What are the 2026 state-by-state differences in AGI thresholds for deducting medical expenses?
Executive summary
The federal floor for deducting unreimbursed medical and dental expenses remains 7.5% of adjusted gross income (AGI) for 2026 — a permanent threshold under current law [1] [2] [3]. The reporting provided is focused on federal rules and guidance from the IRS and tax-preparation firms; it does not include a state-by-state table of differing AGI thresholds, so a precise, sourced state-by-state breakdown cannot be produced from these materials alone [1] [2] [4].
1. Federal baseline: the 7.5% AGI floor is the starting point
For taxpayers itemizing on Schedule A, the IRS allows deduction of medical and dental expenses only to the extent those unreimbursed expenses exceed 7.5% of AGI — a standard reiterated in IRS Topic No. 502 and Publication 502 [1] [2]. Multiple tax guides and preparer notes published for 2025–2026 echo that federal rule, noting that the Consolidated Appropriations Act of 2021 made the 7.5% floor permanent, removing prior year-to-year uncertainty [3] [5].
2. Why the state-by-state question matters — and why it’s not answered here
State income tax systems sometimes "conform" to federal definitions, and sometimes they do not; that means state tax treatment of medical deductions can diverge from the federal rule. The material supplied for this analysis is centered on federal guidance and private tax-advice pieces that explain the 7.5% AGI federal threshold and planning strategies; those sources do not present a state-by-state comparison or list of exceptions, so a verified state-level matrix cannot be drawn from them [1] [2] [6] [4].
3. Practical federal implications frequently cited by tax professionals
High out-of-pocket medical costs can trigger itemization opportunities under the 7.5% rule, but practitioners warn that the elevated standard deduction makes itemizing less common, so medical deductions matter mainly in cases of catastrophic or concentrated expenses [6] [4]. Advisory firms and CPAs counsel strategies such as "bunching" expenses into a single tax year and reviewing timing of elective procedures to maximize the chance of crossing the 7.5% threshold, advice repeated across CPA notes, software tax-help pages, and planning guides [6] [7] [8].
4. High-income interactions and recent legislative context
Beyond the 7.5% rule, recent legislation and administrative changes can affect the net value of itemized deductions for high-income taxpayers; for example, rules enacted under the 2025–2026 tax code changes can limit allowable itemized deductions for top-bracket taxpayers, which may reduce the benefit of clearing the medical-expense floor [9]. Analysts therefore caution that meeting the 7.5% test is necessary but not always sufficient to realize a tax benefit if other limits or phase-downs apply [9] [7].
5. Limits of available reporting and recommended next steps
The supplied reporting reliably establishes the federal 7.5% AGI threshold and common planning guidance from commercial tax advisers and IRS publications [1] [2] [6] [4], but it contains no sourced list of state-level AGI floors or specific state departures from federal conformity; producing an accurate state-by-state comparison would require consulting each state tax authority, state statutes, or a comprehensive, up-to-date database of state conformity rules that is not included here [1] [2]. For a complete state-by-state answer, direct references should be fetched from state revenue department guidance or a specialized tax research service; until those are examined, any attempt to enumerate differences would be unsupported by the materials provided.