Splitting Medical Expenses Between Spouses Ireland 2025: Optimal Strategy

Revenue-compliant guidance — Based on Revenue Tax and Duty Manual Part 15-01-12 (s.469 TCA 1997). Updated for 2025.

Under section 4.6 of Revenue's Tax and Duty Manual Part 15-01-12, where more than one person contributes to the cost of qualifying health care, each person can claim only the portion they personally paid. This means the split between spouses (or between siblings for a parent's nursing home) directly affects the total family tax benefit — particularly for nursing home fees, where the marginal rate applies.

Key Facts at a Glance

• ✓Each spouse claims only the costs they personally paid.
• ✓For standard 20% expenses, the split between spouses is neutral in terms of total relief.
• ✓For nursing home fees (marginal rate), the higher-rate taxpayer should pay as much as possible.
• ✓Where a joint account is used, Revenue accepts either spouse claiming the full amount or splitting.
• ✓Siblings sharing a parent's nursing home costs each claim their own portion at their own marginal rate.

The general rule: each person claims what they paid

Revenue's health expenses guidance at s.4.6 of Part 15-01-12 states clearly: where more than one person contributes to qualifying health care costs, each person can claim only the amount they personally paid. This is the fundamental rule that governs all shared medical expense arrangements — between spouses, between siblings, or between any other contributors.

For standard 20% health expenses (GP, prescriptions, consultant, physio etc.), the marginal tax rate is the same for all standard-rate taxpayers. In this case, whether one spouse claims all expenses or they split them evenly makes no difference to the combined total relief — the result is 20% regardless.

When the split matters: nursing home fees at the marginal rate

The split becomes critically important for nursing home fees, because these are relieved at the individual's marginal rate — 40% for a higher-rate taxpayer or 20% for a standard-rate taxpayer. The higher the proportion paid by the higher-rate taxpayer, the greater the total family tax benefit.

For example, where one spouse earns above the 40% threshold and the other does not, and they are contributing equally to a parent's nursing home fees of €20,000 per year (€10,000 each): the higher-rate taxpayer claims €10,000 at 40% = €4,000; the standard-rate taxpayer claims €10,000 at 20% = €2,000. Combined family refund: €6,000. If instead the higher-rate taxpayer paid €16,000 and the standard-rate taxpayer paid €4,000: the higher-rate taxpayer claims €16,000 at 40% = €6,400; the other claims €4,000 at 20% = €800. Combined: €7,200 — €1,200 more from the same total spend.

Practical structuring for maximum relief

Where one spouse is a higher-rate taxpayer and the other is not, and both are contributing to nursing home costs:

• Have the higher-rate taxpayer pay as much of the nursing home contribution as practically possible from their own income or account.
• Keep a record of who paid what, with bank statements confirming the payments.
• Each spouse claims their own contribution — the higher-rate taxpayer will receive 40% and the standard-rate taxpayer 20% on their respective amounts.

Joint accounts and shared expenses

Where expenses are paid from a joint account, it is generally accepted by Revenue that either spouse can claim the qualifying amount. If both are claiming, they should split the total between them. In practice, for administrative simplicity, many couples have one spouse claim all qualifying health expenses from the joint account — this is fine for standard 20% expenses. For nursing home fees from a joint account, Revenue may accept either arrangement but structuring the payment to come from the higher-rate spouse's sole account avoids any ambiguity.

Siblings sharing a parent's nursing home costs

The same principle applies to siblings contributing to a parent's nursing home placement. Each sibling claims their own contribution at their own marginal rate. The sibling with the highest income tax rate should — where feasible — pay the largest share of the nursing home contribution to maximise the combined family relief. A family discussion about who makes which payments before the care arrangement begins can result in significantly better combined outcomes.

Scenarios

Common Mistakes to Avoid

• ✗Assuming the split of standard 20% expenses matters when both spouses are standard-rate taxpayers.
• ✗Not restructuring nursing home payment arrangements to maximise the higher-rate taxpayer's contribution.
• ✗Paying all nursing home costs from a joint account without ensuring the higher-rate taxpayer's name is on the payment trail.

When This Relief Does Not Apply

Key Takeaways

• ➤The split of standard 20% expenses between spouses has no impact on total relief — but for nursing home fees at marginal rate, having the higher-rate taxpayer pay more can save thousands.
• ➤Document who paid what — bank statements showing who made nursing home payments support the individual claims.
• ➤Siblings sharing a parent's nursing home costs should structure payments to maximise the combined family benefit.

Frequently Asked Questions

Related Guides

• nursing home fees tax relief
• Fair Deal scheme tax relief guide
• claiming for elderly parents
• claiming for any family member
• complete guide to medical expenses relief