Year-end planning for medical expense claims

While our health care system is currently struggling with a number of significant problems, Canadians are nonetheless fortunate to have a publicly funded health care system, in which most major medical expenses are covered by government health care plans. Notwithstanding, there is a large (and growing) number of medical and para-medical costs – including dental care, prescription drugs, physiotherapy, ambulance trips, and many others – which must be paid for on an out-of-pocket basis by the individual. In some cases, such costs are covered by private insurance, usually provided by an employer, but not everyone benefits from private health care coverage. Self-employed individuals, those working on contract, or those whose income comes from several part-time jobs do not usually have access to such private insurance coverage. Fortunately for those individuals, our tax system acts to help cushion the blow by providing a medical expense tax credit to help offset out-of-pocket medical and para-medical costs which must be incurred.

The bad news for such individuals is that while a tax credit is available, the computation of eligible expenses and, in particular, determining when a claim for the credit should be made can be confusing. In addition, the determination of which expenses qualify for the credit and which do not isn’t necessarily intuitive, nor is the determination of when it’s necessary to obtain prior authorization from a medical professional in order to ensure that the planned expenditure will qualify for the credit. For instance, in order to claim the medical expense tax credit for the cost of a cane or a walker, it is necessary to obtain a prescription for that cane or walker from a medical professional. However, where costs are incurred to purchase a wheelchair, those costs are eligible for the medical expense credit, with no requirement that a prescription of any kind be obtained.

The basic rule is that the total cost of qualifying medical expenses (a lengthy list of which can be found on the Canada Revenue Agency website at which exceed 3% of the taxpayer’s net income, or $2,635, whichever is less, can be claimed for purposes of the medical expense tax credit on the taxpayer’s return for 2023.

Put in more practical terms, the rule for 2023 is that any taxpayer whose net income is less than $87,835 will be entitled to claim medical expenses that are greater than 3% of their net income for the year. Those having income of $87,835 or more will be limited to claiming qualifying expenses which exceed the $2,635 threshold.

The other aspect of the medical expense tax credit which can cause some confusion is that it’s possible to claim medical expenses which were incurred prior to the current tax year but weren’t claimed on the return for the year that the expenditure was made. The actual rule is that the taxpayer can claim qualifying medical expenses incurred during any 12-month period which ends in the current tax year, meaning that each taxpayer must determine which 12-month period ending in 2023 will produce the greatest amount eligible for the credit. That determination will obviously depend on when medical expenses were incurred so there is, unfortunately, no universal rule of thumb which can be used.

Medical expenses incurred by family members – the taxpayer, their spouse, and children who are under the age of 18 at the end of 2023, as well as certain other dependent relatives – can be added together and claimed by one member of the family. In most cases, it’s best, in order to maximize the amount claimable, to make that claim on the tax return of the lower-income spouse, where that spouse has tax payable for the year equal to at least the amount of the medical expense tax credit to be claimed.

As the end of the calendar year approaches, it’s a good idea to add up the medical expenses which have been incurred during 2023, as well as those paid during 2022 and not claimed on the 2022 return. Once those totals are known, it will be easier to determine whether to make a claim for 2023 or to wait and claim 2023 expenses on the return for 2024. And, if the decision is to make a claim for 2023, knowing what medical expenses were paid, and when, will enable the taxpayer to determine the optimal 12-month period for that claim.

Finally, it’s a good idea to look into the timing of medical expenses which will have to be paid early in 2024. Where those are significant expenses (for instance, a particularly costly medication which must be taken on an ongoing basis, or some expensive dental work) it may make sense, where possible, to accelerate the payment of those expenses to November or December 2023, where that means they can be included in 2023 totals and claimed on the return for this year.