Bob, a longtime client, showed up at my office during tax season bringing all his receipts and organizer. “You don’t have much in the way of medical expense,” I told him as I perused his itemized deduction worksheet.

“Nah, just some co-pays.”

I looked up from his organizer, surprised he hadn’t said, “WHAT?” After all, Bob is deaf as a stone and has been for years. That’s when I noticed a hearing aid in each ear. “You just get those?” I asked.

“I got them last year.”

“Did Medicare cover them?”

“Nope, I paid for them out of my own pocket. I got top of the line too. These suckers cost me seven grand.”

“And you got them in 2014 – last year – right?” He nodded. “You didn’t list the expense in your organizer, Bob. What’s the matter? You don’t want to write them off?”

His jaw dropped. “I can write them off?”

“Yeah, it’s a valid deductible medical expense. Good thing I noticed because I just saved you $2500 in taxes. How about that Bob?”

And Bob’s not the only one who doesn’t realize what is and what isn’t allowable when it comes to medical expenses. Lots of folks have misconceptions about what can be deducted.

First of all, one must be able to itemize deductions in order to take the medical expense deduction. The IRS grants us an option of the standard deduction – generally taken by renters and lower income individuals or itemized deductions – generally available to homeowners and higher income individuals.  Either the standard deduction or the total of itemized deductions (reported on Schedule A) is subtracted from your income. Income tax liability is calculated on the remainder. So the more itemized deductions you can list, the more you will save in taxes.

Know this; you generally have to have an awful lot of medical expenses in order to take these expenses as an itemized deduction. You don’t just list your medical then deduct it. After totaling your medical expenses, the IRS requires that you subtract 10% (7.5% if you are 65 or older) of your adjusted gross income from the total of your medical expenses. You then write off the remainder.  So if you made $100,000 last year, you can write off the amount above $10,000 ($7,500 if 65 or older) in medical expenses. If you’re healthy, you might not have enough medical bills to enjoy the write-off. But don’t quit reading yet. You can deduct more than just doctor visits.

A complete list of deductible medical expenses is available in Publication 502. Most people track medical insurance, doctor visits, prescriptions, eye and dental care. You may be surprised to find the following are deductible medical expenses:

1.  Capital improvements to your home or vehicle to accommodate a disability
2. Transportation and lodging in another city if the primary purpose is medical care
3. Medicare premiums deducted from your Social Security check
4. Chiropractor, acupuncture, therapeutic massage, psychologist, psychiatrist, marriage counselor, naturopath
5. Alcohol and drug addiction for inpatient treatment at a therapeutic center, including meals and lodging
6. Dentures, birth control pills, and pregnancy test kits, fertility enhancement
7. Cost of buying, training, and maintaining a guide dog or other service animal when required to assist you or your dependent with physical disabilities
8. Unused sick leave to pay for your health insurance premiums
9. Cost of medical conferences and transportation to same if the topic concerns the chronic illness of yourself, your spouse or your dependent
10. Adapters to television sets and telephones for the hearing-impaired.
11. Braille instruction, Braille books and magazines
12. Bandages
13. Health, dental and eye insurance, long term care insurance, HMO fees, disability insurance withheld from your paycheck
14. Lead-based paint removal in your home
15. Cost of weight loss clinic if prescribed by a doctor for treatment of obesity or hypertension
16. Cost of medical care, lodging and meals in a nursing home if there for medical reasons
17. Medical mileage – trips to see practitioners, pharmacy, etc
18. Cosmetic surgery for breast reconstruction after a mastectomy for cancer or to correct a birth defect or other condition that interferes with one’s health.

Generally cosmetic surgery is not deductible.  However, a stripper won a court case several years ago and was allowed a deduction for breast enhancement. However, it was not allowed as a medical expense. Instead, she was able to write it off as an “ordinary and necessary” business expense.

Also not deductible are vitamins and supplements, gym membership, dance lessons and swimming lessons even if recommended by your physician, prescriptions for controlled substances (marijuana, laetrile, etc. that violate federal law) or prescription medicines from foreign countries, hair transplants and teeth whitening.

Taxpertise tip of the day: stack your medical expenses into one year. So for example, if you had a surgery this year and also need a root canal and new glasses, don’t wait until January to have that work done. Do it now so you can maximize the tax benefit. You cannot pay for them now and take the deduction unless you actually undergo the treatment or procedure.