Schedule A

Schedule A Medical Expenses Worksheet 2018 Line 1 • Keep for your records Name(s) Shown on Return Social Security Number 1 Prescription medications 2 Health Insurance premiums: a Premiums other than self-employed health insurance or reported on a 1095-A . . . b From Form(s) 1095-A - net of adjustments Taxpayer's portion of 1095-A premiums (total less spouse) . . . Spouses portion of 1095-A premiums. enter the amount for the spouse, the remaining goes to the taxpayer c Medicare premiums d From Form(s) 1099-R NOTE: If LTC premiums are associated with a specific business activity, enter them directly on the applicable Self-Employed Health and Long-Term Care Insurance Deduction Worksheet, not on lines 2e - 2j below. e Taxpayer's gross long-term care premiums t Taxpayer's allowable long-term care premiums g Spouses gross long-term care premiums h Spouses allowable long-term care premiums I Dep or child under 27 gross long-term care premiums . j Dep or child under 27 allowable long-term care prem. . 2e t 9 h k Total allowable long-term care premiums. sum of lines 2f, 2h, and 2j I Taxpayer's long-term care premiums not deducted as an adjustment to income. . m Spouses long-term care premiums not deducted as an adjustment to income. . . n Dependent's long-term care premiums not deducted as an adj to income o Other self-employed health insurance not deducted as an adj to income 3 Fees for doctors, dentists. etc 4 Fees for hospitals, clinics, etc 5 Lab and x-ray fees 6 Expenses for qualified long-term care 7 Eyeglasses and contact lenses 8 Medical equipment and supplies 9 Medical transportation expenses: a Medical miles driven 9 a b Multiply the number of miles on line 9a by 18 cents per mile c Other medical transportation costs not included above for example: ambulance fees d Total medical transportation expenses (add lines 9b and 9c) 10 Lodging for medical purposes (up to $50 per night per person) 11 Other medical and dental expenses: a b d e 9 h J 12 Total of medical and dental expenses (add lines 1 through 11j) 13 a Less: insurance reimbursement for any expenses listed b Less: medical savings account (MSA) or health savings account (HSA) distributions 14 Total deductible medical and dental expenses. Subtract lines 13a plus 13b from line 12 (to Schedule A, line 1) 2a d k m n 0 b 4 5 6 7 9d 10 11 a b d e 9 h 12 13a b 14 EFTA01222132