Medical Mileage Deduction

The medical mileage rate

The IRS publishes a per-mile rate specifically for medical mileage, separate from the business rate. It's typically lower (in recent years, around 21¢ per mile) because it's intended to cover only the variable costs of driving — gas and oil — not the fixed costs that the business rate also approximates.

You can also use actual gas-and-oil costs instead of the standard medical rate, but parking and tolls are deductible regardless of method. Most filers just use the standard medical rate because it's simpler.

Where it goes on your return

Medical mileage is part of your Schedule A medical expense deduction — meaning you only benefit if (a) you itemize deductions on your return rather than taking the standard deduction, and (b) your total medical expenses exceed 7.5% of your AGI (adjusted gross income).

That second condition is the threshold most filers miss. If your AGI is $80,000, the first $6,000 of medical expenses produces no deduction at all. Only what's above that floor counts. For many filers, especially in years without major medical events, mileage alone won't push them past the floor — which means the mileage deduction effectively contributes zero.

For filers who do exceed the floor — usually due to surgery, hospitalization, ongoing treatment for a chronic condition, or a major medical event — every dollar of additional documented medical mileage helps directly.

What counts as medical mileage

• Travel to and from doctor and dentist appointments for you, your spouse, or a dependent.
• Travel to and from a hospital or clinic for treatment, scans, surgery, or follow-up.
• Travel to and from a pharmacy to pick up prescriptions.
• Travel for therapy or counseling when prescribed by a doctor for a medical condition.
• Travel to a special school or treatment program for a dependent with a diagnosed condition, when the program is primarily medical.
• Visiting a hospitalized patient if the trip is essential to medical care (less common; check with a CPA).

What doesn't count

• Travel for general health — driving to the gym, the yoga studio, or to buy vitamins is not medical mileage.
• Travel for elective cosmetic procedures that aren't medically necessary.
• Trips that combine medical with personal in any significant way — if the primary purpose isn't medical, the trip doesn't qualify.
• Travel for which you were reimbursed (e.g., by insurance or an employer's HRA).

Recordkeeping

Same standard as business mileage: date, destination, purpose, miles, recorded contemporaneously. The "purpose" field should be specific enough that an examiner can connect the trip to a medical expense — "Dr. Patel, follow-up for [condition]" rather than "doctor."

You'll also want to keep the supporting documentation — receipts or insurance statements showing the medical care actually happened — so the trip log corroborates the rest of the medical expense file.

Practical example

Cancer treatment year for a filer with $80,000 AGI. The 7.5% AGI floor is $6,000. Out-of-pocket medical costs are $14,000 (insurance copays, prescriptions, ancillary care). They drove approximately 1,200 miles for treatment over the year. At a 21¢ medical rate, that's $252 of additional deduction.

Total deductible medical: $14,252 − $6,000 floor = $8,252 deduction on Schedule A. The mileage contributed $252 of that — small but real, and free if recorded automatically.

For most years and most filers, medical mileage is a few hundred dollars at most. It's worth tracking only because — if you're going to log the business and personal drives anyway — the medical classification is one tap, and the deduction is there if a year of heavy treatment ever clears the AGI floor.

HSAs and FSAs

Medical mileage is reimbursable through HSAs and Health FSAs at the IRS medical rate. If you have an HSA or FSA, mileage is one of the easiest ways to use leftover funds at year-end — you submit the log and miles, and the plan reimburses tax-free. The mileage you reimburse through the HSA isn't separately deductible on Schedule A, but it's also not subject to the 7.5% AGI floor.

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