Medical Expenses Deduction Cross-Border: What Qualifies in Canada and the US, and Where the Thresholds Sit

Both countries give tax relief for medical costs, and both accept bills paid in the other country, but the thresholds and the lists differ. Canada’s medical expense tax credit covers eligible expenses above the lesser of 3% of net income or $2,890 for 2026 ($2,834 for 2025), at the 14% lowest federal rate plus a provincial credit, over any 12-month period ending in the year. The US deducts medical care above 7.5% of adjusted gross income on Schedule A, for expenses paid in the calendar year, and only if you itemize. Private plan premiums, prescriptions, dental work and travel for care can qualify on both sides, each with its own conditions.

What are the thresholds and rates for 2025 and 2026?

Canada: the credit is 14% of eligible expenses above the lesser of 3% of net income or $2,890 for 2026 ($2,834 for 2025), and the dollar figure is indexed each year. The US: expenses above 7.5% of AGI are deductible on Schedule A for both 2025 and 2026, and only if your itemized deductions beat the standard deduction, which is $15,750 single and $31,500 joint for 2025, and $16,100 and $32,200 for 2026.

	Canada	US
Rule	ITA 118.2	IRC 213
Floor	Lesser of 3% of net income or $2,890 (2026), $2,834 (2025)	7.5% of adjusted gross income
Relief	Non-refundable credit at 14% federal plus the provincial credit	Itemized deduction at your marginal rate
Period	Any 12 months ending in the tax year (24 months around a death)	Calendar year of payment
Whose bills	You, your spouse or partner, and children under 18 on line 33099; other dependants on line 33199 with their own floor	You, your spouse and your dependents
Reimbursed amounts	Excluded	Excluded (“not compensated for by insurance or otherwise”)
Hurdle	None	Itemized deductions must beat $16,100 / $32,200 (2026) or $15,750 / $31,500 (2025)

• ITA 118.2(1) sets the credit at the “appropriate percentage” of 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 base amount before indexing; the CRA’s RC4065 Medical Expenses guide states the 2025 figure as $2,834 and puts the claim on line 33099, or line 33199 for other dependants.
• The 14% is the lowest rate in ITA 117(2) for taxation years after 2024, which ITA 248(1) calls the “appropriate percentage.”
• 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 puts it on Schedule A (Form 1040).
• The standard deduction figures are from the IRS’s 2026 inflation adjustments, and whether itemizing pays is worked through in standard deduction or itemizing for cross-border filers.

Which return a bill belongs on when you have a foot in each country, and whether a dual filer can claim the same bill twice, is the companion question in where to claim cross-border medical expenses.

What qualifies on each side, and what doesn’t?

Canada’s list is in ITA 118.2(2) and it’s specific: payments to a medical practitioner, dentist, nurse or hospital, prescription drugs recorded by a pharmacist, glasses, devices, attendant care and more, minus anything purely cosmetic. The US definition is broader, anything “for the diagnosis, cure, mitigation, treatment, or prevention of disease,” but the Code then excludes cosmetic surgery and allows medicines only if prescribed or insulin. Bills from the other country qualify on both sides, provided a Canadian claim uses a practitioner authorized where the service was given.

Item	Canada	US
Doctor, dentist, hospital	Eligible under 118.2(2)(a)	Medical care under 213(d)(1)(A)
Prescription drugs	Eligible if prescription-only, prescribed, and recorded by a pharmacist	Only “a prescribed drug or … insulin” (213(b))
Over-the-counter drugs, vitamins, supplements	Not eligible, even if prescribed (vitamin B12 excepted)	Drugs only if prescribed; vitamins and supplements only if a practitioner recommends them for a diagnosed condition
Cosmetic procedures	Excluded unless “necessary for medical or reconstructive purposes” (118.2(2.1))	Excluded unless needed for a congenital abnormality, accident injury or disfiguring disease (213(d)(9))
Drugs bought in the other country	Eligible if prescription-only, prescribed, and recorded by a pharmacist	Only if the drug is legal in both countries and bought and used there
Practitioner in the other country	Must be authorized under the laws where the service was given (118.4(2))	No location test in the definition

• ITA 118.2(2)(a): amounts paid “to a medical practitioner, dentist or nurse or a public or licensed private hospital in respect of medical or dental services provided to a person.” ITA 118.4(2) reads “medical practitioner,” for a service, as a person authorized “pursuant to the laws of the jurisdiction in which the service is rendered.”
• RC4065 on drugs: “Prescription drugs and medications that can lawfully be obtained for use by the person only if prescribed by a medical practitioner. Also, the drugs or medications must be recorded by a pharmacist. You cannot claim over-the-counter medications, vitamins, or supplements, even if prescribed by a medical practitioner (except vitamin B12).”
• ITA 118.2(2.1): expenses “provided purely for cosmetic purposes” are out “unless necessary for medical or reconstructive purposes.”
• IRC 213(d)(9): medical care “does not include cosmetic surgery or other similar procedures, unless the surgery or procedure is necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.”
• Publication 502 on foreign drugs: “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 one “brought in (or ordered and shipped) from another country.”

Do health insurance premiums count?

Private plan premiums count on both sides. In Canada, premiums to a private health services plan qualify when 90% or more of what the plan pays for is eligible medical expenses, which takes in most employer plans, individual plans and travel medical policies, unless the premium was already deducted against business income. In the US, premiums for insurance covering medical care are medical care, including Medicare Part B and Part D, though the Medicare payroll tax is a tax. A self-employed person with a net profit can usually take premiums as an adjustment to income, with any leftover going to Schedule A.

• ITA 118.2(2)(q): a “premium, contribution or other consideration under a private health services plan” for the individual, spouse or household family members, “except to the extent that the premium … is deducted under subsection 20.01(1) in computing an individual’s income from a business.” RC4065 adds the test: eligible “as long as 90% or more of the premiums paid under the plan are for eligible medical expenses.”
• IRC 213(d)(1)(D): medical care includes amounts paid “for insurance (including amounts paid as premiums under part B of title XVIII of the Social Security Act, relating to supplementary medical insurance for the aged) covering medical care.” Publication 502: “Premiums you pay for Medicare Part B are a medical expense,” Part D premiums can be included, and “the payroll tax paid for Medicare Part A isn’t a medical expense.”
• Publication 502 on the self-employed: with a net profit for the year you “may be able to deduct, as an adjustment to income, amounts paid for health insurance” for yourself, your spouse, dependents and children under 27, but not “for any month in which you were eligible to participate in a health plan subsidized by your employer, your spouse’s employer,” and the deduction “can’t be more than your earned income from that trade or business.” Any premiums not taken there go on Schedule A “subject to the 7.5% limit.”
• A US citizen in Canada paying for a Canadian private or employer plan has a premium that fits both definitions; anyone on a US Marketplace plan has to net out any premium tax credit first, per Publication 502’s worked examples.

Can I claim travel to get medical care?

Yes, with distance tests in Canada and a lodging cap in the US. Canada allows transportation when substantially equivalent care isn’t available within 40 kilometres of home and the trip is reasonable (your own vehicle only where public transport isn’t readily available), and adds other reasonable travel costs, including meals and accommodation, at 80 kilometres or more, using receipts or the CRA’s flat rates. The US allows transportation “primarily for and essential to medical care,” at 21 cents a mile for 2025 and 20.5 cents for January to June 2026, plus lodging up to $50 a night per person, and never meals.

• ITA 118.2(2)(g): transportation to a place “not less than 40 kilometres” from home where medical services are normally provided, if “substantially equivalent medical services are not available in that locality,” the route is “reasonably direct,” and it is “reasonable … for the patient to travel to that place.” Paragraph (h) adds “reasonable travel expenses” for a place “not less than 80 km” away on the same conditions. Folio S1-F1-C1 paragraph 1.69 reads (h) to include “meals, accommodation and parking.”
• The CRA’s meal and vehicle rates page: simplified method “flat rate of $23 per meal (for the 2025 tax year), to a maximum of $69 per day,” and vehicle costs at the cents-per-kilometre rate “for the province or territory in which the travel begins,” 62.0 cents for Ontario in 2025.
• IRC 213(d)(1)(B): “transportation primarily for and essential to medical care.” IRC 213(d)(2): lodging away from home counts if the care “is provided by a physician in a licensed hospital” or equivalent and “there is no significant element of personal pleasure,” and “shall not exceed $50 for each night for each individual.” Publication 502: “Meals aren’t included.”
• Mileage: Publication 502 gives “the standard medical mileage rate of 21 cents a mile” for 2025; the IRS’s 2026 announcement sets “20.5 cents per mile driven for medical purposes” from January 1, 2026, and the IRS’s standard mileage rates page shows a mid-year change to 23.5 cents for July 1 to December 31, 2026.

Which 12 months, and what about reimbursements and the move year?

Canada lets you pick any 12-month period ending in the tax year, as long as the expenses weren’t claimed for the prior year, so a big bill can be moved into the year it helps most. The US counts what you paid in the calendar year. On both sides only the unreimbursed part counts, and plan payments come off first. In a move year the bills follow your residency, and a US health savings account stops being a clean tool once you live in Canada.

• RC4065: “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. For a person who died in 2025, a claim can be made for expenses paid in any 24-month period that includes the date of death.”
• Folio S1-F1-C1 paragraph 1.17 treats amounts received “under a Private Health Services Plan (PHSP) … or under a public or private medical, dental or hospitalization plan” as reimbursements that reduce the claim. On the US side the statute itself excludes anything “compensated for by insurance or otherwise,” and Publication 502 says a later reimbursement of an expense you never deducted isn’t income “up to the amount of the expense.”
• Which US return covers a move year is in dual-status return or full-year election, and the Canadian departure timeline, including when provincial coverage ends, is in leaving Canada permanently: tax checklist.
• What happens to an HSA when you move to Canada covers the account itself; for this guide, the point is that HSA-paid bills are already tax-free in the US and can’t be deducted again there: IRC 223(f)(6) says a payment out of an HSA for qualified medical expenses “shall not be treated as an expense paid for medical care” for the section 213 deduction.

Convert every foreign bill at the rate on the day you paid it, on either return; currency conversion for cross-border tax lists the rates each agency accepts.

What should I do next?

Total the year’s unreimbursed bills in each currency and run both floors. If the Canadian floor clears, pick the 12-month window that maximizes the excess and check every foreign practitioner is licensed where the service was given. If the US floor clears, add up the rest of your itemized deductions before deciding whether Schedule A is worth filing. Keep receipts for lodging and parking, log the kilometres or miles, and keep the plan statements that show what was reimbursed, because both agencies ask for those first.

• Where to claim cross-border medical expenses, which return a bill belongs on and whether dual filers can claim both
• HSA and moving to Canada, what happens to the account
• Standard deduction or itemizing for cross-border filers, whether the US medical deduction can ever count
• Cross-border tax return cost, what medical schedules add to the return
• Leaving Canada permanently: tax checklist, the departure-year timeline including health coverage

Related guides:

• Cross-Border Medical Expenses: Tax Deductions for Healthcare Costs Paid in the Other Country

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

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