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I have had to do extensive travel for health care and the IRS recognizes well under half of medical travel costs as a medical expense. I have had years with actual costs over $30,000 and was better off taking the standard deduction.

Actually, the IRS recognizes expenses based on the laws that Congress passes, so blame your representatives, not the IRS. For travel, the mileage rate for driving your own car is only $0.17 per mile or actual expenses like gas and oil. Unlike for business travel, you don't get to include expenses like depreciation, insurance or general repairs, which is why the mileage rate for business travel is significantly higher than for medical travel. All other allowable travel expenses (like lodging, car rental or plane tickets) are recognized at their cost. And of course, there is the issue that only expenses in excess of 7.5% (or 10%, depending on the year and your age) of your AGI are deductible, and the issue that the standard deduction significantly increased with passage of the TCJA. So, yes, it's quite possible that taking the standard deduction would be better than itemizing even with over $30k in allowable expenses.

That said, for those in long term care, it's often still possible to offset some/all of the taxes on their RMD income by deducting medical expenses. So, for those who are self-insuring for the possibility of long term care, converting 100% their Traditional retirement account money to Roth is probably not the best strategy to pay the least taxes in their lifetime.

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