Medical expense credit

Legislative history

The medical expense deduction was introduced in the 1942 budget; this page traces the provision from its conversion to a credit in the 1987 tax reform. The 1988 Act carried the existing list of expenses, including the travel rules with their 40 km and 80 km thresholds and three conditions, from former paragraph 110(1)(c) into subsection 118.2(2) without change of substance, and almost every amendment since has added to the list or adjusted the formula; the travel paragraphs themselves have been altered only twice, in 1991 to let a patient who travels alone claim under paragraph (h), and in 2013 to require the attendant certificate in writing. The Justice Laws consolidation lists twenty amendments after 1985 and serves fourteen point-in-time versions, from 31 August 2004 to 20 June 2024. What follows is drawn from what was digitally available on Justice Laws, on parl.ca, on publications.gc.ca, and in the Library of Parliament’s historical bills and journals; where only a bill was available, and not the enacted statute, that is said. Once the Statutes of Canada volumes for 1988 and 1990 and the Department of Finance notes for the amendments of 1992 to 2008 can be examined, this history will be updated.

• Before 1988: paragraph 110(1)(c). The deduction allowed medical expenses in excess of three per cent of income. Its subparagraph (viii.1) already allowed payments “to a person engaged in the business of providing transportation services” for the patient and one accompanying individual certified as needed, “from the locality where the patient was dwelling to a place, not less than 40 kilometres from that locality, where medical services are normally provided”, if “substantially equivalent medical services were not available in that locality”, “the route travelled by the patient was, having regard to the circumstances, a reasonably direct route”, and “the patient travelled to that place to obtain medical services for himself and it was reasonable, having regard to the circumstances, for the patient to travel to that place to obtain those services”; subparagraph (viii.2) allowed “reasonable travelling expenses” where the place was not less than 80 kilometres away. Practitioners had to be “qualified to practise under the laws of the place where the expenses were incurred”, the origin of the place-of-service rule now in subsection 118.4(2). The text is taken from the explanatory notes to Bill C-139; the Act that first enacted the travel subparagraphs was not identified.
• S.C. 1988, c. 55, s. 92 (Bill C-139, royal assent 13 September 1988). The 1987 tax reform converted the deduction to a credit at 17 per cent of expenses above the lesser of three per cent of income and $1,500, “to give equal tax recognition of this expense to all taxpayers regardless of their income” (Tax Reform 1987: The White Paper, p. 31); “Converting the deduction to a 17-per-cent credit ensures that all taxpayers receive the same level of tax assistance for eligible medical expenses above the 3-per-cent income threshold” (Income Tax Reform, p. 77). New paragraphs (g) and (h) restated the travel rules in the present tense. As enacted, paragraph (h) read as if the patient had always to be accompanied. The bill as reprinted after committee and the Revised Statutes print were read; the enacted chapter was not digitally available.
• S.C. 1990, c. 39, s. 25 (Bill C-28). Added paragraph (l.1), transplant costs including travel, board, and lodging of the donor and patient and one companion each “other than expenses described in paragraphs (g) and (h)”, and paragraph (l.2), dwelling modifications, for 1988 and later years. Read from the first-reading bill.
• R.S.C. 1985, c. 1 (5th Supp.), s. 118.2. The revision printed the section with the source note “1988, c. 55, s. 92; 1990, c. 39, s. 25” and modernized the wording (“for himself” became “for himself or herself”).
• S.C. 1991, c. 49, restated as S.C. 1994, c. 7, Sch. II, s. 89 (Bill C-18, royal assent 17 December 1991). Paragraph (h) was replaced, for 1988 and later years, so that the companion’s expenses are allowed “where the patient was, and has been certified by a medical practitioner to be, incapable of travelling without the assistance of an attendant”, and the patient’s own expenses regardless. The Department of Finance explained that paragraph (h) “currently requires, in all cases, a patient to be accompanied by another individual in order to claim an amount under that paragraph. This amendment, which applies to the 1988 and subsequent taxation years, ensures that a patient may be entitled to claim an amount under paragraph 118.2(2)(h) where the patient travels alone” (Explanatory Notes, May 1991, clause 89). The same Act rewrote paragraph (b), added paragraph (b.1) (part-time attendant care in Canada, capped at $5,000), extended paragraph (l) to animals trained to assist patients with impaired use of arms or legs, restructured paragraph (m), and added paragraph (i.1), for expenses after 1990.
• S.C. 1992, c. 48, and 1993, c. 24, restated as S.C. 1994, c. 7, Sch. VII, s. 9, and Sch. VIII, s. 54. The 1992 Act introduced a dependant’s income reduction into the formula and defined the patient by reference to subsection 118(6), for 1993 and later years; the 1993 Act added paragraph (l.3), rehabilitative therapy for hearing or speech loss, and extended the reimbursement exclusion to the patient’s own entitlement, for 1992 and later years.
• S.C. 1998, c. 19, s. 23 (Bill C-28, royal assent 18 June 1998). Coordinated the credit with the new refundable medical expense supplement in subsection 122.51(2); raised the paragraph (b.1) cap to $10,000; added paragraphs (l.4) (sign language interpretation), (l.5) (moving expenses to $2,000), (l.6) (driveway alterations), and (l.7) (adapted van); and rewrote paragraph (3)(b) in its present form, for 1997 and later years.
• S.C. 1999, c. 22, s. 34; 2000, c. 12, s. 142; 2000, c. 19, s. 25; 2001, c. 17, ss. 95 and 244. Added paragraph (l.8) (caregiver training) and excluded premiums deducted under subsection 20.01(1) from paragraph (q) (1998 onward); replaced “spouse” with “spouse or common-law partner” throughout (2001 onward); added paragraphs (b.2) (group home in Canada), (l.9) (therapy), and (l.91) (tutoring) (1999 onward); and added paragraph (l.21) (incremental construction costs) (2000 onward).
• S.C. 2003, c. 15, s. 73 (Budget Implementation Act, 2003). Added real-time captioning to paragraph (l.4), paragraphs (l.41) (note-taking) and (l.42) (voice recognition software), and paragraph (r), the incremental cost of gluten-free food for a patient with celiac disease, for 2003 and later years, after the Federal Court of Appeal had declined to treat shopping for and preparing such food as a disability (Kash v. The Queen, 2006 TCC 662, paras. 7 and 10–11, describing Hamilton).
• S.C. 2005, c. 19, s. 24 (Bill C-33, royal assent 13 May 2005). Replaced subsection (1) with the present formula A × [(B − C) + D], pooling the expenses of the spouse or common-law partner and children under 18 in B, raising the dollar threshold from $1,500 to $1,813 (indexed under section 117.1), and adding for each other dependant the lesser of $5,000 and the dependant’s expenses above the dependant’s own threshold, for 2004 and later years. The Technical Advisory Committee on Tax Measures for Persons with Disabilities had recommended in December 2004 that the caregiver’s limit be raised from $5,000 to $10,000 (Disability Tax Fairness, Recommendation 4.1).
• S.C. 2006, c. 4, s. 62 (Budget Implementation Act, 2006). Raised the other-dependant cap to $10,000; added phototherapy equipment and oxygen concentrators to paragraph (i); confined paragraphs (l.2) and (l.21) to expenses “not of a type that would typically be expected to increase the value of the dwelling” and “not normally … incurred by persons who have normal physical development”, for expenses after 22 February 2005, in response to decisions allowing hardwood floors and hot tubs (Hendricks v. The Queen, 2008 TCC 497, para. 10); and added paragraphs (l.43), (l.44), (s), (t), and (u) (medical marihuana).
• S.C. 2008, c. 28, s. 16 (Budget Implementation Act, 2008). Restructured paragraph (n) so that a drug qualifies only if it “can lawfully be acquired for use by the patient only if prescribed” and its purchase is recorded by a pharmacist, with a new subparagraph (n)(ii) for drugs prescribed by regulation (now Regulation 5701, enacted by S.C. 2009, c. 2, s. 110), for expenses after 26 February 2008; and extended paragraph (l) to severe autism and severe epilepsy.
• S.C. 2010, c. 12, s. 13 (Jobs and Economic Growth Act, royal assent 12 July 2010). Added subsection (2.1), for expenses incurred after 4 March 2010. Budget 2010 explained that “expenses incurred for purely cosmetic procedures (including related services and other expenses such as travel) be ineligible”, while a procedure “required for medical or reconstructive purposes, such as surgery to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease” continues to qualify.
• S.C. 2011, c. 24, s. 27. Removed the $10,000 cap on other dependants’ expenses, for 2011 and later years, “to better recognize the impact that extraordinary medical expenses can have on a caregiver’s ability to pay tax” (Budget 2011).
• S.C. 2013, c. 34, s. 249 (Technical Tax Amendments Act, 2012, royal assent 26 June 2013). Required every medical practitioner’s certification in paragraphs (c), (d), (e), (g), and (h) to be “in writing”, for certifications made after 20 December 2002; changed “80 kilometres” to “80 km” and “(g)(iii), (iv) and (v)” to “(g)(iii) to (v)” in paragraph (h); and provided that an individual with both a spouse and a common-law partner may claim for one but not both. No Finance note explaining the “in writing” change was located.
• S.C. 2014, c. 20, s. 10; 2017, c. 20, s. 15; 2017, c. 33, s. 44; 2018, c. 12, s. 12; 2019, c. 29, s. 17. Added severe diabetes to paragraph (l) and paragraph (l.92) (individualized therapy plans) for expenses after 2013; added subsection (2.2), the fertility rule, for 2017 and, on a timely refund request, any earlier year within the ten-year window, so that “individuals who require medical intervention in order to conceive a child are eligible to claim the same expenses that would generally be eligible for individuals on account of medical infertility” (Budget 2017); added nurse practitioners to paragraphs (l.9) and (l.92) and recast the cannabis paragraph; extended paragraph (l) to psychiatric service dogs for severe mental impairment (expenses after 2017); and rewrote paragraph (u) for the Cannabis Regulations from 17 October 2018.
• S.C. 2022, c. 19, s. 18 (Fall Economic Statement Implementation Act, 2022, royal assent 15 December 2022). Added paragraph (v), fees paid to a fertility clinic or donor bank in Canada for sperm or ova, and subsection (2.21), surrogacy and donor expenses incurred in Canada, for 2022 and later years, because the credit was “not available to those who need to pay medical expenses of others in order to become a parent” (Budget 2022). S.C. 2024, c. 17, s. 28, added “embryos” to paragraph (v), deemed in force 1 January 2022. Regulation 5700 was last amended by S.C. 2026, c. 3, s. 111, adding the low-vision navigation device at (z.5).

Interpretation and application →

Interpretation and application

Section 118.2 sits in Subdivision A of Division E, the rules computing an individual’s tax, and operates as a credit against Part I tax rather than a deduction in computing income. Subsection (1) multiplies the appropriate percentage by the sum of two amounts: the individual’s own medical expenses, pooled with those of the spouse or common-law partner and of children under 18, less the lesser of $1,813 as indexed ($2,834 for 2025) and three per cent of the individual’s income; and, for each other dependant within subsection 118(6), that dependant’s expenses less the lesser of the same indexed amount and three per cent of the dependant’s income. The expenses must be evidenced by receipts, must not have been used under this section, section 64, or subsection 122.51(2) for any year by any taxpayer, and must have been paid by the individual or the individual’s legal representative within any twelve-month period ending in the year, or within 24 months including the day of death where the patient died in the year. Because the threshold is computed on the claimant’s income, the CRA’s published example has the lower-income spouse claim the pooled expenses (line 33099 page). The condition that the expense be “paid by the individual” is read literally: payment by a spouse from a joint account did not qualify, since subsection (3)(a) deems only employer-paid amounts to be paid by the individual and “there is no other deeming rule in the ITA applicable” (Andrews, para. 36).

Subsection (2) is the heart of the section and it is exhaustive. “As drafted, this provision is exhaustive” (Mantha v. The Queen (TCC, 12 August 1999), para. 10); the Federal Court of Appeal has read the enumeration as indicating “a legislative purpose of limiting the availability of the METC to a specific list of items” (Ali, para. 17), and the closed list has repeatedly withstood challenge under section 15 of the Charter on the footing that no one receives the credit for an unlisted item, so that no benefit provided by law is denied on an enumerated ground (Ali, paras. 12–20; Tall, para. 3; Ray (2010), para. 3; Keehn, paras. 11–14, on the 80 km rule; Breen v. The King, 2023 TCC 48, paras. 19–34, on the moving-expense cap; Zanatta, paras. 11–22). The courts have at the same time applied the “humane and compassionate” construction drawn from Johnston and Radage in the disability tax credit context to the words Parliament used (Zaffino, para. 8; Yanta, para. 44), while insisting that “it is not open to this Court, or the Tax Court, to disregard statutory requirements imposed by Parliament, even if they are difficult to rationalize on policy grounds” (Ray (2004), para. 11). A recurring theme is that the list gives “no tax relief … for the ordinary expenses of living such as the costs of accommodation and food, except where those expenses are inextricably tied to a specific need resulting from a physical or mental impairment” (Lister, para. 15).

Paragraph (a), fees paid to a medical practitioner, dentist, nurse, or public or licensed private hospital for medical or dental services provided to the patient, is the paragraph of widest use and it supplies the definition of “patient” that governs the rest of the subsection. Three points of construction recur. First, who is a “medical practitioner” is settled by subsection 118.4(2) and the law of the place where the service is rendered; the person must be “authorized to practise”, meaning formally recognized under a regulatory regime, not merely not prohibited (Couture, paras. 12–16), a question of law reviewed for correctness (para. 9). Second, payment to a clinic or institute through which an authorized practitioner provides the service is payment to the practitioner (Mudry v. The Queen, 2008 TCC 160, paras. 31–35; Folio S1-F1-C1, para. 1.28). Third, the service must be a “medical service”, which after Tallon means a service obtained from a provider, so that neither a warm climate (Tallon, para. 43) nor a facility’s room and board (Bissonnette, paras. 10–12) qualifies, and the service must be provided to the patient as defined, which excludes a surrogate or donor (McNeilly, para. 98). Paragraphs (b) to (e) cover attendant care, nursing homes, group homes, and institutions, each with its own certificate and its own interaction with the disability tax credit under paragraph 118.3(1)(c); the leading authorities are Lister on paragraph (e) and the residential-versus-institutional line (paras. 12–19), Canada v. Title Estate, 2001 FCA 106, and Scott on what a certificate must say (it “must at least specify the mental or physical handicap from which the patient suffers, and the equipment, facilities or personnel that the patient requires”), and Zaffino on the breadth of “attendant care”. Paragraphs (i) to (m) cover devices, with paragraph (m) reaching Regulation 5700; paragraph (n) drugs, with the pharmacist-recording rule; paragraph (o) diagnostic procedures “as prescribed by a medical practitioner”, which requires the practitioner’s recommendation and not a generic best practice (Shapiro, para. 17; Chen v. The Queen, 2019 TCC 192, para. 14); and paragraphs (q) to (v) private health plan premiums (a public provincial plan is not one, Ross, para. 44), gluten-free food, Special Access Programme drugs and devices, cannabis, and fertility clinic fees.

Subsection (2.1), the cosmetic exclusion, applies to services “provided purely for cosmetic purposes, unless necessary for medical or reconstructive purposes”, and to “any related expenses”, which Budget 2010 and the CRA’s guide expressly extend to travel. Subsection (2.2) deems fertility-related amounts to be medical expenses where they would be so if the patient were medically infertile, so that single individuals and same-sex couples are not excluded for want of a diagnosed condition; subsection (2.21) and paragraph (v), from 2022, bring in the costs of surrogates and donors and of obtaining gametes and embryos, but only where incurred or paid in Canada. The Tax Court’s decision in McNeilly, on a 2015 arrangement involving a Toronto clinic and a clinic in Nepal, holds that before those amendments the “patient” definition excluded all donor and surrogate expenses, that Parliament was entitled to act incrementally, and that the 2022 relief is not retroactive (paras. 64–69, 78–79, 98, 154–156). Subsection (3) deems employer-paid expenses included in income to be paid by the employee and excludes any expense to the extent of an entitlement to reimbursement, whether of the individual, the patient, a related person, or their legal representative, unless the reimbursement is itself taxable; the exclusion is applied as written (Tessier, para. 4). Subsection (4) deems a reasonable vehicle cost to have been paid where no commercial carrier is readily available, which is the basis of the CRA’s simplified per-kilometre method and of the Tax Court’s rejection of an operating-cost-only rate (Mullin, paras. 7–11). The travel paragraphs (g) and (h), and the position of treatment obtained outside Canada, are treated in the two sections that follow.

Three points of construction remain open on the material read. No reported decision construes subsection (2.1), paragraph (r), or paragraph (u) directly. The 2025 credit rate of 14.5 per cent applied on the return does not appear in the consolidated paragraph 117(2)(a), which reads 14 per cent; the transitional provision was not located. And the status of the Budget 2025 proposal to bar a double claim under this credit and the home accessibility tax credit, which would reverse the CRA’s position in paragraph 1.154 of the folio, has not been checked.

← Legislative historyTravel to obtain medical services: paragraphs (g) and (h) →

Travel to obtain medical services: paragraphs (g) and (h)

Paragraph (g) allows amounts paid “to a person engaged in the business of providing transportation services” for carrying the patient, and one accompanying individual where the patient has been certified in writing as incapable of travelling without an attendant, “from the locality where the patient dwells to a place, not less than 40 kilometres from that locality, where medical services are normally provided, or from that place to that locality”, on three conditions: “(iii) substantially equivalent medical services are not available in that locality, (iv) the route travelled by the patient is, having regard to the circumstances, a reasonably direct route, and (v) the patient travels to that place to obtain medical services for himself or herself and it is reasonable, having regard to the circumstances, for the patient to travel to that place to obtain those services”. Paragraph (h) allows “reasonable travel expenses (other than expenses described in paragraph (g))” of the patient and the certified companion “to obtain medical services in a place that is not less than 80 km from the locality where the patient dwells if the circumstances described in subparagraphs (g)(iii) to (v) apply”. Subsection (4) extends paragraph (g) to the patient’s own vehicle where no carrier is readily available. The CRA restates the conditions as four, counting the distance (Folio S1-F1-C1, paras. 1.65 and 1.68), and allows under paragraph (h) meals, accommodation, parking, and local transport for the journey and for the period of treatment “provided that it is reasonable in the circumstances for the patient to have remained at the place where they received the medical services” (para. 1.69); meals and vehicle costs may be computed by its simplified method, $23 per meal to $69 per day and a provincial cents-per-kilometre rate (62.0 cents for Ontario in 2025), while accommodation requires receipts and proof that the lodging “is necessary as a result of the distance travelled, or the condition of the patient for travel, and not solely for the sake of convenience” (para. 1.72).

The purpose of the provisions was stated by the Federal Court of Appeal in the only appellate decision on them. Paragraph (g) provides “fiscal support for Canadians required to travel from home to access specialized services not available where they live”, within limits that “cannot be ignored or relaxed in the face of sympathetic circumstances” (Tallon, para. 39). The Court adopted the Tax Court’s account of the 1973 legislative history in Tokarski (paras. 16–18), where the budget speech and Commons debates of April 1973 were read as directed at residents of smaller communities who had to travel to larger centres for care. The Tax Court has put the same point from the claimant’s side: “A travel expense that is incurred in order to obtain treatment which is not available to the taxpayer locally is one such additional cost” of illness that the credit recognizes (Patton, para. 30), and “the travel expenses are to accommodate those who cannot access medical services where they dwell. They are not to accommodate personal needs or preferences due to family circumstances” (Young, para. 9).

The threshold requirement is that the journey be to obtain “medical services”, a phrase that bears the meaning it has in paragraph (a). In Tallon a Thunder Bay resident with a jaw disorder aggravated by cold spent the winter in Thailand and Indonesia and claimed the flights, accommodation, and meals of herself and her husband; the Tax Court had allowed the claim, following an earlier unreported judgment for the same taxpayer, and had left the reasonableness condition aside because the Crown had not argued it (Tallon (2014), paras. 15–20 and 27). The Federal Court of Appeal reversed. The question whether the salutary effects of a warm climate are medical services was an extricable question of law (para. 31); “medical services” means the same thing in paragraphs (a), (g), and (h) (para. 34); under paragraph (a) “a medical service must be obtained from a medical service provider” (para. 36); and relief obtained from climate, not from a person or hospital, is therefore not travel to obtain medical services (paras. 38, 42–43). The Court also noted that the Tax Court had made no finding that the services were unavailable locally and that the spouse’s own evidence, “Yes they are available here in Canada, but a lot of times access is much better in Thailand”, would have precluded one (paras. 29–30). The decision confirms the line of informal decisions that had refused claims for winter travel to Nevada, Arizona, and Florida for sunlight: “In order for a taxpayer to get travel expenses under either paragraph, he or she must travel and receive medical service from some person in the health care field”, and “Being exposed to the sun is not a medical service even though it may give relief to the sufferer” (Goodwin, paras. 26–27; Lazenby, para. 3). It also displaces the reasoning in Sienema, where self-administered hot tub and ultraviolet treatment at a relative’s house 51 km away had been accepted as medical services (para. 25). Services delivered by trained non-medical staff at a specialized learning program have been treated as medical services for paragraph (g) (Patton, paras. 25–32), a result consistent with Tallon because persons provided them; the broader reasoning in Patton that paragraph (g), unlike paragraph (a), does not require a medical practitioner should be read with Tallon, para. 38.

The first condition, that substantially equivalent medical services are not available in the patient’s locality, is objective and is the condition on which most claims fail. In Tokarski a Victoria resident of modest income obtained implants, bone grafts, and crowns in Poland for about a third of the Victoria estimate and claimed her airfare; the Tax Court accepted that she went because the local cost was prohibitive and that her travel was “clearly reasonable”, but held that “the express language of the subject provision does not invite a subjective construction of the circumstances of the particular taxpayer requiring the medical services”, so that services available locally at an unaffordable price are nonetheless available, and that any gap is for Parliament (paras. 31–34). The same answer was given to a Toronto patient who obtained IVF with donor eggs in Syracuse and Ukraine for reasons of donor ethnicity, cost, and clinic preference: “All of these reasons are personal to the Appellant but they do not make the services less available in Canada” (AB, para. 24), and to the Thunder Bay patient on her second visit to the Tax Court, where cardiology, dermatology, and endocrinology were available in Ontario and “The personal likes or dislikes of a taxpayer regarding local medical services does not mean that equivalent medical services are not available locally” (Tallon (2017), paras. 34–37). The condition is satisfied where the specialty is not practised in the locality: in Yanta the Tax Court found on the patient’s uncontradicted evidence that the complex full-mouth reconstruction he needed required a prosthodontist and that none practised in North Bay, and held that affordability is irrelevant to subparagraph (g)(iii) in either direction (paras. 16–28). It is also satisfied where a distant centre offers a treatment the local centre does not, as where Calgary offered pre-operative radiation that Ottawa did not (Young, para. 11), or where a physician’s protocol was practised by only two practitioners in Canada and the patient had exhausted the Toronto alternatives (Knechtel v. The Queen (TCC, 11 April 2000)). Letters that no “similar facility” exists in Canada do not show that the medical services actually obtained were unavailable (Bissonnette, paras. 8 and 12–13), and disagreement with the local doctors’ recommendations is not unavailability (Tallon (2017), para. 37).

The second condition, a reasonably direct route, has not been the ground of any reported refusal. The Crown argued in Tallon (2017) that a winter in Thailand and Cambodia was not a direct route to any treatment (para. 16), but the appeal was decided on the other conditions; in Yanta the itinerary through Toronto, Vienna, and Munich was not contested (para. 29). The words “having regard to the circumstances” accommodate the connections that international travel requires.

The third condition has two parts. The patient must travel “to obtain medical services for himself or herself”, which looks to the purpose of the journey; a trip taken primarily for the climate, on which services were obtained because the patient “happened to be there”, with no evidence of specific pre-planned services, fails this limb (Tallon (2017), para. 31). And it must be “reasonable, having regard to the circumstances, for the patient to travel to that place to obtain those services”. The fullest analysis is Yanta. The Tax Court found the text ambiguous as to the relevant factors (para. 39), drew on the 1973 purpose of supporting rural residents who travel to larger centres (paras. 35–36), and held that nothing in paragraph (g) confines the patient to the closest place where the services are offered (para. 43) or to a place in Canada, since Parliament wrote “in Canada” into paragraphs (b.1), (b.2), and (v) and subsection (2.21) and not into (g) or (h) (para. 45). “The reasonableness standard imparts an objective assessment” that “concerns the availability and nature of the services needed”, so that a complex case travelling to a centre of expertise, an experimental treatment, or an urgent need may make distant travel reasonable (para. 50); but “the personal affordability of the medical services that a patient requires is not a factor when considering the reasonableness condition in s. 118.2(2)(g)(v)”, because otherwise a patient in Toronto could never claim what a patient in North Bay could (para. 51). It was not reasonable to travel many thousands of kilometres to Antalya when the same services were available in Toronto and other nearby centres, and the accommodation claim under paragraph (h) fell with it (paras. 52–54). Tokarski had already held that reasonableness of the amount spent is not enough: “The reasonableness of the expenditure on travel, such as in this case where the travel was clearly reasonable, is not enough” (para. 33); Yanta treats that remark as obiter so far as it suggested affordability might bear on subparagraph (v) (para. 46). Travel of thousands of kilometres and a stay of four and a half months for services available in Ontario was unreasonable (Tallon (2017), para. 38), while a cancer patient’s single journey from Ottawa to Calgary for a treatment not offered in Ottawa was reasonable “in his specific circumstances” (Young, para. 11), and a diligent but fruitless search for a comparable local program made a journey to California for a physician-led cardiac program “not unreasonable” (Demont v. The Queen (TCC, 23 October 2002), paras. 72–74 and 84).

The amounts allowable under paragraph (h) have generated a second line of cases. The provision covers “the attendant costs of living away from home during the treatment period”, so that a certified companion’s hotel, local taxis between hotel and hospital, and hospital parking are claimable (Bell, paras. 5–6), as are an accompanying spouse’s near-daily return trips during a six-month rehabilitation (Jordan, para. 13), although a later judge thought that result “over-reaching in light of the wording in that provision” (AB, para. 33) and the CRA’s published example denies a spouse’s visit during a hospital stay. A per diem for unidentified incidentals is not an amount paid (Bell, para. 7); meals are the patient’s, not the companion’s, under the simplified method as the Tax Court has applied it (Sienema, para. 27); a vehicle shared by patient and companion is claimed once (Bartlett, para. 7); accommodation and car rental for a long stay may be apportioned to treatment days (Knechtel); and lodging paid to a facility as part of an inclusive fee is analysed under paragraph (a) (AB, para. 28), which explains the early refusal of hotel costs in Demont (paras. 85–86) that later decisions have not followed. Hospital parking is a travel expense but only where the one-way distance is at least 80 km (Keehn, paras. 9 and 12). Transport to a school whose fees qualify under paragraph (e) qualifies under (g) or (h) on the usual conditions, but rental accommodation near the school and visits home do not (Folio S1-F1-C1, para. 1.71). Travel “only to pick up a device or medication” is not, in the CRA’s view, travel to obtain medical services (Guide RC4065), and a claim for a 56 km trip to a pharmacy failed for want of evidence (Chobotar v. The Queen, 2009 TCC 260, para. 2).

On evidence and review, the taxpayer must prove each condition on a balance of probabilities (Tallon (2017), para. 28); an expert is not required, and “In the informal procedure, the Court may well be satisfied by a letter of opinion from a knowledgeable medical practitioner” (para. 33), as in Young, where the family physician’s letter was accepted without cross-examination because calling a doctor 2,500 miles away was “simply too much to ask” (para. 2). Claims fail where there is no evidence at all on distance or local availability (Scully v. The Queen, 2008 TCC 617, para. 26; Lejeune v. The Queen, 2004 TCC 589, para. 19), or where the claimant admits that the services were available at home (Tokarski, para. 4; AB, para. 3; Tallon, para. 29). Whether an expense is a medical expense is a question of mixed fact and law reviewed for palpable and overriding error, unless an extricable question of law arises, which is reviewed for correctness (Tallon, para. 17), and that correctness review applies to informal-procedure decisions as it does to general-procedure decisions (Ray (2004), paras. 8–10). Most of the travel cases are informal-procedure decisions without precedential value (Warnock, para. 12), though later judges follow them (Yanta, para. 21); the Federal Court of Appeal has not ruled directly on subparagraphs (g)(iv) or (g)(v).

← Interpretation and applicationMedical tourism: treatment obtained outside Canada →

Medical tourism: treatment obtained outside Canada

Nothing in paragraphs (a), (g), or (h) confines the credit to services obtained, or travel undertaken, in Canada. The Act draws the line expressly where it means to: attendant care under paragraph (b.1) must be “provided in Canada”, a group home under paragraph (b.2) must be “in Canada”, fertility clinic and donor bank fees under paragraph (v) must be paid to a clinic or bank “in Canada”, surrogacy and donor expenses under subsection (2.21) must be “incurred in Canada”, and a talking textbook under Regulation 5700(w) must relate to an institution in Canada or a designated educational institution. The Tax Court has drawn the inference in terms: Parliament’s use of “in Canada” in those provisions, and its absence from paragraph (g), means that the travel conditions do not require the services to be in Canada (Yanta, para. 45). The CRA’s position is the same: “As a general rule, however, eligible medical expenses are not restricted to those paid in Canada or for medical services provided in Canada”, with the listed exceptions (Folio S1-F1-C1, para. 1.12); “Generally, you can claim all amounts paid, even if they were not paid in Canada” (Guide RC4065); and the CRA’s expense list carries an entry for “Travel expenses (outside of Canada)” whose worked example allows a Winnipeg resident’s flights and a week’s hotel in Germany where “similar medical services were not available near his home, John took a direct travelling route, and it was reasonable, under the circumstances, for him to travel to Germany to get medical services”.

The fees for the foreign treatment itself are governed by paragraph (a) and subsection 118.4(2). The practitioner must be “authorized to practise as such … pursuant to the laws of the jurisdiction in which the service is rendered”, which for treatment abroad is the foreign jurisdiction; the CRA’s province-by-province list of authorized practitioners has no application to a foreign provider, and the Couture standard, formal recognition under a regulatory regime rather than mere absence of prohibition, is the test. A licensed private hospital abroad is one “licensed under the laws of the jurisdiction in which it operates”, and the claimant should keep “full particulars of the licence under which the facility operates, as well as the details of the professional qualifications of the medical staff in attendance and of the medical or remedial care given” (Folio S1-F1-C1, para. 1.25). Payments to a foreign clinic or facilitator company qualify only where the person who provided the service was an authorized practitioner and the service was a medical service (para. 1.28; Mudry, paras. 31–35). Fees to an English clinic failed for want of proof that the payee was a medical practitioner within subsection 118.4(2) (Hoare v. The Queen, 2007 TCC 292, paras. 30–32), and massage therapy in Dubai failed for want of any evidence of the law there (Ross, paras. 33–42). Where the foreign treatment is itself eligible, the Crown has conceded that the associated travel follows (Mudry, paras. 9–10, New York and New Jersey; Pearen v. The Queen, 2014 TCC 294, paras. 2–5, India), and in Demont a physician-led cardiac program in California was held to be a medical service “the clinic’s location outside Canada” notwithstanding (paras. 81–82).

Whether the cost of getting there qualifies turns on the three conditions, and the reported decisions on treatment abroad divide sharply along them. Travel has been allowed where the claimant proved that nothing substantially equivalent was available at home and a specific provider’s service was the object of the journey: the patient’s airfare to Oakland for the Ornish program after both spouses had “searched diligently for a similar type program available to them in their own area and were unable to find one” (Demont, paras. 74, 84, and 87), and United States trips for a specialized implant problem on a local physician’s written opinion that there was no Canadian solution (Tallon (2017), paras. 6 and 33, allowed on consent). Travel has been refused where the services were available in Canada and the patient went abroad for cost, preference, or convenience: dental work in Poland (Tokarski), full-mouth reconstruction in Türkiye where Toronto offered it (Yanta, para. 52), IVF in Syracuse and Ukraine where Toronto offered it (AB, paras. 24–27), and a Mexican health retreat whose medical component “could be obtained in this area in British Columbia” (Bissonnette, para. 12). Travel has been refused outright where the object was climate rather than a provider’s service: Thailand and Indonesia (Tallon), Las Vegas and Phoenix (Goodwin), and Arizona (Lazenby). The pattern is consistent with the purpose the Federal Court of Appeal identified: the provisions support patients who must leave home to reach care, not patients who choose a foreign provider for a service they could obtain where they live.

Several features of medical tourism deserve separate mention. Cost is not a route to eligibility: that the foreign treatment is cheaper, or that the Canadian price is beyond the patient’s means, bears on neither availability (Tokarski, para. 31) nor reasonableness (Yanta, para. 51). Waiting times are a different matter. No reported decision turns on them, but the French text of subparagraph (g)(iii), “il n’est pas possible d’obtenir dans cette localité des services médicaux sensiblement équivalents”, speaks of the possibility of obtaining the services, and Yanta names urgency among the circumstances that can make distant travel reasonable (para. 50), so a documented inability to obtain timely treatment locally is the strongest footing for a wait-time claim; the Ontario Health Insurance Plan’s own out-of-country approval test, which asks whether “the identical or equivalent service is not performed in Ontario” or whether travel is necessary “to avoid a delay that would result in death or medically significant irreversible tissue damage” (R.R.O. 1990, Reg. 552, s. 28.4(2)(c)), is a different and stricter test applied at the provincial level, but an approval or refusal under it is evidence on the federal question. Reimbursement matters twice over: an amount the provincial plan or a private insurer pays or is obliged to pay for the foreign treatment is excluded by paragraph (3)(b) to that extent, and the travel costs that no plan covers remain claimable on the usual conditions. Cosmetic procedures abroad are excluded with “any related expenses”, which Budget 2010 expressly said includes travel. Cross-border fertility and surrogacy arrangements are confined by the “in Canada” conditions of paragraph (v) and subsection (2.21), although a Canadian clinic’s purchase of gametes from abroad in accordance with the Assisted Human Reproduction Act may qualify (Folio S1-F1-C1, para. 1.146.2), and the costs of a foreign donor or surrogate were ineligible before 2022 and remain so where incurred abroad (McNeilly; Zanatta). The companion rule applies abroad as at home: the spouse’s airfare failed in Demont for want of a certificate (para. 83) and in AB for the same reason (paras. 31 and 33). The CRA’s meal allowance may be claimed “in Canadian or US funds”, the vehicle rate is that of the province where the travel begins, and the CRA has published nothing on currency conversion of foreign fees; the practical course is to convert at the rate on the date of payment and keep the exchange record with the receipts. Finally, the Quebec credit follows the same structure, with 40 km and 80 km thresholds and no Canada-only limit in its general travel paragraphs, but requires “the most reasonably direct route” and excludes cosmetic-related travel in its own words (Taxation Act, CQLR c. I-3, ss. 752.0.11.1(h), (i), and 752.0.11.1.3(c)); its separate 20 per cent credit for care not available within 200 km (s. 752.0.13.1) applies only to care obtained in Québec.

← Travel to obtain medical services: paragraphs (g) and (h)Policy purpose and commentary →

Policy purpose and commentary

The deduction was introduced in 1942 and the Department of Finance classifies the credit as a structural measure that “recognizes the effect of above-average medical and disability-related expenses on the ability of an individual to pay income tax” (Report on Federal Tax Expenditures 2026, Part 6). Its conversion to a credit was explained in 1987 on grounds of equity: “A deduction rather than a credit for medical expenses gives a greater tax benefit to individuals in higher income groups. Converting the deduction to a 17-per-cent credit ensures that all taxpayers receive the same level of tax assistance for eligible medical expenses above the 3-per-cent income threshold” (Tax Reform 1987: Income Tax Reform, p. 77). The cost of the credit was estimated at $2,290 million for 2025 and projected at $2,540 million for 2027, with about 5.8 million claimants in 2023 (Report, Parts 2 and 6). The Department states that “the list of expenses eligible for this credit is regularly reviewed and expanded in light of new technologies and other disability-specific or medically-related developments”, and the amendments since 1988 bear that out. The Technical Advisory Committee on Tax Measures for Persons with Disabilities described the credit in 2004 as “the fastest growing” of the disability-related measures and recommended raising the caregiver limit, renaming the credit, and gathering data on what is actually claimed (Disability Tax Fairness, pp. 71 and 126–128); it made no recommendation on travel. The 2010 cosmetic exclusion rests on the principle that an expense “is not generally intended to be eligible if it is ordinarily incurred by persons without a disability or a medical condition or has a substantial element of personal consumption and choice” (Budget 2010). The travel rules have attracted no Finance commentary since the 1991 correction of paragraph (h); the Tax Court in Tokarski and Yanta has had to reconstruct their purpose from the 1973 budget speech and debates, and both decisions identify the gap between a provision designed for rural patients travelling to regional centres and the modern phenomenon of patients travelling abroad for cheaper or faster care as one for Parliament rather than the courts (Tokarski, para. 34; Yanta, paras. 35–36 and 51).

The Canadian Tax Foundation catalogue lists work on the credit and on health spending accounts, including “Private Health Services Plans for Small Businesses”, Canadian Tax Focus (2015), and an article in the Canadian Tax Journal (2010), vol. 58, no. 3, pp. 529–575, returned for medical-travel queries; no item specifically on medical tourism or paragraphs (g) and (h) was found. These are recorded as catalogue entries only; the site refused automated access.

← Medical tourism: treatment obtained outside CanadaRelevant case law →

Relevant case law

Travel and treatment abroad (paragraphs (g) and (h)):

• Canada v. Tallon, 2015 FCA 156. The only appellate decision on the travel paragraphs. Standard of review (para. 17); “medical services” has the same meaning in (a), (g), and (h) and must be obtained from a provider, so warm-climate relief does not qualify (paras. 34–38 and 42–43); purpose of (g) and its limits (para. 39, adopting Tokarski, paras. 16–18); no finding of local unavailability was possible on the evidence (paras. 29–30). Reverses 2014 TCC 193.
• Anka v. Canada (FCA, 5 June 1997). Judicial review dismissed; the Tax Court’s findings on a child’s travel and schooling costs under (e) and (h) not disturbed.
• Yanta v. The King, 2026 TCC 173 (informal; amended reasons 24 September 2026). North Bay to Türkiye for full-mouth reconstruction: (g)(iii) met because no prosthodontist practised locally, affordability irrelevant (paras. 16–28); (g)(iv) not contested (para. 29); (g)(v) is an objective test turning on the availability and nature of the services, not confined to the closest place or to Canada, and failed because the services were available in Toronto (paras. 35–52); (h) fell with it (paras. 53–54).
• Tallon v. The Queen, 2017 TCC 244 (informal). Second winter in Thailand and Cambodia: burden on the claimant for each condition (para. 28); purpose limb of (g)(v) failed where services were obtained because the patient happened to be there (para. 31); no evidence of unavailability, and personal preference is not unavailability (paras. 32–37); travel of thousands of kilometres for four and a half months unreasonable (para. 38); earlier United States travel allowed on consent.
• Tallon v. The Queen, 2014 TCC 193 (informal). Allowed the 2009 Thailand and Indonesia travel, following an unreported judgment for 2008; attendant certificate not specific to the year accepted (para. 24); reasonableness not argued (para. 27). Reversed.
• AB v. The Queen, 2014 TCC 157 (informal; cited elsewhere as Ismael). Toronto to Syracuse and Ukraine for IVF: list exhaustive (paras. 11–13); donor fees not for the patient and an ovum not an organ (paras. 15–23); personal reasons do not make services unavailable (paras. 24–27); companion fails without a certificate (paras. 31 and 33); comments on Bissonnette, Demont, Sienema, and Jordan (paras. 28–30 and 33).
• Tokarski v. The Queen, 2012 TCC 115 (informal). Victoria to Poland for dental work: (g)(iii) is objective and unaffordable services are still available (para. 31); reasonableness of the travel expenditure is not enough (para. 33); legislative history of 1973 (paras. 16–18); gap for Parliament (para. 34).
• Jordan v. The Queen, 2012 TCC 394 (informal). Weyburn to Regina: an accompanying spouse’s repeated trips during a six-month treatment period are travel expenses under (h) (paras. 11–13).
• Sienema v. The Queen, 2010 TCC 468 (informal). Self-administered hot tub and UVB treatment 51 km away treated as medical services and vehicle and meal costs allowed; companion’s transport and meals refused (paras. 24–27). Superseded on the “medical services” point by Tallon; criticized on the 80 km point in AB, para. 30.
• Johnson v. The Queen, 2010 TCC 321 (informal). Thunder Bay to Chicago: a flight obtained with loyalty points is an “amount paid” (paras. 13–15 and 26); onus on the Crown for an unpleaded valuation point (para. 27).
• Young v. The Queen, 2009 TCC 628 (informal). Ottawa to Calgary for cancer treatment not offered in Ottawa allowed on a physician’s letter (paras. 2 and 11); Edmonton legs failed (g)(iii) and the Airdrie commute failed 80 km (paras. 7–9); travel provisions accommodate those who cannot access services where they dwell, not family preference (para. 9); meals and vehicle at CRA rates (para. 12).
• Bell v. The Queen, 2009 TCC 523 (informal). Nanaimo to Victoria: (h) covers the attendant costs of living away from home during treatment, including local taxis and parking (paras. 5–6); a per diem for unidentified incidentals is not an amount paid (para. 7).
• Chobotar v. The Queen, 2009 TCC 260 (informal). Travel to a pharmacy and doctors failed for want of evidence (para. 2).
• Scully v. The Queen, 2008 TCC 617 (informal). (g) and (h) “refer to travel to obtain medical services not available in the locality of the patient’s residence”; claim failed for want of proof of distance and unavailability (paras. 25–26).
• Bartlett v. The Queen, 2008 TCC 494 (informal). Patient and certified companion in one vehicle: the simplified-method amount is claimed once (para. 7).
• Mudry v. The Queen, 2008 TCC 160. Chelation therapy in New York and New Jersey and Toronto: payment to a clinic through which practitioners act is payment to the practitioner (paras. 31–35); travel allowed on the Crown’s admission (paras. 9–10 and 36–37).
• Patton v. The Queen, 2005 TCC 704 (informal). Daily travel to a learning program: “medical services” are services related to the diagnosis, treatment, and prevention of disease, and need not be provided by a medical practitioner under (g) (paras. 25–29); purpose of the travel provisions (para. 30). Read with Tallon, para. 38.
• Lejeune v. The Queen, 2004 TCC 589 (informal). Travel to a doctor refused for want of evidence (para. 19).
• Estate of Claussen v. The Queen (TCC, 13 January 2003) (informal). Travel from Powell River to a Vancouver naturopath conceded under (h) (para. 1).
• Demont v. The Queen (TCC, 23 October 2002) (informal). Nova Scotia to California for a physician-led cardiac program: fees qualify under (a) regardless of location (paras. 81–82); patient’s airfare allowed on proof of diligent search and no local equivalent (paras. 72–74, 84, and 87); spouse’s airfare fails without a certificate (para. 83); hotel refused following Bissonnette (paras. 85–86), a result later cases have not followed.
• Bissonnette v. The Queen (TCC, 25 February 2002) (informal). Mexican health retreat: room and board are not medical services (paras. 10–12); travel refused because the medical services obtained were available in British Columbia (para. 12).
• Goodwin v. The Queen (TCC, 26 September 2001) (informal). Calgary to Las Vegas and Phoenix for sunlight: a taxpayer “must travel and receive medical service from some person in the health care field” (para. 26); sun exposure is not a medical service (para. 27). Relied on in Tallon.
• Lazenby v. The Queen (TCC, 1 December 2000) (informal). Winter in Arizona: travel “was not to obtain medical services” but a better climate (para. 3).
• Knechtel v. The Queen (TCC, 11 April 2000) (informal; transcript). Toronto to Saskatoon for a physician’s pain protocol: the claimant “did everything reasonable to find out if she could receive in the Toronto area substantially equivalent medical services”; airfare allowed and lodging apportioned to treatment days.
• Mullin v. The Queen (TCC, 7 April 1999). Subsection (4): a reasonable vehicle amount reflects full ownership costs, not operating costs alone; $0.30 per kilometre allowed for northern Manitoba (paras. 6–11).
• Bryce v. The Queen (TCC, 11 August 1998) (informal). Parents’ travel from Whitehorse to Calgary allowed through (e) on a humane construction; (g) and (h) not analysed. An outlier of limited weight.
• Keehn v. The King, 2023 TCC 1 (informal). Hospital parking is a travel expense under (h) only where the one-way distance is at least 80 km; the distance rule is not discrimination (paras. 9–14). Followed in Breen.
• Pearen v. The Queen, 2014 TCC 294 (informal). Travel and meals in India for the appellant’s own fertility services allowed by concession; surrogate’s expenses refused (paras. 2–7).

Other paragraphs:

• Canada v. Couture, 2008 FCA 412. “Authorized to practise” in subsection 118.4(2) requires formal recognition under provincial law, not mere permission; acupuncturist in Ontario not a medical practitioner (paras. 9 and 12–16).
• Ali v. Canada, 2008 FCA 190 (leave to appeal refused). The list is closed and limits the credit to specific items (para. 17); “recorded by a pharmacist” does not infringe section 15 or section 7 of the Charter (paras. 12–22).
• Canada v. Ray, 2004 FCA 1. “Recorded by a pharmacist” cannot be disregarded; it excludes off-the-shelf purchases (paras. 11–13); correctness review of informal-procedure decisions on law (paras. 8–10).
• Tall v. Canada, 2009 FCA 342, and Ray v. Canada, 2010 FCA 17. Ali followed; “It is settled law in this Court that paragraph 118.2(2)(n) does not contravene section 15”.
• Dunn v. Canada, 2002 FCA 506. A practitioner permitted to dispense drugs is not “authorized to practise” as a pharmacist; compassionate reading cannot displace the words (paras. 3–5).
• Bekker v. Canada, 2004 FCA 186. A Charter challenge requires a notice of constitutional question, in informal appeals too, and a factual record (paras. 7–12).
• Lister v. Canada, 2006 FCA 331. Paragraph (e) contemplates institutional care; a residence that mainly provides accommodation is not within it; no relief for ordinary living costs unless inextricably tied to the impairment (paras. 12–19).
• Canada v. Scott, 2008 FCA 286, and Canada v. Title Estate, 2001 FCA 106. A certificate under (e) must specify the handicap and the equipment, facilities, or personnel required; certification is a pre-condition and cannot be supplied at trial (Scott, paras. 22–29); a university-preparatory school does not “specially provide” for the handicap (paras. 11–18).
• Weeks v. Canada (FCA, 12 December 2000). The family home is not a nursing home or institution; in-home devices qualify only within paragraphs (i) to (m); Charter claim failed for want of a factual foundation.
• Canada v. Klywak, 2005 FCA 354. Regulation 5700(i) then said “designed to assist”, so a hot tub designed in part to assist walking qualified; writing in “exclusively” is for Parliament (paras. 7–8). The item has since been amended.
• Canada v. Gibson, 2001 FCA 356, and Gibson v. The Queen (TCC, 2 November 2000). Paragraph (l.2) turns on mobility or function within the dwelling; installation of a hot tub allowed under the pre-2005 text, the tub itself not.
• Tessier v. Canada, 2003 FCA 415. An expense for which the taxpayer is entitled to reimbursement is excluded by paragraph (3)(b) however unfair the result (paras. 1–5).
• McNeilly v. The King, 2024 TCC 162. “Patient” in paragraph (a) governs (n), (o), and (2.2); a donor or surrogate is not the claimant’s patient; history of (2.2), (2.21), and (v); Charter challenge dismissed (paras. 64–69, 78–79, 98, and 154–160).
• Warnock v. The Queen, 2014 TCC 240, and Zanatta v. The Queen, 2014 TCC 293 (informal). Surrogate not a “patient”; Zieber not followed; informal decisions have no precedential value (Warnock, paras. 11–17; Zanatta, paras. 7–22).
• Zieber v. The Queen, 2008 TCC 328 (informal). Embryo transplant treated as an organ transplant under (l.1). Not followed.
• Zaffino v. The Queen, 2007 TCC 388 (informal). “Attendant care” includes house cleaning provided alone (paras. 6–9); a missed-appointment fee is not for a medical service (para. 13).
• Hoare v. The Queen, 2007 TCC 292. Tutoring “supplementary to the primary education” turns on function, not location; the (l.91) certificate read compassionately; fees to a United Kingdom clinic failed under (a) (paras. 18–32).
• Lang v. The Queen, 2009 TCC 182 (informal). Private-school fees partly allowed as tutoring under (l.91) (paras. 48–58).
• Hendricks v. The Queen, 2008 TCC 497, and Barnes v. The Queen, 2009 TCC 429 (informal). The 2005 conditions in (l.2): hardwood floors and a conventional pool fail because persons without impairments install them (Hendricks, paras. 6–12; Barnes, paras. 10–13).
• Henschel v. The Queen, 2010 TCC 344, Ross v. The Queen, 2014 TCC 317, and Breen v. The King, 2023 TCC 48 (informal). Items not in Regulation 5700 fail under (m); massage therapy abroad requires proof of authorization there; public plan premiums are not (q) premiums; Charter challenges to the caps dismissed.
• Shapiro v. The Queen, 2014 TCC 74, and Chen v. The Queen, 2019 TCC 192 (informal). Paragraph (o): “prescribed” means recommended by the practitioner; cord-blood banking as a best practice not prescribed (Shapiro, paras. 9–17; Chen, paras. 13–15).
• Breger v. The Queen, 2007 TCC 254, and Mantha v. The Queen (TCC, 12 August 1999) (informal). Pre-2008 (n): pharmacist-recorded supplements allowed in Quebec; gluten-free food refused before paragraph (r); “As drafted, this provision is exhaustive”.
• Chevalier v. The Queen, 2008 TCC 11 (informal). Naturopathy and osteopathy in Quebec not authorized; the credit turns on the product or service, not the disability (paras. 16–19 and 37).
• Savoy v. The Queen, 2011 TCC 73, and Andrews v. The King, 2023 TCC 19 (informal). “Dependant” and “paid by the individual” in subsection (1).
• Kash v. The Queen, 2006 TCC 662 (informal). Background to paragraph (r).
• Cited through verified judgments only, not read in the original: Collins v. Canada, [1998] T.C.J. No. 396, para. 20 (the four conditions of (e), as quoted in Scott, para. 4); Tsiantoulas v. Canada, [1994] T.C.J. No. 984, para. 11 (apportionment under paragraph (g) of a single asset, as quoted in Heaps v. The Queen, 2008 TCC 130, para. 15); Johnston v. Canada, 98 D.T.C. 6169 (FCA), and Radage v. The Queen, 96 D.T.C. 1615 (humane and compassionate construction); Herzig v. The Queen, 2004 TCC 344 (remuneration for therapy under (l.9), as quoted in Henschel, para. 15); Carlson v. The Queen (TCC, 13 June 2013, oral reasons) (surrogate not a patient, as described in Warnock and Zanatta); the unreported 2011 oral judgment in the first Tallon appeal.

← Policy purpose and commentaryCRA documents →

CRA documents

• Income Tax Folio S1-F1-C1, Medical Expense Tax Credit, effective 15 August 2025, which on first publication (28 March 2013) replaced and cancelled IT-519R2 together with Folios S1-F1-C2 and S1-F1-C3. The formula and the pooling of a spouse’s or partner’s expenses (paras. 1.1–1.3); “dependant” and dependence for support as a question of fact (paras. 1.4–1.7); conditions, the twelve-month period, and payment (paras. 1.9–1.15); medical expenses outside Canada, the general rule and its exceptions (paras. 1.12–1.13); reimbursements (paras. 1.16–1.17); the list is exhaustive (para. 1.18); medical practitioners, the Couture test, and the authorized-practitioner list (paras. 1.20–1.23); fees to corporations and clinics, block fees, and virtual services rendered across jurisdictions (paras. 1.28–1.30.2); a licensed private hospital abroad and the records to keep (para. 1.25); “medical services” (para. 1.26); attendant care and nursing homes (paras. 1.31–1.63); transportation and travel, paragraphs (g), (h), and subsection (4), the four conditions, “readily available” as a question of fact, costs during treatment, the accompanying individual, travel to a school, accommodation receipts and the “not solely for the sake of convenience” test, and the detailed and simplified methods (paras. 1.64–1.72); kidney supplies at 40 km (para. 1.86); transplant travel (para. 1.93); each Regulation 5700 item, including the positions on CPAP machines, water softeners, air conditioners, custom mattresses, hot tubs, and Segways (paras. 1.118–1.122.1); drugs (paras. 1.123–1.127); cosmetic procedures (paras. 1.143–1.146); fertility and surrogacy, including “expense incurred in Canada” and a Canadian clinic’s purchase of gametes from abroad (paras. 1.146.1–1.146.5); receipts (para. 1.147). The folio cites Couture, Rannelli, and Lister and no case on travel; its chapter history records that the “urgency of the situation” was dropped as a factor in whether transport is readily available.
• Authorized medical practitioners for the purposes of the medical expense tax credit (modified 22 January 2026): 57 professions by province and territory; Ontario recognizes 36, including naturopaths, homeopaths, kinesiologists, and registered massage therapists, Quebec 35 and none of those four. The table has no column for foreign practitioners.
• Lines 33099 and 33199 – Eligible medical expenses and Details of medical expenses (modified 20 January 2026): “Generally, you can claim all amounts paid, even if they were not paid in Canada”; the $2,834 threshold for 2025; entries for travel under 40 km (not eligible), at least 40 km, at least 80 km, and outside Canada, each restating the three statutory conditions and the attendant certificate, with the St-Hyacinthe, Sydney, Prince Rupert, and Winnipeg-to-Germany examples; “Medical services outside of Canada”, “Hospital services”, and “Cancer treatment – in or outside Canada”; cosmetic surgery; fertility; whirlpool bath treatments; and the Ontario limits for moving expenses ($3,525) and vans ($8,813).
• Guide RC4065, Medical Expenses (2025): the travel section in full, the sentence “This may include travelling outside Canada” under the 80 km heading, “You also cannot claim travel expenses if you travel only to pick up a device or medication”, the exclusion of cosmetic procedures “including any related services and other expenses, such as travel”, and the documents to keep, including proof of payment and, for a dependant over 18, proof of support.
• Meal and vehicle rates used to calculate travel expenses (modified 20 January 2026): simplified method of $23 per meal to $69 per day “in Canadian or US funds” for 2025; vehicle rates by the province where the travel begins (Ontario 62.0, Quebec 60.5 cents per kilometre for 2025), with tables back to 2013; the detailed method requires receipts and a kilometre log for the chosen twelve-month period.
• Folios S1-F1-C2, Disability Tax Credit, paras. 2.19, 2.24, and 2.28, and S1-F1-C3, Disability Supports Deduction, paras. 3.5 and 3.8, on the interaction with paragraph 118.3(1)(c) and the election between section 64 and section 118.2.
• IT-519R2 (consolidated), Medical Expense and Disability Tax Credits and Attendant Care Expense Deduction, cancelled 28 March 2013; no copy is available on canada.ca. Its travel paragraphs (32 to 34) and outside-Canada paragraph (12) survive in revised form in the folio, as the chapter history records.
• Income Tax Audit Manual: no chapter on the credit or on the verification of medical travel; the estates checklist directs the auditor to “determine whether the deceased claimed medical expenses in the 24-month period prior to the date of death” (chapter 17, modified 1 September 2026), and chapter 28 records the penalty computation for the refundable supplement.

← Relevant case lawRegulations, forms, and elections →

Regulations, forms, and elections

• Income Tax Regulations, Part LVII, ss. 5700 and 5701 (Regulations current to 21 September 2026). Regulation 5700 lists the devices and equipment prescribed for paragraph (m), from (a) to (z.5), with their conditions and caps written into each item (for example, an air conditioner “to the extent of the lesser of $1,000 and 50% of the amount paid”; a walking device “exclusively designed to assist”); its history runs from SOR/80-948 to S.C. 2026, c. 3, s. 111. Regulation 5701 prescribes, for subparagraph (n)(ii), a drug that is for a therapeutic purpose, is prescribed for a patient by a medical practitioner, and “may, in the jurisdiction in which it is acquired, be lawfully acquired for use by the patient only with the intervention of a medical practitioner”. Neither regulation bears on paragraphs (g) or (h).
• Reimbursement Related to Assisted Human Reproduction Regulations, SOR/2019-193, ss. 2 to 4, named in subsection (2.21): the reimbursable expenditures of a donor (travel, dependant and pet care, counselling, legal, drugs and devices, physician-recommended products, insurance, records) and of a surrogate (the same, with midwife or doula services, groceries, maternity clothes, telecommunications, prenatal classes, and delivery), and the maintenance and transport of an in vitro embryo.
• The T1 return, Step 5, lines 33099 and 33199 (with the Federal Worksheet for other dependants), line 33200, and the federal non-refundable credit rate at line 114 (14.5 per cent for 2025); provincial Form 428 lines 58689 and 58729; Form T2222 where the claimant also qualifies for the northern residents deduction; Form T929 for the section 64 alternative; and Form T2201, whose completion fee may itself be claimed. The expenses are claimed on the return and the receipts, certificates, prescriptions, and proof of payment are kept for production on request.
• Section 118.2 contains no election. The claimant chooses the twelve-month period, which spouse claims the pooled expenses, and whether an expense is taken under this section or section 64; subsection (2.2) was given retroactive effect on a timely refund request under paragraph 164(1.5)(a).

← CRA documentsCompliance →

Compliance

• Claim only listed expenses, and keep the proof. The list is closed (Ali, para. 17); every claim must fit a paragraph of subsection (2) and, for devices and drugs, the Regulations. Receipts must show the payee, the patient, the purpose, the date, and where applicable the prescribing practitioner; the CRA may also ask for proof of payment and, for a dependant over 18, proof of support (Guide RC4065).
• Check the practitioner’s authorization in the place of service. For services in Canada, consult the CRA’s provincial list; for services abroad, obtain evidence of the provider’s licence and the hospital’s licence under the foreign law (Folio S1-F1-C1, paras. 1.21–1.25). A payment to an unregulated practitioner fails under paragraph (a) wherever it is made (Couture; Ross, paras. 33–42).
• Get the certificates before the claim, in writing. The attendant certificate under paragraphs (g) and (h), and the certificates under paragraphs (c), (d), (e), (l.41) to (l.43), (l.91), and (r), must exist before the claim and must say what the paragraph requires (Scott, paras. 22–29; Title Estate). A doctor’s letter obtained after the fact has been accepted in the informal procedure where it described a continuing condition (Tallon (2014), para. 24), but that is not to be relied on.
• For travel, document the three conditions. Measure the one-way distance from the patient’s dwelling; obtain a letter from the treating or referring practitioner stating that substantially equivalent services were not available in the locality and why the patient needed to go to that place; keep the itinerary; and record the specific services obtained. Claims with no evidence of distance or unavailability fail (Scully, para. 26; Lejeune, para. 19; Chobotar, para. 2), and an admission that the services were available at home is fatal (Tokarski; AB; Tallon, para. 29).
• Compute travel costs by the detailed or the simplified method, consistently. Under the simplified method, meals at $23 per meal to $69 per day and vehicles at the rate of the province where the travel begins, with a kilometre log and no receipts; accommodation always requires receipts and a reason beyond convenience (Folio S1-F1-C1, para. 1.72). Claim the patient’s meals, not the companion’s; claim a shared vehicle once; do not claim a per diem (Bell, para. 7; Sienema, para. 27; Bartlett, para. 7). Hospital parking and local transport require the 80 km distance (Keehn).
• Reduce the claim by any reimbursement entitlement. Provincial plan payments for approved out-of-country care, private insurance, and employer plans reduce the expense to the extent of the entitlement, unless the reimbursement is taxable and not deductible (paragraph (3)(b); Tessier). An employer-paid expense included in income is the employee’s own expense (paragraph (3)(a)).
• Choose the period and the claimant. Any twelve-month period ending in the year may be chosen; expenses of the spouse or partner and minor children are pooled with the claimant’s and the lower-income spouse usually claims (CRA example); each other dependant’s expenses are reduced by that dependant’s own threshold; and an expense may be claimed once, by one taxpayer, under one of section 118.2, section 64, and subsection 122.51(2).
• Exclude cosmetic procedures and their travel. Unless necessary for medical or reconstructive purposes, the procedure and “any related expenses”, including travel, are excluded; obtain the practitioner’s description of the medical purpose where a procedure is cosmetic in nature (Folio S1-F1-C1, para. 1.144).

← Regulations, forms, and electionsPlanning and dispute notes →

Planning and dispute notes

• Treatment abroad is claimable; travel abroad is claimable only on the conditions. The fees qualify under paragraph (a) if the foreign provider is authorized where the service is rendered, and the CRA so accepts (Folio S1-F1-C1, para. 1.12; Details page, “Medical services outside of Canada”). The travel qualifies only if substantially equivalent services were not available in the patient’s locality and it was reasonable to travel to that place; a lower foreign price does not satisfy either condition (Tokarski, para. 31; Yanta, para. 51). Advise patients considering medical tourism that the airfare and hotel will be refused where the same treatment is offered in their region, and that the strongest cases are those where a specialty, a specific treatment, or timely access is unavailable at home and a Canadian practitioner says so in writing.
• Wait times. The point is untested in the reported decisions. The French text of subparagraph (g)(iii) speaks of whether it is possible to obtain the services locally, and Yanta counts urgency among the circumstances relevant to reasonableness (para. 50). A claimant relying on delay should document the local wait, the medical consequences of waiting, and any provincial refusal or approval of out-of-country funding under rules such as Ontario Regulation 552, s. 28.4, which asks a different question but produces evidence on the federal one.
• The second Tallon decision shows how an abroad claim is lost. The claimant had earlier won on an unreported judgment and on an unargued point; when the Crown put every condition in issue, the absence of any physician evidence on unavailability, the admission that the specialties were available in Ontario, and the length and itinerary of the trip defeated the claim (Tallon (2017), paras. 28–38). Expect the Crown to plead all three conditions and the “medical services” point after Tallon (FCA).
• Companion costs. They depend entirely on a written certificate that the patient was incapable of travelling without an attendant; obtain it in advance. Once certified, the companion’s costs during the treatment period are claimable on the authority of Bell and Jordan, but the CRA’s example denies visits during a hospital stay and AB doubts Jordan; a companion who stays is on firmer ground than one who comes and goes.
• Informal-procedure decisions. Nearly all of the travel cases were decided under the informal procedure and have no precedential value, though they are followed in practice (Warnock, para. 12; Yanta, para. 21). Only Tallon binds, and it decides the “medical services” point and the standard of review, not the content of subparagraphs (g)(iv) and (v). A general-procedure appeal on the reasonableness test, or an appeal from Yanta, would be the first to settle it at the appellate level.
• The Charter is not a route around the list. Section 15 challenges to the pharmacist-recording rule, the 80 km rule, the moving-expense cap, and the surrogacy exclusion have all failed on the Auton principle that no benefit provided by law is denied where no one receives the credit for the item (Ali; Keehn; Breen; Zanatta), and a notice of constitutional question and a factual record are required (Bekker).
• Fertility and surrogacy across borders. Since 2022 the costs of a surrogate or donor are claimable only where incurred in Canada, and clinic and donor bank fees only where paid to a Canadian clinic or bank; a Canadian clinic’s own purchase of gametes from abroad may qualify (Folio S1-F1-C1, para. 1.146.2). Subsection (2.2) and paragraph (a) continue to cover the intended parent’s own IVF wherever obtained, subject to the travel conditions for the journey; Ontario’s new fertility credit, by contrast, requires services “provided entirely in Canada” (Taxation Act, 2007, s. 103.0.7(3)).
• Section 64 or section 118.2. A person with a disability who earns income may prefer the disability supports deduction, which reduces income rather than tax; the choice is made expense by expense and cannot be reversed by another taxpayer claiming the same expense.

← ComplianceProvincial and treaty parallels →

Provincial and treaty parallels

• Ontario. The Taxation Act, 2007, S.O. 2007, c. 11, Sch. A, s. 9(20), gives a credit at the lowest Ontario rate on “the individual’s medical expenses … that are included in determining the individual’s medical expense credit for the year under subsection 118.2(1) of the Federal Act”, above a threshold of the lesser of $2,010 (indexed) and three per cent of income, and caps each other dependant’s amount at $10,835 (indexed), a cap the federal Act dropped in 2011. Ontario therefore adopts the federal list, the travel conditions, and the federal treatment of services abroad without change. Section 103.0.7 adds a 25 per cent fertility treatment credit on up to $20,000 of expenses for goods or services “provided entirely in Canada”. Out-of-country funding under the Health Insurance Act, R.R.O. 1990, Reg. 552, ss. 28.1–28.4, requires prior written approval and that “the identical or equivalent service is not performed in Ontario” or that travel is necessary “to avoid a delay that would result in death or medically significant irreversible tissue damage”.
• Quebec. The Taxation Act, CQLR c. I-3, ss. 752.0.11 to 752.0.13.3, legislates its own list. The credit is 20 per cent of expenses above three per cent of the combined income of the individual and eligible spouse, with no dollar ceiling. Paragraphs 752.0.11.1(h) and (i) are the counterparts of federal (g) and (h), with the same 40 km and 80 km thresholds; they require “equivalent or substantially equivalent services were not available in that locality”, that the person “travelled to that place to obtain such services for himself or herself”, that “having regard to the circumstances, it was reasonable to travel to that place”, and that “the route travelled was the most reasonably direct route”, and they contain no Canada-only limit. Section 752.0.11.1.3 excludes cosmetic services and “the transportation, travel or lodging expenses paid for” them in terms. A separate credit of 20 per cent of travel and lodging to obtain in Québec care not available within 200 km (s. 752.0.13.1), and a related moving credit (s. 752.0.13.1.1), require a prescribed physician’s certificate. Sections 752.0.11.1.4 and 752.0.11.1.5 mirror federal (2.2) and (2.21); section 752.0.11.2 mirrors subsection (4).
• Alberta and British Columbia. The Alberta Personal Income Tax Act, RSA 2000, c. A-30, s. 12, and the Income Tax Act, RSBC 1996, c. 215, s. 4.5, take the federal amount in the description of B with their own rates and thresholds ($2,884 and $1,772, as indexed); British Columbia requires the same twelve- or 24-month period as the federal claim.
• Treaties. No tax treaty bears on the credit, which is a domestic computation of a resident’s tax, and the Income Tax Conventions Interpretation Act contains nothing relevant. The place-of-service rule in subsection 118.4(2) is domestic law and does not depend on any treaty.

← Planning and dispute notesAnnotated cross-references →

Annotated cross-references

• Section 64: the disability supports deduction; an expense may be claimed under section 64 or section 118.2 but not both (subparagraph 64(a)(iv); paragraphs (b) and (c) of the description of B).
• Section 117 and section 117.1: the lowest rate that is the “appropriate percentage”, and the indexing of the dollar amounts in subsection 118.2(1).
• Section 118: subsection 118(6), “dependant”, imported by subsections 118.2(1) and (2).
• Section 118.3: the disability tax credit, barred by paragraph 118.3(1)(c) where attendant or nursing home care is claimed under this section other than under paragraph (b.1), and the eligibility condition for paragraphs (b), (b.1), (b.2), (l.9), and (l.92).
• Section 118.4: “prolonged” and the basic activities of daily living (subsection (1)); the authorization rule for medical practitioners and the other professions, by the law of the place of service, residence, or supply (subsection (2)).
• Section 122.51: the refundable medical expense supplement, computed from the amount under subsection 118.2(1) and excluded from double use.
• Section 164: paragraph 164(1.5)(a), the ten-year refund request through which subsection (2.2) was applied to earlier years.
• Section 248: the definitions of “amount”, “appropriate percentage”, “common-law partner”, “individual”, “legal representative”, “prescribed”, “private health services plan”, and “taxpayer”.
• Section 252: the extended meaning of “child”; subsection 252(3) does not extend “spouse” for this section.
• Section 6: employer-paid medical benefits included in income under subsection 6(1), which paragraph 118.2(3)(a) treats as the employee’s own expense.
• Regulations 5700 and 5701, and the Reimbursement Related to Assisted Human Reproduction Regulations, SOR/2019-193: see “Regulations, forms, and elections”.

← Provincial and treaty parallelsSources →

Sources

• Income Tax Act, R.S.C. 1985, c. 1 (5th Supp.), s. 118.2: Justice Laws Website (Act current to 21 September 2026, last amended 18 June 2026), the French text, the fourteen point-in-time versions from 31 August 2004 to 20 June 2024, the amendments not in force, and sections 64, 117, 117.1, 118, 118.3, 118.4, 122.51, 248, and 252.
• Income Tax Regulations, C.R.C., c. 945, ss. 5700 and 5701; Reimbursement Related to Assisted Human Reproduction Regulations, SOR/2019-193; Interpretation Act, R.S.C. 1985, c. I-21, ss. 14, 26–28, 33, 35, 37, and 38; Income Tax Application Rules, R.S.C. 1985, c. 2 (5th Supp.), and Income Tax Conventions Interpretation Act, R.S.C. 1985, c. I-4 (searched; nothing relevant).
• Historical texts: Revised Statutes of Canada, 1985, 5th Supplement (s. 118.2 with its source note); Library of Parliament, Canadian Parliamentary Historical Resources: Bill C-139 (1988) as introduced and as reprinted after committee, with the explanatory notes reproducing former paragraph 110(1)(c), and the Commons Journals recording royal assent on 13 September 1988; Bill C-28 (1990), clause 25; Bill C-18 (1991), clause 89, and Bill C-15 (1994), Sch. II, s. 89. Parliament of Canada royal assent texts: S.C. 1994, c. 7, 1998, c. 19, 1999, c. 22, 2000, c. 12, 2000, c. 19, 2001, c. 17, 2003, c. 15, 2005, c. 19, 2006, c. 4, 2008, c. 28, 2010, c. 12, 2011, c. 24, 2013, c. 34, 2014, c. 20, 2017, c. 20, 2017, c. 33, 2018, c. 12, 2019, c. 29, 2022, c. 19, and 2024, c. 17.
• Department of Finance: Tax Reform 1987: The White Paper, pp. 30–32, and Tax Reform 1987: Income Tax Reform, p. 77 (page numbers from the OCR text); Explanatory Notes to Legislation Relating to Income Tax (May 1991), clause 89; Explanatory Notes to Legislative Proposals Relating to Income Tax and Sales and Excise Taxes (October 2011), clause 24; Budget plans for 2010, 2011, 2014, 2017, 2018, 2019, and 2022; Report on Federal Tax Expenditures 2026, Parts 2 and 6; Legislative Proposals (Technical Amendments) (23 July 2026) and Draft Legislative Proposals (15 September 2026), both read through a summarizing fetch; Technical Advisory Committee on Tax Measures for Persons with Disabilities, Disability Tax Fairness (December 2004).
• Federal Court of Appeal: Tallon, Anka, Couture, Ali, Ray (2004), Tall, Ray (2010), Dunn, Bekker, Lister, Scott, Title Estate, Weeks, Klywak, Gibson, Tessier.
• Tax Court of Canada: Yanta, Tallon (2017), Tallon (2014), AB, Tokarski, Jordan, Sienema, Johnson, Young, Bell, Chobotar, Scully, Bartlett, Mudry, Patton, Lejeune, Claussen, Demont, Bissonnette, Goodwin, Lazenby, Knechtel, Mullin, Bryce, Keehn, Pearen, McNeilly, Warnock, Zanatta, Zieber, Zaffino, Hoare, Lang, Hendricks, Barnes, Henschel, Ross, Breen, Shapiro, Chen, Breger, Mantha, Chevalier, Savoy, Andrews, Kash, Heaps, Gibson (TCC).
• Canada Revenue Agency: Folios S1-F1-C1 (with its chapter history), S1-F1-C2, and S1-F1-C3, the authorized medical practitioners page, the lines 33099 and 33199 page and the Details of medical expenses list, Guide RC4065 (2025), the meal and vehicle rates page, the T1 return (2025), Forms T2201 and T929, the IT bulletin–folio table of concordance, and the Income Tax Audit Manual, all read 1 October 2026.
• Ontario: Taxation Act, 2007 (e-Laws, consolidated from 1 July 2026), ss. 9(20), 23(1), and 103.0.7, and R.R.O. 1990, Reg. 552, ss. 28.1–28.4. Quebec: Taxation Act, CQLR c. I-3 (LégisQuébec, up to date to 10 June 2026), ss. 752.0.11–752.0.13.3. Alberta: Alberta Personal Income Tax Act, s. 12. British Columbia: Income Tax Act, s. 4.5.
• Canadian Tax Foundation items under “Policy purpose and commentary”: catalogue entries only; the site refused automated access.

← Annotated cross-references