Who can claim medical expenses as exceptional costs?
Anyone who can provide evidence of medical expenses can also declare them in their tax return. You will need a receipt, an invoice and, in some cases, a medical certificate. It does not matter whether you incurred the expense for your own illness, for your spouse's illness or for a child for whom you are entitled to child benefit. What counts is the date you paid the invoice, not the date the invoice was due.
If you have medical expenses related to a commuting accident or a work accident, you should declare them as income-related expenses or business expenses. This also applies to costs incurred due to an occupational illness or retraining due to illness. The advantage is that in this case a reasonable burden is not deducted.
Who can claim medical expenses as exceptional costs?
What are medical remedies?
Remedies or therapeutic methods are intended to cure diseases or prevent the worsening of symptoms. A remedy generally refers to therapies and treatments such as:
- massages,
- physiotherapy or exercise therapy,
- speech therapy measures or
- occupational therapy.
What are medical remedies?
What medical expenses can I deduct?
Medical expenses can be deducted without limit as extraordinary expenses in the tax return. However, the tax office deducts a reasonable personal contribution, which ranges from 1% to 7% of annual income, depending on income, marital status, and number of children. Reimbursements from health insurance or other insurance must be deducted from the expenses.
Deductible medical expenses:
- Medical treatment
- Spa treatments, physiotherapy
- Care services
- Alternative practitioners or homeopaths
- Medications and pharmacy co-payments
- Medical aids
- Hospital stays
- Travel expenses to doctor, hospital, physiotherapy, etc.
Travel expenses:
- Public transport: Actual costs can be deducted; tickets should be kept.
- Own car: A flat rate of 0.30 Euro per kilometre can be claimed.
Costs for dental prostheses or a medically prescribed cure are also deductible. Not deductible are expenses for hospital visits or preventive measures such as diets or massages for relaxation.
Bonus programmes and reimbursements
Many statutory health insurance companies offer bonus programmes under § 65a SGB V for health-conscious behaviour. These bonus payments do not reduce the special expenses deduction for health insurance contributions, as they do not constitute premium refunds (BFH ruling of 1.6.2016, X R 17/15; BFH ruling of 6.5.2020, X R 16/18).
Examples include premiums for preventive medical check-ups, vaccinations, or sporting activities. Bonuses for family-insured members are credited to the main insured person.
- Premium refunds reduce the special expenses deduction, e.g. premiums under § 53 SGB V for participation in general practitioner-centred care.
- Bonus payments for measures outside basic health insurance cover, such as osteopathy or gym memberships, are not considered refunds and do not reduce the special expenses deduction.
Tips:
- Bonus payments up to 150 Euro per person do not reduce the special expenses deduction. If the bonus exceeds this amount, the excess must be counted as a premium refund.
- Check the tax assessment notice: Sometimes bonus programmes are not reported correctly by the health insurance company. Therefore, check the values applied.
- Private health insurance: Bonus payments from private health insurance to promote cost-conscious behaviour reduce the special expenses deduction if they are paid regardless of financial expenditure incurred.
What medical expenses can I deduct?
How do I provide evidence of medical expenses?
You must provide evidence of expenses for medication, remedies, and other medical costs with receipts. The tax office also requires proof that the medication or treatment is medically necessary. You usually need a doctor's prescription for this. If you have a chronic illness, presenting the medical certificate once is usually sufficient. If your ophthalmologist has prescribed glasses for you once, a confirmation from the optician is sufficient for the necessity of expenses for further glasses.
As soon as you have a medical certificate from your doctor recommending a specific measure or medication, collect the receipts. Only at the end of the year will you know the total amount of your expenses for remedies and treatments. Medical costs, together with expenses for other general extraordinary burdens, form a sum. You can then use our overview to calculate whether it is worthwhile to include them in your tax return, as the tax office deducts your reasonable personal contribution from the actual expenses. Only the amount that exceeds the reasonable burden has a tax-reducing effect.
In certain cases, the medical necessity must be proven by a certificate from the public health officer or a statement from the Medical Service of the Health Insurance. It is important that this proof is obtained before the start of the treatment or before purchasing the medical remedy. This strict proof is required in the following cases:
- Bath or spa treatment; in the case of a preventive spa treatment, the risk of an illness to be averted by the treatment, in the case of a climate treatment, the medically indicated spa location and the expected duration of the treatment must also be certified,
- psychotherapeutic treatment,
- medically necessary accommodation away from home for a child of the taxpayer suffering from dyslexia or another disability,
- necessity of care for the taxpayer by an accompanying person, unless this is already evident from the severely disabled person's pass,
- medical aids considered to be general everyday items,
- scientifically unrecognised treatment methods, such as fresh and dry cell treatments, oxygen, chelation, and autologous blood therapy.
The certificate must contain sufficiently specific information about the spa location in accordance with § 64 para. 1 sentence 1 no. 2a EStDV. The statement "in a tropical climate" alone is not sufficient to determine the spa location. The certificate must show that the taxpayer is ill and that a stay at a specific spa location for a certain period is medically indicated. The public health officer must specify in their statement where exactly a climate treatment is medically indicated due to the existing conditions (FG Münster, judgement of 23.2.2022, 7 K 2261/20 E).
The Federal Fiscal Court has recently ruled in favour of taxpayers that expenses for liposuction to treat lipoedema are deductible, and from 2016 onwards, they can be considered as extraordinary burdens without the need for a medical report from the public health officer or a medical certificate from the Medical Service of the Health Insurance before the operations (BFH judgement of 23.3.2023, VI R 39/20).
How do I provide evidence of medical expenses?
