Which costs count as medical expenses?

Deductible items include prescription co-payments, out-of-pocket amounts for dental work, glasses, hearing aids, alternative medicine (with a prescription), physiotherapy, transport to doctors (€0.30/km), and medically necessary cures. Not deductible: cosmetic surgery without medical need, wellness/spa, or over-the-counter supplements without a prescription.

Is a professional dental cleaning deductible?

Yes, in principle — but only with a medical recommendation or prescription. Pure hygiene cleaning without documented medical indication is often rejected. A written recommendation from your dentist in the treatment plan or on the invoice significantly improves your chances.

Is it worth bundling dental appointments into one calendar year?

Yes — this is one of the single most effective strategies. Because the zumutbare Belastung resets every year, bundling planned costs (second treatment step, glasses, physio) into the same year means you only have to clear the threshold once. Every euro beyond that is directly deductible.

How does the disability lump-sum work?

With a recognised degree of disability (GdB) from 20 onwards, you can use a flat-rate deduction (Behindertenpauschbetrag) instead of itemising medical costs: from €384 (GdB 20) to €2,840 (GdB 100). The lump sum is deducted without the zumutbare Belastung — usually simpler and often more favourable than itemising.

Medical Expense Tax Deduction in Germany 2026

Q: What is the 'zumutbare Belastung' (reasonable burden)?

It's the portion of medical costs you must bear yourself before anything becomes deductible. Between 1% and 7% of your total income, staged by income bracket and family status. Since the 2017 federal tax court ruling, the threshold is applied in steps — not flat on your whole income, which saves most taxpayers several hundred euros compared with the old linear calculation.

You paid €3,000 out of pocket for a dental implant this year. Plus €450 for glasses, €200 in prescription costs, €80 driving to the physio. That’s €3,730 you’ve spent on health — and now the question: how much of it is actually deductible? The answer hinges on a number the Finanzamt calls the zumutbare Belastung (reasonable burden), and getting it right is the whole game.

In short: Medical costs are extraordinary expenses (außergewöhnliche Belastungen) under §33 EStG. Deductible only to the extent they exceed your personal zumutbare Belastung — between 1% and 7% of your income depending on bracket and family status. Since the 2017 federal tax court ruling, the threshold is calculated in stages, not flat — which saves most taxpayers a few hundred euros.

Why is there a threshold at all?

German tax law says: medical costs are part of everyday life up to a certain amount. Only exceptional costs should provide tax relief. So every medical-cost claim is first reduced by your personal zumutbare Belastung (§33 Abs. 3 EStG).

Only the amount above the threshold lowers your taxable income.

The 2026 thresholds

Your zumutbare Belastung depends on two things: your total income and your family status.

Annual income	Single	Married	1–2 kids	3+ kids
up to €15,340	5%	4%	2%	1%
€15,341 – €51,130	6%	5%	3%	1%
above €51,130	7%	6%	4%	2%

Since the 2017 federal court ruling (BFH VI R 75/14), the brackets are applied in steps, not as a flat percentage on your whole income. That’s where most people save money without realising it.

Old (wrong, but still widely assumed)

Single, €40,000: 6% × €40,000 = €2,400 threshold.

New (correct, step by step)

Single, €40,000:

5% on the first €15,340 = €767
6% on €15,341 – €40,000 (€24,660) = €1,480
Threshold: €2,247 — roughly €150 lower

That €150 drops directly into your deductible amount.

Worked example: when it pays off

Franziska, 45, employee, married without children, total income €55,000. In 2026:

Item	Cost
Dental implant (out-of-pocket)	€3,000
Prescriptions + glasses	€400
Physiotherapy (on prescription)	€350
Transport to doctors	€80
Total	€3,830

Zumutbare Belastung (married, €55,000):

4% on €15,340 = €614
5% on €15,341 – €51,130 (€35,790) = €1,790
6% on €51,131 – €55,000 (€3,870) = €232
Threshold: €2,636

Deductible: €3,830 − €2,636 = €1,194.

At a 40% marginal rate: about €478 in tax saving.

What’s actually deductible?

The Finanzamt’s rule: medically necessary and documented.

✅ Clearly deductible

Co-payments on prescriptions, hospital, rehab, aids
Out-of-pocket amounts above statutory exemption limits (GKV/PKV)
Dental implants, crowns, bridges, orthodontics
Glasses, contact lenses, hearing aids (out-of-pocket after insurance)
Alternative medicine with a prescription: Heilpraktiker, osteopathy, TCM, acupuncture
Medication: prescription always; over-the-counter only with a medical prescription
Transport to doctors, therapy, cures — €0.30/km + parking

❌ Not deductible

Cosmetic surgery without medical indication
Wellness, spa, gym (unless rehab prescribed)
Supplements without prescription/certificate
Self-medication from the drugstore (headache pills, etc.)
Private supplementary insurance premiums (separate category: Vorsorgeaufwendungen)
Smoking cessation, weight-loss programs without a medical certificate

Tip: If you use alternative medicine (osteopath, acupuncture), always get a prescription from your regular doctor first. Without it: no deduction. With it: fully deductible. The 5-minute ask at the GP’s office often delivers €100+ in tax savings.

The dental hack: bundle costs into one year

Because the threshold resets every year, it almost always pays off to bundle planned costs into the same calendar year.

Bad strategy: split across two years

2026: First dental treatment €1,800 → below €2,636 threshold → €0 deductible
2027: Second dental treatment €1,800 → below threshold again → €0 deductible
Total: €0

Good strategy: do teeth in one year

2026: Both treatments + glasses + physio = €3,800
Threshold €2,636
Deductible: €1,164
At 40% marginal rate: about €466 back

Same money spent, ~€450 more in your pocket. A single ask to your dentist whether the second treatment can be pulled forward is often enough.

Transport: often forgotten, easily €100

If you regularly travel to doctors, therapy, or rehab, transport costs count:

€0.30 per km (round trip)
Plus parking, public-transport tickets, taxi when medically necessary
Occasional doctor visits: yes, but most Finanzämter accept this only for longer-running treatment

At weekly physio, 20 km per visit, 30 visits a year: 20 × 2 × €0.30 × 30 = €360 — often the difference between “below threshold” and “deductible”.

Medical costs vs. disability lump sum

With a recognised degree of disability (GdB), you have an alternative: the Behindertenpauschbetrag.

GdB	Annual lump sum 2026
20	€384
30	€620
40	€860
50	€1,140
60	€1,440
70	€1,780
80	€2,120
90	€2,460
100	€2,840

The lump sum applies without the zumutbare Belastung, and it’s almost always the simpler choice. Itemising can pay off only for people with very high actual costs — but you can’t combine the two.

Where to enter it on your tax return

Everything goes into the Anlage Außergewöhnliche Belastungen (extraordinary expenses):

Line “Krankheitskosten” — total sum (don’t submit receipts, keep for 7 years)
Line “Fahrtkosten” — separate entry or rolled into total
The Finanzamt automatically applies the zumutbare Belastung

Documents to keep:

Dentist, doctor, and therapist invoices
Insurance statements (showing the out-of-pocket amount)
Bank or credit card statements
Prescriptions for alternative medicine and over-the-counter drugs
Mileage log or list of appointments + distances

Common mistakes

Claimed without a prescription. Heilpraktiker, osteopath, over-the-counter meds: nothing without a doctor’s note.
Linear threshold calculation. Old = 6% × 40k = €2,400; correct (stepwise) = €2,247. Most tools calculate correctly, but manual math often gets it wrong.
Costs split across two years. Classic dental scenario. Always bundle.
Private supplementary insurance on the wrong line. Premiums belong under Vorsorgeaufwendungen (§10), not extraordinary expenses.
Wellness vs. cure confusion. A cure is only deductible with prescription AND insurance subsidy. Personal wellness trips are not.
Transport ignored. For chronic conditions, €200–€500 in deductions are often missed here.

How Restio helps

Medical expenses are the textbook “I didn’t think it was worth it” item — exactly why millions of Germans give up tax refunds every year. Restio does the maths for you:

Live threshold calculator — enter your income and family status, Restio shows your exact zumutbare Belastung — stepwise, not linear.
Receipt scanner — snap a photo of your dentist, pharmacy, or physio receipt. Restio categorises and totals it through the year.
Bundling tip — if you’re at €1,800 by late November and have planned costs (glasses, dental), Restio shows whether pulling them into December pays off and how much tax it saves.
Instant answers — “Is my osteopath deductible?”, “Does professional dental cleaning count?”, “Transport to physio — how?” — in English or German, in seconds.

The threshold isn’t a dealbreaker. With the right bundling and a few quick decisions, you pull several hundred euros back that would otherwise disappear.