Deductibility of long-term medical care services. The costs of qualified long-term care, including nursing home care, are deductible as medical expenses to the extent they, along with other medical expenses, exceed 10% of adjusted gross income (AGI).
Qualified long-term care services are necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, and rehabilitative services, and maintenance or personal-care services required by a chronically ill individual provided under a plan of care presented by a licensed health-care practitioner.
To qualify as chronically ill, an individual must be certified by a physician or other licensed health-care practitioner (e.g., nurse, social worker, etc.) as unable to perform, without substantial assistance, at least two activities of daily living (eating, toileting, transferring, bathing, dressing, and continence) for at least 90 days due to a loss of functional capacity, or as requiring substantial supervision for protection due to severe cognitive impairment (memory loss, disorientation, etc.). A person with Alzheimer’s disease qualifies.
Deductibility of premiums paid for qualified long-term care insurance. Premiums paid for a qualified long-term care insurance contract are deductible as medical expenses (subject to an annual premium deduction limitation based on age, as explained below) to the extent they, along with other medical expenses, exceed the 10% of AGI threshold mentioned above. A qualified long-term care insurance contract is insurance that covers only qualified long-term care services, doesn’t pay costs that are covered by Medicare, is guaranteed renewable, and doesn’t have a cash surrender value. A policy isn’t disqualified merely because it pays benefits on a per diem or other periodic basis without regard to the expenses incurred.
Qualified long-term care premiums are includible as medical expenses up to the following dollar amounts: For individuals over 60 but not over 70 years old, the 2019 limit on deductible long-term care insurance premiums is $4,220 ($4,160 for 2018), and for those over 70, the 2019 limit is $5,270 ($5,200 for 2018).
Deductibility of amounts paid to the nursing home. Amounts paid to a nursing home are fully deductible as a medical expense if the person is staying at the nursing home principally for medical, rather than custodial, etc., care. If a person isn’t in the nursing home principally to receive medical care, then only the portion of the fee that is allocable to actual medical care qualifies as a deductible medical expense. But if the individual is chronically ill (as defined above), all of the individual’s qualified long-term care services, including maintenance or personal care services, are deductible.
Including medical expenses you pay for your parent as part of your deductible medical expenses. If your parent qualifies as your dependent under the tests discussed below at (a) through (d), you can include any medical expenses you incur for your parent along with your own when determining your medical deduction. Importantly, if your parent doesn’t qualify as your dependent only because the tests at (b) and (c), below are flunked—and the tests at (a) and (d) are passed—you can still include these medical costs with your own.
Dependency tests. Even though the dependency exemption doesn’t apply for 2018–2025 (see below), the tests for dependency still apply in determining whether a taxpayer is entitled to various other tax benefits, such as head-of-household filing status (see below). To qualify: (a) you must provide more than 50% of your parent’s support costs; (b) your parent must not have gross income in excess of the exemption amount ($4,200 for 2019; $4,150 for 2018); (c) your parent must not file a joint return for the year; and (d) your parent must be a U.S. citizen or a resident of the U.S., Canada, or Mexico. Your parent can qualify as your dependent even though he or she doesn’t live with you, provided the support and other tests mentioned above are met.
Amounts you pay for qualified long-term care services required by your parent and eligible long-term care insurance premiums, discussed above, as well as amounts you pay to the nursing home for your parent’s medical care, are included in the total support you provide.
If the support test ((a) above) can only be met by a group (you and your brothers and sisters, for example, combining to support your parent), a multiple support form can be filed to grant one of you the exemption, subject to certain conditions.
Qualification for head-of-household filing status. If you aren’t married and the dependency tests are met for your parent (see “Dependency tests,” above), you may qualify for head-of-household filing status, which has a higher standard deduction and lower tax rates than the single filing status. You may be eligible to file as head of household even if the parent for whom you claim an exemption doesn’t live with you. In order to qualify for head-of-household status, generally you must have paid more than half the cost of maintaining a home for yourself and a qualifying relative for more than half the year. In the case of a parent, however, you may be eligible to file as head of household if you pay more than half the cost of maintaining a home that was the principal home for your parent for the entire year. Thus, if your parent is confined to a nursing home, you’re considered to be maintaining a principal home for your parent if you pay more than half the cost of keeping your parent in the nursing home.
Dependency exemption (suspended for tax years 2018–2025). The dependency exemption is suspended for tax years 2018–2025. For tax years after 2025, the taxpayer may be able to claim an exemption for a parent that qualifies as the taxpayer’s dependent under the tests discussed above. The deduction claimed on the return is equal to the inflation-adjusted exemption amount.
Exclusion for payments under life insurance contracts. If your parent is terminally or chronically ill and is insured under a life insurance contract, he or she may be able to receive tax-free payments (accelerated death benefits or so-called “viatical” payments) while living. Any lifetime payments received under a life insurance contract on the life of a person who is either terminally or chronically ill are excluded from gross income. A similar exclusion applies to the sale or assignment of a life insurance contract to a person who regularly buys or takes assignments of such contracts and meets other qualifying standards. These lifetime payments could be used to help pay the costs of your parent’s nursing home.