The short answer is yes — nursing home expenses can be tax deductible. The longer answer is that a single IRS determination separates a family that deducts the entire cost of a nursing home stay from a family that deducts almost nothing. Most families never learn which side of that line they are on, because no one tells them until tax season is already over.
Nursing home care in the United States costs a national median of $9,581 per month for a semi-private room and $10,798 for a private room. In North Carolina, the median private room runs approximately $9,125 per month — over $109,000 per year. For families paying any portion of that out of pocket, the tax implications are not a footnote. They are a financial planning decision that can mean thousands of dollars in a single tax year.
Here is what the IRS actually allows, what most families miss, and how to make sure you are claiming what you are entitled to.
The one determination that controls everything
The IRS draws a single line that governs the entire deduction: is the person in the nursing home primarily for medical care, or primarily for personal reasons?
If the primary reason for the nursing home stay is medical care — meaning the resident requires skilled nursing, ongoing medical treatment, or supervision due to a medical condition — then the entire cost of the stay is deductible as a medical expense. That includes room and board, nursing services, medications administered by the facility, and meals. All of it.
If the primary reason is non-medical — the person cannot live alone but does not require skilled or medical care — then only the portion of the cost directly attributable to medical services qualifies. Room and board do not. Meals do not. The deductible amount shrinks to a fraction of the total bill.
In practice, most nursing home residents are there because of medical necessity. A person admitted for post-surgical rehabilitation, for management of a progressive neurological condition, for skilled nursing following a stroke, for dementia care requiring professional supervision — these are medical admissions. The facility's own admission records, the attending physician's orders, and the care plan documentation will generally establish the medical basis. But the distinction matters, and families should confirm it — ideally with a tax professional and the facility's billing department — before filing.
IRS source: Publication 502 (Medical and Dental Expenses) at irs.gov/publications/p502
The 7.5% floor — and what it means in real dollars
Even when nursing home expenses qualify as medical expenses, the IRS does not let you deduct the full amount. Medical expenses are deductible only to the extent they exceed 7.5% of your adjusted gross income (AGI). This threshold was made permanent in 2021 and applies for the 2025 and 2026 tax years.
What does that look like in practice?
If your AGI is $60,000, your floor is $4,500. You can deduct medical expenses above that amount. If your total qualifying medical expenses — including nursing home costs, prescription drugs, Medicare premiums, and other medical costs — total $50,000, your deduction is $45,500. At a 22% marginal tax rate, that saves you roughly $10,010 in federal taxes.
If your AGI is $150,000, the floor is $11,250. At $50,000 in qualifying expenses, the deduction drops to $38,750.
Two things matter here. First, the nursing home cost itself is often large enough to clear the 7.5% floor on its own — a $115,000 annual nursing home bill exceeds the AGI threshold for most families. Second, you should be aggregating all qualifying medical expenses in the same tax year: Medicare Part B and Part D premiums, supplemental insurance premiums, prescription copays, dental work, hearing aids, eyeglasses, transportation to medical appointments, and home modifications for medical necessity. The nursing home cost opens the door; everything else walks through it.
You must itemize deductions on Schedule A to claim this. The standard deduction for 2025 is $15,000 for single filers and $30,000 for married filing jointly (with an additional $1,600–$2,000 for filers over 65). If your total itemized deductions — including the medical expense deduction — do not exceed the standard deduction, itemizing does not help. But for families paying nursing home costs out of pocket, the medical expenses alone will almost always push itemized deductions well above the standard deduction threshold.
IRS source: Topic No. 502 at irs.gov/taxtopics/tc502
What most families miss: deducting a parent's nursing home costs
You do not have to be the person receiving care to claim the deduction. If you are paying nursing home expenses for a parent, you may be able to deduct those costs on your own return — and this is the provision that the largest number of families either miss entirely or misunderstand.
To deduct medical expenses paid for a parent, the parent must qualify as your dependent. The IRS requires that the parent's gross income fall below $5,200 (2025) and that you provide more than half of their total support. The parent does not need to live with you. Social Security benefits are only partially counted as gross income for this test — for many elderly parents, especially those whose primary income is Social Security, the income threshold is met.
Here is the part most people do not know: even if your parent's income is too high to claim them as a dependent, you can still deduct medical expenses you paid for them — as long as the only reason they fail the dependency test is the income threshold. If you provide more than half their support and they meet the relationship test, you can deduct the nursing home costs you personally pay, even without claiming them as a dependent. The IRS calls this the "medical expense test" rather than the "dependency exemption test," and the distinction matters.
When siblings share the cost of a parent's care, a Multiple Support Agreement (IRS Form 2120) allows one sibling to claim the parent as a dependent if no single person provides more than 50% but the group collectively does. The person claiming the dependent must contribute at least 10% of support. However — and this is important — each sibling can deduct the medical expenses they personally paid, regardless of who files the Form 2120.
IRS source: IRS FAQ on nursing home expenses at irs.gov/faqs/itemized-deductions-standard-deduction/medical-nursing-home-special-care-expenses
Long-term care insurance premiums get their own deduction
If you or your family member carries a tax-qualified long-term care insurance policy, the premiums count as medical expenses — but only up to age-based limits that the IRS adjusts annually.
For the 2025 and 2026 tax years:
Age at end of tax year 2025 deductible limit 2026 deductible limit 40 or younger $480 $500 41–50 $900 $930 51–60 $1,800 $1,860 61–70 $4,810 $4,960 71 and older $6,020 $6,200
These limits apply per person. A married couple both over 71 could deduct up to $12,040 in LTCI premiums in 2025 — and those premiums are added to the same pile of medical expenses that includes the nursing home costs, clearing the 7.5% AGI floor faster.
Self-employed individuals get a better deal: they can deduct qualifying LTCI premiums as an above-the-line deduction, which means they do not need to itemize and the 7.5% AGI floor does not apply.
One important caveat: hybrid life insurance/LTC policies — which have become the dominant product in the long-term care insurance market — generally do not qualify for the premium deduction. The tax benefit applies to standalone, tax-qualified long-term care insurance policies.
The HSA strategy most families overlook
Health Savings Account funds can be used tax-free for qualifying medical expenses, including nursing home costs and LTCI premiums up to the age-based limits. For families with an HSA — or adult children who maintain one through a high-deductible health plan — this creates a powerful second channel.
HSA contribution limits for 2026 are $4,400 for individual coverage and $8,750 for family coverage, with an additional $1,000 catch-up contribution for anyone 55 or older. There is no deadline for withdrawing HSA funds to reimburse past medical expenses — you can pay a nursing home bill out of pocket today and reimburse yourself from your HSA years later, as long as you keep the receipts and the expense occurred after the HSA was established.
The coordination between HSA distributions and the medical expense deduction matters: you cannot double-dip. Expenses paid with tax-free HSA funds cannot also be claimed as itemized medical deductions. The optimal strategy is typically to use HSA funds for medical expenses that fall below the 7.5% AGI floor (since those would not be deductible anyway) and claim the Schedule A deduction for expenses above the floor. A tax professional can help model the right split for your specific situation.
What the IRS considers "medical care" in a nursing home
The IRS definition of deductible medical care under IRC Section 213 is broader than many families realize. In the nursing home context, qualifying expenses include:
The full cost of the stay — room, board, meals, nursing care, and personal care services — when the person is in the facility primarily for medical care. This is the determination described at the top of this article, and it is worth repeating because it controls the largest dollar amount.
Specific medical services even when the stay is not primarily medical: skilled nursing, physical therapy, occupational therapy, speech therapy, laboratory work, prescription medications administered by the facility, and medical equipment.
Personal care services for a chronically ill individual — defined as someone who has been certified by a licensed healthcare practitioner as unable to perform at least two activities of daily living (bathing, dressing, eating, toileting, transferring, continence) for at least 90 days, or who requires substantial supervision due to severe cognitive impairment. This definition matters because it captures most dementia patients and most residents requiring long-term custodial care.
Transportation to and from the facility for medical care (at 67 cents per mile for 2025 if using the standard medical mileage rate, or actual expenses).
What does not qualify: the portion of a facility's charges attributable to non-medical personal convenience, entertainment, or general living expenses when the stay is not primarily medical. In practice, this distinction arises most often in assisted living settings, where a resident may be there partly for social support and convenience rather than medical necessity. In a skilled nursing facility, the medical basis is almost always established.
Timing and documentation: what to do before you file
The tax deduction applies in the year the expense is paid, not the year the expense is incurred. If you prepay several months of nursing home care in December 2025, those payments are deductible on your 2025 return. This creates a legitimate planning opportunity: families facing a high-expense year may benefit from accelerating or timing payments to maximize the deduction in a single tax year rather than splitting it across two years where neither exceeds the AGI threshold by a meaningful amount.
Documentation you should maintain:
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Facility billing statements showing the total amount paid, broken down by category if available (some facilities will separate room/board from medical services on request)
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Physician's statement or care plan establishing that the admission is primarily for medical care — ask the facility or attending physician for a letter stating this if one does not exist in the medical record
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Proof of payment — canceled checks, bank statements, credit card records
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Records of the parent's income and support if you are claiming the deduction for a parent's expenses, including Social Security benefit statements (Form SSA-1099), pension records, and documentation of support you provided
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Form 2120 if a Multiple Support Agreement is in effect among siblings
A conversation with a tax professional before the end of the tax year — not after — is worth the cost. The deduction planning for nursing home expenses is one of the areas where a CPA or enrolled agent familiar with elder care tax issues can identify strategies that a general tax preparer may miss.
What the data tells us about the financial pressure families face
An analysis of 12,079 verified Google reviews from 312 nursing and care facilities across all 50 states — the dataset that powers NursingHomeIQ's review intelligence — reveals that cost and billing concerns are among the most emotionally charged themes in the entire dataset. Reviews mentioning billing disputes, unexpected charges, or financial pressure consistently appear alongside the lowest overall satisfaction scores, not because the care was necessarily poor, but because the financial weight of nursing home placement affects how families experience everything else about the facility.
The financial burden is real and it is large. At a national median of $114,975 per year for a semi-private room, a family paying out of pocket for even a portion of that cost is facing a financial event comparable to a second mortgage. The tax deduction does not eliminate that burden. But for a family paying $80,000 or $100,000 in qualifying medical expenses in a single year, a properly claimed deduction can return $15,000 to $25,000 or more in reduced federal tax liability. That is not a rounding error. It is a meaningful offset — and one that too many families leave on the table because no one walked them through it.
Key government sources referenced in this article:
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IRS Publication 502 (Medical and Dental Expenses): irs.gov/publications/p502
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IRS Topic No. 502: irs.gov/taxtopics/tc502
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IRS FAQ on nursing home medical expenses: irs.gov/faqs/itemized-deductions-standard-deduction/medical-nursing-home-special-care-expenses
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IRS Form 2120 (Multiple Support Declaration): irs.gov/forms-pubs/about-form-2120
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Schedule A (Itemized Deductions): irs.gov/forms-pubs/about-schedule-a-form-1040
NursingHomeIQ provides information to help families navigate nursing home decisions. This article is for educational purposes and does not constitute tax advice. Consult a qualified tax professional for guidance specific to your situation.