Cross-Border Medical Expenses: Where Do I Claim Them, Canada or the US?

Claim a medical bill in the country whose floor it clears, and if you file in both countries, check whether it clears both. Canada’s medical expense credit starts above the lesser of 3% of net income or $2,890 for 2026 ($2,834 for 2025), pays 14% federally plus a provincial credit, and doesn’t need itemizing. The US deduction starts above 7.5% of adjusted gross income, is worth your marginal rate, and only counts if you itemize. Both countries accept bills paid in the other country, so the decision comes down to thresholds and residency.

How does Canada’s medical expense credit compare with the US deduction?

Canada gives a non-refundable credit at the lowest federal rate, 14%, on eligible expenses above the lesser of 3% of net income or $2,890 for 2026 ($2,834 for 2025), with a provincial credit on top and no need to itemize. The US gives an itemized deduction for unreimbursed medical care above 7.5% of AGI, worth your marginal rate, and only if your itemized deductions beat the standard deduction ($16,100 single, $32,200 joint for 2026). Canada’s floor is lower for most incomes; the US deduction is worth more per dollar once you’re over both hurdles.

	Canada (medical expense tax credit)	US (Schedule A medical deduction)
Rule	ITA 118.2	IRC 213
Floor	Lesser of 3% of net income or $2,890 (2026) or $2,834 (2025)	7.5% of adjusted gross income
What it’s worth	14% federal credit on the excess, plus the provincial credit	Deduction at your marginal rate
Itemizing needed	No	Yes; itemized deductions must beat $16,100 single / $32,200 joint (2026), $15,750 / $31,500 (2025)
Claim period	Any 12-month period ending in the tax year	Expenses paid in the calendar year
Bills paid in the other country	Eligible, if the practitioner is authorized where the service was given (attendant care, group homes, fertility and surrogacy costs must be in Canada)	Eligible; no location test in the definition of medical care
Who can claim	Canadian residents (part-year residents for the resident part of the year only)	US citizens and resident aliens; nonresident aliens on a 1040-NR cannot

• The Canadian formula is ITA 118.2(1): the appropriate percentage times medical expenses “paid by the individual or the individual’s legal representative within any period of 12 months that ends in the taxation year,” less “the lesser of $1,813 and 3% of the individual’s income.” The $1,813 is the unindexed base; the CRA’s RC4065 guide gives $2,834 for 2025. The 14% is the lowest rate in ITA 117(2) for taxation years after 2024.
• The US rule is IRC 213(a): a deduction for expenses “not compensated for by insurance or otherwise, for medical care of the taxpayer, his spouse, or a dependent … to the extent that such expenses exceed 7.5 percent of adjusted gross income.” Publication 502 confirms the 7.5% and that it’s a Schedule A item.
• The 2026 and 2025 standard deduction figures are from the IRS’s 2026 inflation adjustments.

What each side counts as a medical expense, the premium rules, and the travel rules are in the companion guide on what qualifies for the cross-border medical deduction.

Can I claim medical bills paid in the other country?

Yes, in both directions. CRA’s folio says eligible medical expenses “are not restricted to those paid in Canada or for medical services provided in Canada,” and RC4065 says a person who travels outside Canada for care can claim what they paid to a medical practitioner or a public or licensed private hospital. IRC 213 defines medical care by what it’s for, with no location test, and Publication 502 draws one foreign line: a prescription drug counts if you buy and use it in the other country and it’s legal in both countries; a drug brought back or shipped in generally doesn’t, unless it was imported legally.

• Folio S1-F1-C1, paragraph 1.12: “As a general rule, however, eligible medical expenses are not restricted to those paid in Canada or for medical services provided in Canada.” The exceptions it lists are attendant care, group homes, fertility clinic fees and surrogacy costs, which have to be in Canada.
• RC4065, under “Medical services outside of Canada”: “if you travel outside Canada to get medical services, you can claim the amounts you paid to a medical practitioner and a public or licensed private hospital. A ‘licensed private hospital’ is a hospital licensed by the jurisdiction that it operates in.”
• The practitioner has to be authorized where the service was given. ITA 118.4(2) reads the reference to a medical practitioner, for a service, as one authorized “pursuant to the laws of the jurisdiction in which the service is rendered,” so a licensed Florida physician qualifies for a Canadian claim.
• On the US side, IRC 213(d)(1)(A) defines medical care as amounts paid “for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body,” with nothing about where. Publication 502: “You can include the cost of a prescribed drug you purchase and consume in another country if the drug is legal in both the other country and the United States,” but generally not a drug “brought in (or ordered and shipped) from another country.”

Convert each bill at the exchange rate for the day you paid it, on both returns; currency conversion for cross-border tax covers the accepted rates.

Can I claim the same expense on both returns?

If you file both returns, yes, for the unreimbursed part. ITA 118.2 only strips out amounts another taxpayer claimed and amounts reimbursed, and IRC 213 only strips out expenses “compensated for by insurance or otherwise”; neither treats a tax benefit in the other country as a reduction. That’s our read of the two statutes and it’s how we file. The catch is the foreign tax credit: the Canadian credit lowers the Canadian tax a US citizen can claim on Form 1116, so the two benefits overlap rather than stack.

• ITA 118.2(1) counts medical expenses “that are not included in determining an amount under this subsection, section 64 or subsection 122.51(2), by any other taxpayer for any taxation year,” and the folio treats reimbursements under a private or public plan as reductions (paragraph 1.17). Nothing in the section mentions a foreign deduction.
• IRC 213(a) limits the deduction to expenses “not compensated for by insurance or otherwise.” A Canadian tax credit isn’t compensation for the expense.
• The Form 1116 credit is for foreign taxes “paid or accrued,” so anything that lowers Canadian tax lowers the credit. How that limitation works is in Form 1116 and Canadian tax changes.

What if I’m a snowbird or a visitor and only file in one country?

A Canadian resident who gets care in Florida claims it on the T1 like any other bill, converted to Canadian dollars, and the travel medical insurance premium counts as a private health services plan premium if 90% or more of what the plan pays for is eligible medical expenses. A Canadian who files a US 1040-NR for rental income can’t add medical bills to it, because nonresident aliens get only a short list of itemized deductions. A US resident who gets care in Canada claims it on Schedule A if they itemize.

• RC4065 on premiums: “Premiums paid to private health services plans including medical, dental, and hospitalization plans. They can be claimed as a medical expense, as long as 90% or more of the premiums paid under the plan are for eligible medical expenses.” The statutory hook is ITA 118.2(2)(q).
• Publication 519 for nonresident aliens: “You can deduct certain itemized deductions if you receive income effectively connected with your U.S. trade or business,” and beyond those, “you can deduct certain charitable contributions and casualty and theft losses even if they do not relate to your effectively connected income.” Medical expenses aren’t on the list, and nonresident aliens “cannot claim the standard deduction” either.
• A snowbird who stays long enough to become a US resident under the substantial presence test is a different case, and how many days a Canadian snowbird can spend in the US sets out where that line is.

What about the year I move, or a US citizen living in Canada?

Residency sets which return the bill lands on. In a move year, expenses paid while you were a Canadian resident go on the Canadian return, using any 12-month period ending in the year, and expenses from the US-residency period go on the US return, or the whole year’s if you elect full-year US treatment. A US citizen living in Canada files both every year, so the same bills can go on both, and the Canadian credit usually does more work because its floor is lower and it doesn’t need itemizing.

• The Canadian 12-month rule is in ITA 118.2(1)(d), and RC4065 restates it: “You can claim eligible medical expenses paid in any 12-month period ending in 2025 and not claimed by you or anyone else in 2024.”
• Which US return covers a move year, dual-status or full-year, is in dual-status return or full-year election.
• If you bring a health savings account with you, what happens to an HSA when you move to Canada is its own problem, separate from the deduction question.

What should I do next?

Sort the year’s receipts by who was resident where when the bill was paid, and by whether any of it was reimbursed. Run the Canadian floor (lesser of 3% of net income or $2,890 for 2026, $2,834 for 2025) and the US floor (7.5% of AGI) on the unreimbursed total. If only one clears, that’s the return. If you file both and both clear, claim both and let the foreign tax credit sort out the overlap. Pick the Canadian 12-month window last, because moving it by a month can pull a large bill into the year that needs it.

• What qualifies for the cross-border medical deduction, the eligible-expense, premium and travel rules on each side
• Standard deduction or itemizing for cross-border filers, the hurdle a US medical deduction has to clear
• Form 1116 and the foreign tax credit, why a Canadian credit shrinks the US credit
• US citizen living in Canada: what to file, the baseline for dual filers
• Should I retire in Canada or the US?, the healthcare cost side of the comparison

This guide is general information, not tax advice for your specific situation. Which points apply, and how, depends on your facts.