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First, I know about the 7.5% AGI floor for medical deductions in 2018 (scheduled to go to 10% of AGI in 2019). We are above the 7.5% AGI floor.

Our doc has recently transferred to a concierge practice. The monthly fee covers everything he will do for us, including house visits at any hour (yes, I am sure of this). Of course, things he doesn't do such as major surgery, would be billed as usual through our insurance (you would be surprised at some of the things that are called surgery, that could be done in his office, and would be covered by his monthly fee).

My question: Is all of our fee deductible or do I have to estimate the value of the services he actually provides and deduct only that amount?

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I looked into this a few years ago when a doctor that I was using decided to convert to a concierge practice. From what I could find, the answer was a bit murky.

Not all medical expenses are deductible (eg. cosmetic) so if your concierge doctor is performing them, it may be flagged. From what I found, the concierge fee is deductible if legitimate services are being performed but may not be deductible if all you are paying for is access.

Tax law changes all of the time so the short answer is consult with a competent accountant.

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    +1 Thanks, but it is still unclear whether one legitimate service, e.g., a physical exam, validates the entire fee for IRS purposes, or only that portion of the fee equal to the reasonable cost of the exam. As you say, it is murky. – ab2 ReinstateMonicaNow Sep 13 '18 at 13:03
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    Sorry but I can't clarify it for you. If you read various web explanations, they say that all legitimate medical services are deductible regardless of how you pay for them (traditional insurance versus concierge fee). But none of them break it down and detail when all, some or none of the concierge fee is tax deductible. Give the IRS a call. Visit free tax web sites like Turbo Tax and H&R Block. If you find an answer, plz share. – Bob Baerker Sep 13 '18 at 13:25
  • I'll ask the concierge medical office first -- they have been in business for about 15 years. – ab2 ReinstateMonicaNow Sep 13 '18 at 18:50
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The answer appears to be that you can deduct your doctor's concierge medical fee in toto, provided you are paying for services that would be deductible in any case, and are not paying merely for access.

This answer is based on a source that I quote from below, and also from my (very reputable) CPA's acceptance of my list of medical expenses, which included the concierge fee in total, which was large enough that there was no conceivable way that the CPA could have not noticed it. I realize that this paragraph is not a 100% definitive answer, but, combined with the next part of my answer, it is surely enough to proceed on.

This Source says:

Deducting the retainer [earlier the Source called it the concierge fee] itself plunges you into murkier waters. The IRS says retainers may be deductible -- or a legitimate expense for a health savings account -- depending on what you get for your money. If your fee pays for you to get a physical once or twice a year, plus ready access in emergencies, then you're paying for deductible services and the retainer is also deductible. If all you get is access -- the fee doesn't pay for any services -- there's no write-off. If part of the fee is for services, that part is deductible. (Emphases Added.)

Of course, the head-scratcher is the last sentence:

If part of the fee is for services, that part is deductible.

It could be argued that if part of the fee is for services, then part of the fee is for access and that part is not deductible (except for access in emergencies). But almost anything can be (and often is) argued.

I argue that if the practice does not specify what part of the fee is for non-emergency access, then I have no basis to not deduct that part.

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