Which specific medical transportation costs are deductible and how to calculate the IRS medical mileage deduction for 2026?

1. What counts as deductible medical transportation — the IRS definition and scope

Deductible transportation costs are those primarily for and essential to medical care: driving to and from doctors, hospitals, dentists, therapists, and other medically necessary appointments — transportation that the IRS treats as a medical expense under §213; Publication 502 explains that car-related out‑of‑pocket costs (or the standard rate) and related items like tolls and parking can be included with other medical expenses ^[3]. The IRS and its 2026 standard‑mileage notice make clear the medical/moving rate applies to “medical purposes” and “necessary medical care,” while noting some moving deductions remain suspended except for qualifying military/intelligence situations ^[5][2].

2. What specific vehicle costs are deductible (standard rate vs. actual expenses)

Taxpayers may choose the IRS’s optional standard mileage method — multiplying medical miles by the medical rate — or, in limited situations, add actual out‑of‑pocket car expenses; Publication 502 sets out that you can include gas and oil or use the standard rate, while excluding items such as depreciation, insurance, general repairs and maintenance if using the standard rate calculation ^[3]. The standard‑rate approach simplifies recordkeeping and is often preferable for routine trips, whereas the actual‑expense method requires detailed receipts and allocation rules ^[3][4].

3. The 2026 medical mileage rate and how it was set

For miles driven in 2026 the IRS published an optional standard medical/moving mileage rate of 20.5 cents per mile — down a half‑cent from 2025 — and noted that the medical/moving rates are computed from variable vehicle costs in the agency’s study ^[1][6]. The rate is effective for deductible transportation expenses paid or incurred on or after Jan. 1, 2026, as formalized in Notice 2026‑10 ^[2][5].

4. Step‑by‑step calculation for 2026 medical mileage

Track and document the miles driven solely for qualifying medical care, then multiply total medical miles by $0.205 to get the deductible mileage amount (Miles × $0.205 = deduction) ^[6][7]. Add out‑of‑pocket parking fees and tolls to that mileage figure (Publication 502 gives examples adding tolls/parking to mileage totals) and subtract any reimbursements received; if the reimbursement equals or exceeds the expense, there’s no deduction for those amounts ^[3][4].

5. Filing mechanics, limits and important caveats

Medical transportation deductions are part of overall medical expenses that are claimed with other qualifying medical costs—generally claimed on Schedule A when itemizing—and are subject to the usual rules about reimbursements and which taxpayers itemize ^[3]. Recent law changes and IRS guidance remind taxpayers that many unreimbursed employee travel expenses are disallowed as miscellaneous itemized deductions (the OBBBA changes), so employees should not assume workplace travel qualifies unless specific exceptions apply ^[2][5]. For some groups (eligible educators, certain reservists, qualifying performers, and some military personnel) there are nuanced rules or alternative adjustments referenced in Notice 2026‑10 ^[2].

6. Practical recordkeeping and decision points

Because the IRS allows either the standard mileage rate or actual expenses, taxpayers should keep contemporaneous mileage logs, appointment records, and receipts for parking and tolls to substantiate deductions; third‑party guidance and tax‑prep resources emphasize the simplicity of the Miles × Rate method but also stress retaining documentation in case of audit ^[4][7]. Taxpayers uncertain which method yields a larger deduction should calculate both approaches for the year and consult Publication 502 and Notice 2026‑10 for the detailed rules ^[3][2].