Are tuition and medical payments I make for someone exempt from gift tax?

Yes. The IRS provides unlimited educational and medical exclusions that sit entirely outside the gift tax system, on top of your annual exclusion. If you pay tuition directly to the school or medical bills directly to the provider, those payments don't count as taxable gifts no matter how large, and you don't file a gift tax return for them. The catch is 'directly': you must pay the institution, not hand the money to the student or patient to pay themselves, or it becomes an ordinary gift. Tuition covers only tuition, not room, board, or books. This is a powerful, often-overlooked way for grandparents to help with college or family medical costs while shrinking a taxable estate.