minus 7.5% (.075) of adjusted gross income	1,500
Total medical expense deduction	$900
Step 2.
Last year, your itemized deductions, including medical expenses, were $5,100. This year, you collected $600 from your insurance policy for part of last year's medical expenses. If you had collected it last year, your deduction for medical expenses would have been only $300, figured like this:
Medical expenses	$1,900
Insurance premiums	500
Total	$2,400
Minus: insurance payments	600
Balance	$1,800
Minus: 7.5% (.075) of adjusted gross income	1,500
Total medical expense deduction	$300
Step 3.
Your $900 medical expense deduction last year reduced your income tax in that year. You must include the $600 of insurance reimbursement in income this year. Report the $600 on line 21 of Form 1040.

For more information about the recovery of an amount that you claimed as an itemized deduction in an earlier year, see Recoveries in Publication 525.

What If You Are Reimbursed for Medical Expenses You Did Not Deduct?

If you did not deduct a medical expense in the year you paid it because your medical expenses were not more than 7.5% of your adjusted gross income, or because you did not itemize deductions, do not include in income the reimbursement for this expense that you receive in a later year. However, if the reimbursement is more than the expense, see What If Your Insurance Reimbursement Is More Than Your Medical Expenses, earlier.

Example. Last year, you had $500 of medical expenses. You cannot deduct the $500 because it is less than 7.5% of your adjusted gross income. If, in a later year, you are reimbursed for any of the $500 of medical expenses, you do not include that amount in your gross income.

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