The SNAP Medical Expense Deduction for Seniors: What Counts and How to Claim It
If someone in your household is 60 or older or disabled, out-of-pocket medical costs can raise your SNAP benefit. Here is who qualifies, which costs count, what proof the office needs, and the mistakes that leave money on the table.
SNAP lets a household subtract the medical costs of any member who is 60 or older or disabled, for the part above $35 a month. The costs must be out of pocket: not paid by insurance or by someone outside the household. Medicare and other health premiums, copays, prescriptions, dentures, hearing aids, glasses, rides to medical care and in-home help all count. A bigger deduction means lower countable income, and lower countable income means a bigger SNAP benefit. You need proof of the costs when you apply.
Many older people on SNAP get less than they should because they never list their medical costs, or list only prescriptions. The deduction is in the federal SNAP rules, at 7 CFR 273.9(d)(3), so it applies in every state. The $35 threshold is written into that regulation and is the same figure USDA's own eligibility pages show for October 2026 through September 2027.
To see whether you are likely to qualify and roughly how much you would get, use our SNAP calculator. It has a box for monthly medical costs. This article explains what to put in that box, and how to prove it to your SNAP office.
Who qualifies for the medical deduction
The deduction is for medical costs of a household member who is elderly or disabled as SNAP defines those words. Elderly means 60 or older. Disabled covers people who, among other things:
- get SSI, or Social Security disability or blindness benefits
- get state disability or blindness payments based on SSI rules
- get a government disability retirement benefit for a permanent disability
- get a Railroad Retirement annuity and are eligible for Medicare or disabled under SSI rules
- are veterans rated totally disabled by VA, or found to need aid and attendance or to be permanently housebound
- are certain surviving spouses or children of veterans who get VA benefits and are considered permanently disabled
- get Medicaid based on disability, under criteria at least as strict as SSI's
Two points trip people up. First, only the elderly or disabled member's own costs count. If a 66-year-old lives with a 40-year-old son who is not disabled, the son's doctor bills do not go into the deduction. Second, you do not need everyone in the household to be 60 or older. One qualifying member is enough for that member's costs to count.
Households with an elderly or disabled member also get two other breaks in SNAP: they only have to pass the net income test, not the gross income test, and their shelter deduction has no cap. That is why the medical deduction can decide not just how much you get, but whether you qualify at all.
How the $35 rule works
Add up the qualifying member's out-of-pocket medical costs for a month. SNAP deducts everything above $35.
| Monthly out-of-pocket medical costs | Medical deduction |
|---|---|
| $30 | $0 (not over $35) |
| $35 | $0 |
| $100 | $65 |
| $250 | $215 |
There is no upper limit on the medical deduction. The amounts in this table are examples, not standard figures.
How the deduction raises your SNAP benefit
SNAP starts with your gross income and takes off a series of deductions in a set order: 20% of any earnings, the standard deduction, dependent care, child support where the state allows it, the medical deduction, and finally the excess shelter deduction. What is left is your net income.
USDA expects a household to spend about 30% of its net income on food. Your SNAP benefit is the maximum amount for your household size minus 30% of your net income. So every dollar the medical deduction removes from net income raises the benefit by about 30 cents.
For a household with high rent, the effect can be larger. The shelter deduction is the part of housing costs above half of your income after the other deductions. When the medical deduction lowers that income, half of it also goes down, so the shelter deduction goes up. The worked example below shows this.
What medical costs count
The federal regulation lists these allowable costs for the elderly or disabled member:
- Medical and dental care, including psychotherapy and rehabilitation, from a licensed practitioner or other qualified health professional. That includes copays and deductibles you pay for this care.
- Hospital and outpatient care, nursing care and nursing home care. This includes payments the household makes for someone who was a household member right before entering a hospital or nursing home.
- Prescription drugs, and over-the-counter medicines, including insulin, when a licensed practitioner or other qualified health professional has approved them.
- Medical supplies and equipment, including sick-room equipment, rentals and other prescribed equipment.
- Health insurance premiums, such as a Medigap policy, a drug plan or a Medicare Advantage plan premium.
- Medicare premiums, including a Part B premium taken out of a Social Security payment, and any Medicaid cost-sharing or spend-down amounts.
- Dentures, hearing aids and prosthetics.
- Eyeglasses prescribed by an eye doctor or an optometrist.
- A seeing eye or hearing dog, including its food and vet bills.
- Reasonable transportation and lodging to get medical treatment, such as bus fare, taxi or rideshare costs, or mileage to medical appointments.
- An attendant, homemaker, home health aide, housekeeper or child care that is needed because of age, illness or infirmity. If the household provides most of an attendant's meals, an extra amount equal to the one-person SNAP benefit is also deducted.
Medicare leaves out routine hearing aids, eyeglasses and dental care, so many seniors pay for these themselves. Those payments count here. See does Medicare cover hearing aids and what vision care Medicare pays for.
What does not count
- Special diets. The regulation excludes them, even when a doctor recommends one.
- Costs paid by insurance, Medicare, Medicaid or someone outside the household. Only the part you pay counts. If a Medicare Savings Program pays your Part B premium, that premium is not your cost.
- Costs of household members who are under 60 and not disabled.
- Policies that pay cash for a death, an injury or lost income, such as accident or dismemberment policies, or policies that keep up mortgage or loan payments while you are disabled.
- Schedule I controlled substances under federal law, and costs tied to their use.
- Over-the-counter items no practitioner has approved.
- The same cost twice. Attendant care that could count as a medical cost or as a dependent care cost can be deducted as one or the other, not both.
When insurance has not decided yet
The part of a bill that insurance will not pay still counts. If you report a cost at certification but cannot prove it yet, and the office cannot reasonably estimate it from your condition and coverage, the federal rules say the part you owe is counted once you report and verify it, for example after the insurer's explanation of benefits arrives.
Worked example
Illustration (made-up numbers, not current SNAP limits): Ruth is 72 and lives alone. After the standard deduction, her income is $1,000 a month. Her rent and utilities come to $700. Each month she pays a $40 drug plan premium, $25 in copays, $60 for prescriptions and $45 for rides to her heart doctor, for $170 in medical costs.
| Step | Without medical costs listed | With medical costs listed |
|---|---|---|
| Income after standard deduction | $1,000 | $1,000 |
| Medical deduction ($170 minus $35) | $0 | $135 |
| Income after medical deduction | $1,000 | $865 |
| Half of that income | $500 | $432.50 |
| Shelter deduction ($700 minus half of income) | $200 | $267.50 |
| Net income | $800 | $597.50 |
| 30% of net income (subtracted from the maximum benefit) | $240 | $179.25 |
Listing her medical costs cuts Ruth's net income by $202.50, not just $135, because her shelter deduction grows too. The amount subtracted from the maximum benefit drops by $60.75, so her benefit would be about $61 a month higher, or more than $700 a year. Your state's rounding rules and the current maximum and minimum benefits decide the exact figure. Run your own numbers in the SNAP calculator.
How to report and prove medical costs
Federal rules require the office to verify the amount of your medical costs, and any insurance reimbursements, before it first approves the deduction. Proof that offices commonly accept includes:
- your Social Security benefit letter or Medicare notice showing the Part B premium
- premium notices or statements for a Medigap, drug or Medicare Advantage plan
- pharmacy printouts of what you paid for prescriptions over recent months
- bills or receipts from doctors, dentists, hospitals, hearing aid and eyeglass providers
- insurance explanation of benefits forms showing what you still owe
- a note from your doctor approving an over-the-counter medicine or supply
- a log of trips to medical appointments with dates and distances, plus taxi or bus receipts
- bills or a written statement from a paid aide or home care agency
Ask your SNAP office what it will accept for each item. If you list a cost but cannot get the proof in time, the office can approve your case without that deduction. Send the proof as soon as you have it. When it arrives, the office must recalculate your benefit and pay any increase.
Costs that repeat, and one-time costs
The office sets your medical deduction for the whole certification period, based on the costs you report and verify and on changes it can reasonably expect, such as a monthly prescription or a premium. Bills that come less often than monthly, like a quarterly premium, can be averaged over the months they cover.
For a one-time cost reported during your certification period, such as new dentures, you can choose to have it deducted in a single month or spread over the remaining months. Ask which works better for you. A large one-time cost deducted in one month can raise that month's benefit sharply.
Changes during the year and at recertification
You do not have to report changes in medical costs during your certification period. You can choose to. If a new cost would raise your benefit, the office will ask for proof, either before acting or before your second monthly payment after the change. If you report a drop in costs, the office acts on it without asking for proof.
At recertification you report and verify your medical costs again. The office has to re-check costs you have not reported before and any recurring costs that changed by more than $25. Recurring costs that changed by $25 or less do not need new proof unless the information is incomplete or unclear.
Standard medical deduction states
Some states have USDA approval to run a standard medical deduction (SMD) demonstration project. In those states, a qualifying household gets a set medical deduction instead of having every bill added up, which makes proof simpler. USDA lists the SMD as one of the demonstration projects states can request.
Which states use an SMD, the dollar amount, and the proof they need are decided state by state and change over time, so we do not list them here. Ask your SNAP office three questions: does my state have a standard medical deduction, what proof do I need for it, and can I claim my actual costs if they are higher? USDA's SNAP State Directory of Resources lists every state agency.
Common mistakes
- Leaving out the Medicare premium. It is often the largest monthly medical cost, and it is easy to forget because it comes out of the Social Security payment.
- Forgetting transportation. Reasonable costs of rides and mileage to doctors, dialysis and therapy count.
- Assuming over-the-counter items never count. They can, with a practitioner's approval.
- Skipping the deduction because the costs seem small. Anything above $35 a month helps.
- Not reporting a big new cost. Reporting is optional during the year, but if you start paying for an aide or buy hearing aids, telling the office can raise your benefit.
- Counting a cost someone else pays. If a Medicare Savings Program, Extra Help or a relative outside the household pays it, it is not your cost. Check the Medicare Savings Program calculator and the Extra Help calculator anyway: help with premiums and drug costs may be worth more than the deduction it replaces.
Where to get help
- Our guide on how to apply for SNAP covers the application, the interview waiver many older households can ask for, and the 30-day deadline.
- Your Area Agency on Aging can help gather documents, and a legal aid office can help if you think the deduction was left out of your benefit.
- SNAP can be combined with other food help. See senior food programs beyond SNAP.
Frequently Asked Questions
Who can get the SNAP medical expense deduction?
Any SNAP household with a member who is 60 or older or who counts as disabled under SNAP rules, for example because they get SSI, Social Security disability, a VA rating of total disability, or Medicaid based on disability. Only that member's medical costs count, not those of younger, non-disabled people in the household.
How does the $35 rule work?
Add up the elderly or disabled member's out-of-pocket medical costs for the month. SNAP deducts the part above $35. If the costs are $135 a month, the deduction is $100. If they are $35 or less, there is no deduction.
Does my Medicare premium count as a medical expense for SNAP?
Yes. Medicare premiums are on the federal list of allowable medical costs, along with other health insurance premiums. If a Medicare Savings Program or anyone outside your household pays a premium for you, that premium is not your cost and does not count.
Do I have to report every new medical bill during the year?
No. Federal rules say a household does not have to report changes in medical expenses during its certification period. You can choose to report a new or higher cost, and if it would raise your benefit, the office will ask for proof. At recertification you report and verify your medical expenses again.
What is a standard medical deduction?
Some states run a USDA-approved demonstration project that gives qualifying households a set medical deduction instead of adding up every bill. Whether your state has one, the amount, and what proof it needs are set by the state, so ask your SNAP office.
This article explains the federal SNAP medical expense deduction as of October 2026. Examples marked as illustrations use made-up numbers, not current SNAP limits. States set their own procedures, proof requirements and any standard medical deduction. This is general educational information, not a benefits determination. See our disclaimer. Your state SNAP agency decides your benefit.