Detailed analysis of the list of medical expenses deductible in the 2026 income tax and what cannot be included

The Personal Income Tax (IRPF) declaration has the deduction of medical expenses as one of its most sensitive and advantageous mechanisms for the taxpayer. Unlike education expenses, which have a ceiling pre-established by the Federal Revenue Service, health expenses can be deducted in full from the tax calculation base, as long as they are duly proven. However, this lack of limits makes this category the main focus of inspection of fine mesh. For the 2026 financial year (referring to the calendar year 2025), understanding exactly what makes up the list of deductible medical expenses and what must be excluded is essential to guarantee tax efficiency and avoid sanctions.

How deduction works in the complete model

In order for the taxpayer to benefit from the tax deduction generated by medical expenses, it is mandatory to opt for the complete model of taxation at the time of sending the declaration. In the simplified model, a standard 20% discount is applied to taxable income (limited to a fixed amount), which negates the need and benefit of itemizing specific expenses.

In the complete model, the tax logic operates by reducing the calculation base on which the tax rate will apply. The system cross-references the information provided by the taxpayer with the DMED (Declaration of Medical and Health Services), sent by service providers (doctors, clinics and hospitals). Therefore, the supporting documentation — invoices and receipts containing the provider’s and beneficiary’s CPF/CNPJ — is not just a formality, but the legal basis of the operation.

The deduction includes expenses incurred for the benefit of the taxpayer himself and his dependents or support (in the latter case, only if provided for in a court decision or public deed). It is crucial to note that any reimbursement received from health plans must be subtracted from the declared amount, under penalty of tax infraction.

List of tax-deductible medical expenses 2026

Brazilian tax legislation, governed by the Income Tax Regulation (RIR), defines a specific scope of accepted services and procedures. Below, the list of deductible medical expenses for the 2026 cycle is detailed:

• Consultations and professional fees: Payments made to doctors of any specialty, dentists, psychologists, physiotherapists, occupational therapists and speech therapists.
• Health establishments: Expenses for hospitals, clinics and clinical and radiological analysis laboratories.
• Health plans: Monthly fees for medical and dental assistance plans, as well as co-participation in exams and consultations.
• Laboratory and radiological examinations: It ranges from routine blood tests to highly complex procedures such as MRIs and CT scans.
• Orthopedic devices and prosthetics: Mechanical legs and arms, wheelchairs, walkers and insoles or orthopedic shoes, as long as they are proven with a medical prescription and invoice.
• Dental prosthetics: The placement and maintenance of orthodontic appliances and dentures are deductible, as long as the invoice is issued by the dentist or clinic (does not cover the direct purchase of the material by the patient without the attached service).
• Plastic surgeries: Aesthetic or restorative procedures are fully deductible if carried out in a hospital environment and charged by a medical establishment or qualified professional, with the exception of expenses for silicone prostheses if these are not included in the hospital bill.
• Medical expenses abroad: Payments made to doctors and hospitals outside Brazil are accepted, requiring the conversion of amounts into US dollars and, later, into reais, using the Central Bank exchange rate.
• In vitro fertilization: Allowed as a deductible medical expense if incurred in the name of the patient (taxpayer or dependent).
• Pacemaker and intraocular lenses: Deductible when the amount is integrated into the hospital bill or professional invoice.

What cannot be included and regulatory limitations

The main source of errors that leads taxpayers into fine-graining is the inclusion of health-related expenses that, for tax purposes, are not considered deductible medical expenses. The distinction between “health expenses” and “deductible medical expenses” is technical and restrictive.

The items below configure what cannot include in the statement:

• Pharmacy medicines: The purchase of medicines, even those for continuous use and with a prescription, is not deductible if purchased in pharmacies. The exception only occurs if the medication is included in the hospital bill for an inpatient stay.
• Nurses and masseuses: Nursing and massage services are not deductible unless they are part of the hospital bill. Home care is only accepted if it is included in the bill of a hospital or health plan.
• Glasses and contact lenses: The purchase of prescription glasses, contact lenses and hearing aids does not generate tax relief.
• Vaccines: Vaccines administered in private clinics are generally not deductible, unless the clinic issues an invoice as “medical services” or “hospital”. Purchasing the vaccine at a pharmacy is non-deductible.
• Nutritionists (restriction): Consultation with a nutritionist is deductible. However, purchasing dietary supplements recommended by this professional is not.
• Gym and swimming: Expenses on physical activities, even if prescribed by doctors for rehabilitation, are not deductible.
• DNA Test: DNA tests for paternity investigation are not considered medical expenses for IRPF purposes.
• Veterinarian: Pet medical expenses are not deductible.

Frequently asked questions about medical expenses and IRPF

1. Is there an amount limit for deducting medical expenses?

No. Unlike education expenses, medical expenses can be deducted in full, as long as they are duly proven and the taxpayer opts for the full taxation model.

2. Does health insurance reimbursement affect the deductible?

Yes. The taxpayer must declare the total amount paid and, in the specific field, inform the amount reimbursed (“Non-deductible portion”). Only the difference between what was paid and what was refunded will be used to deduct the tax.

3. Can I deduct expenses for elderly people in nursing homes?

Only if the institution is classified as a hospital and issues an invoice with that specific classification. Nursing homes that only offer accommodation and basic care, without a hospital framework, do not generate deductible expenses.

4. Is Covid-19 testing deductible?

If carried out in a clinical analysis laboratory or hospital, yes. Rapid tests purchased at pharmacies (self-test) are not deductible.

The correct segregation between deductible and non-deductible expenses is a pillar of individual tax planning. While the list of tax-deductible medical expenses in 2026 offers significant opportunities for tax recovery, the improper inclusion of prohibited items — such as pharmacy medications or gym memberships — substantially increases audit risk. It is recommended that all tax receipts be kept for a minimum period of five years from the date of submission of the declaration.

Disclaimer: The information contained in this article is for informational and educational purposes only, based on the legislation in force at the date of publication. Tax rules may change. It is recommended to consult a qualified meter or tax auditor to analyze specific cases.