Deducting Medical Home Improvements

You can deduct certain home improvements if their main purpose is medical care for you, your spouse, or your dependents.

Ordinarily, you cannot deduct the cost of permanent improvements to your home. But these is an important exception: such improvements can be deductible as a medical expense. However, changes brought about by the Tax Cuts and Jobs Act (TCJA) make it harder for most taxpayers to deduct these expenses than in the past.

What Home Improvements are Deductible as Medical Expenses?

Home improvements can be deductible as a medical expense if their main purpose is medical care for you, your spouse, or your dependents. These expenses are fully deductible subject to the limits discussed below if they don’t increase the value of your home. Examples of such fully deductible expenses are improvements to make your home wheelchair accessible or to make it easier for a disabled person to get around the home, including:

  • constructing entrance or exit ramps for your home
  • widening doorways at entrances or exits to your home
  • widening or otherwise modifying hallways and interior doorways
  • installing railings, support bars, or other modifications to bathrooms
  • lowering or modifying kitchen cabinets and equipment
  • moving or modifying electrical outlets and fixtures
  • installing porch lifts and other forms of lifts
  • modifying fire alarms, smoke detectors, and other warning systems
  • modifying stairways
  • adding handrails or grab bars anywhere (whether or not in bathrooms).
  • modifying hardware on doors
  • modifying areas in front of entrance and exit doorways, and
  • grading the ground to provide access to the residence.

However, some improvements increase the value of your home--for example, installing an elevator so that a disabled person does not have to use stairs, or installing a new bathroom on the ground floor of your home to avoid having to use stairs. For these types of improvements you must reduce the amount of your deduction by the increase in value of your home.

Example: You have a heart ailment. On your doctor's advice, you install an elevator in your home so that you will not have to climb stairs. The elevator costs $8,000. An appraisal shows that the elevator increases the value of your home by $4,400. You may deduct $3,600 of the $8,000 expense as a medical deduction.

It can even be possible to deduct the cost of adding a swimming pool to your home. However, use of the pool must be prescribed by a doctor as medical treatment or physical therapy. Thus, for example, you can't deduct the cost of a pool because swimming is good exercise. Moreover, the IRS may question the deduction unless the pool is specially designed for medical treatment. For example, the IRS permitted a deduction by an osteoarthritis patient whose doctor prescribed swimming several times a day as treatment. He built a special indoor lap pool with specially designed stairs and a hydrotherapy device.

You can also deduct amounts you pay for operation and upkeep of an improvement, as long as the main reason for them is medical care. This rule applies even if none or only part of the original cost of the capital asset qualified as a medical care expense.

Example: If, in the previous example, the elevator increased the value of your home by $8,000, you would have no medical expense deduction for the cost of the elevator. However, the cost of electricity to operate the elevator and any costs to maintain it are deductible medical expenses as long as the medical reason for the elevator exists.

Two Rules that Limit or Eliminate Your Deduction

However, there are two tax rules that work together to limit or eliminate entirely your medical expense deduction for home improvements:

  • you must itemize to deduct medical expenses, and
  • there is an AGI threshold on deducting medical expenses.

You Must Itemize to Deduct Your Medical Expenses

First, you can deduct home improvements as medical expenses only if you itemize your personal deductions instead of taking the standard deduction. If you don’t itemize, you get no deduction for your medical expenses, including home improvements. Changes brought about by the Tax Cuts and Jobs Act that took effect in 2018 make it far more difficult for most taxpayers to itemize than in the past.

You should itemize only if all your deductible personal expenses exceed the standard deduction.The TCJA almost doubled the standard deduction to $12,000 for single taxpayers and $24,000 for married couples filing jointly (as almost all do). This means you have to have a lot of personal deductions to itemize. However, the TCJA limited or eliminated personal expenses that used to be deductible. Starting in 2018, only the following personal expenses may be deducted by itemizers:

  • out-of-pocket medical expenses (subject to the AGI threshold discussed below)
  • charitable contributions
  • up to $10,000 in state and local taxes
  • home mortgage interest (subject to home loan limits)
  • casualty and theft losses due to a federally declared disaster, and
  • gambling losses (up to gambling winnings).

In the past, about 30% of all taxpayers itemized their personal deductions. As a result of the TCJA's changes, it’s expected that no more than 5% of taxpayers will be able to itemize.

AGI Threshold on Deducting Medical Expenses

The other major impediment to deducting home improvements as medical expenses is that you can’t deduct the full cost of such expenses, even if you itemize. You can deduct only the amount they and any other deductible medical expenses exceed a specified percentage of your adjusted gross income (AGI). Your AGI is your total taxable income, minus deductions for retirement contributions and one-half of your self-employment taxes (if any), plus a few other items (as shown at the bottom of your Form 1040).

During 2017 through 2018, medical expenses are deductible only if, and to the extent, they exceed 7.5% of your AGI. Thus, for example, if your AGI is $100,000, you can deduct your home improvements and other medical expenses as an itemized deduction only to the extent they exceed $7,500. If you have $10,000 in total medical expenses, you can deduct only $2,500. You would add the $2,500 to your other deductible personal expenses and, if they total more than the standard deduction, you would deduct them as an itemized deduction. On the other hand, if you have a $100,000 AGI and your medical expenses are less than $7,500, you would not be able to deduct them at all.

Starting in 2019, the percentage threshold for deducting medical expenses increases to 10% of AGI. This makes it even more difficult to qualify for the deduction. For example, if your AGI is $100,000 in 2020 or later, you'll be able to deduct medical expenses only if, and to the extent, they exceed $10,000.

Because of the AGI threshold on deducting home improvements as a medical expense, it’s advisable to bunch such expenses together into a single year. For example, if you want to install exit ramps and a stairway lift in you home, have all the work done in a single year. This will give you as large a deduction as possible for that year. You should follow this strategy for your other deductible personal expenses as well, such as charitable contributions.

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