You can write off Medicare premiums on your taxes, and there are two ways to do it. Most people claim them as itemized medical expenses on Schedule A, where only the portion of total medical costs above 7.5% of adjusted gross income counts. Self-employed taxpayers get a better route: an above-the-line deduction that reduces AGI directly, with no percentage floor to clear.
Which Medicare Premiums Count
The IRS treats premiums for every major part of Medicare as a qualifying medical expense. Part B, Part C (Medicare Advantage), Part D prescription drug coverage, and Medigap supplemental policies all qualify. Dental and vision premiums count when they’re part of a qualified health insurance plan.
Part A is free for most enrollees because they or a spouse paid at least 40 quarters of payroll tax, so there’s no premium to deduct. Enrollees who don’t qualify for premium-free Part A pay either $311 or $565 per month in 2026, and those payments are fully deductible.1Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles The payroll taxes you paid during your working years, however, are not a deductible medical expense.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses
IRMAA surcharges also count. If your income two years back put you above the threshold, the Income-Related Monthly Adjustment Amount added to your Part B and Part D premium is deductible under the same rules that apply to the base premium. At the top bracket, combined IRMAA surcharges can reach roughly $6,936 per year per person, which alone can push high earners past the 7.5% floor.1Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
The 7.5% AGI Floor on Itemized Medical Deductions
Federal law allows a deduction for medical expenses, but only the portion that exceeds 7.5% of your adjusted gross income.3Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses With an AGI of $60,000, the first $4,500 of medical costs produces zero deduction. Only dollars above that count.
To reach the floor, aggregate everything the IRS treats as a medical expense: premiums, copays, deductibles, prescription drugs, dental work, vision care, hearing aids, and long-term care costs.4Internal Revenue Service. Topic No. 502 – Medical and Dental Expenses The standard Part B premium of $202.90 a month is a strong starting point, and combined premiums for Part D, Medigap, and any IRMAA surcharges often add several thousand more per year.
Clearing the 7.5% floor still isn’t enough on its own. Itemizing only pays off if your total itemized deductions beat the standard deduction, which in 2026 is $16,100 for single filers and $32,200 for joint filers, with an extra amount for filers 65 and older.5Internal Revenue Service. IRS Releases Tax Inflation Adjustments for Tax Year 2026 Many retirees with moderate expenses find the standard deduction is the better deal, in which case Medicare premiums produce no direct tax savings through this route.
The Better Deal for the Self-Employed
Sole proprietors, partners, and S-corporation shareholders who own more than 2% of the company can deduct health insurance premiums as an adjustment to income under 26 U.S.C. ยง 162(l).6Office of the Law Revision Counsel. 26 USC 162 – Trade or Business Expenses This above-the-line deduction reduces AGI directly. There’s no itemizing requirement and no 7.5% floor.
The deduction covers Part A (when a premium is paid), Part B, Part D, Medigap, and Medicare Advantage premiums for you, your spouse, your dependents, and your children under 27. Because it lowers AGI, it can also reduce the income figures that drive other tax calculations, including future IRMAA surcharges.
Two hard limits apply. The deduction cannot exceed net self-employment income from the business that established the health plan, so a business loss or thin profit caps what you can write off. And the deduction is unavailable for any month in which you were eligible to participate in a subsidized employer plan, including one through your spouse’s employer.7Internal Revenue Service. Instructions for Form 7206 The IRS applies this month by month. Any premium amount that doesn’t qualify above the line can still go on Schedule A as an itemized medical expense, subject to the 7.5% floor.
Paying Premiums From an HSA
If you built up a Health Savings Account before enrolling in Medicare, the balance stays yours. You can’t contribute after Medicare coverage begins, but you can withdraw tax-free for qualified medical expenses.8Internal Revenue Service. Publication 969 – Health Savings Accounts and Other Tax-Favored Health Plans Once you’re 65 or older, those tax-free distributions can cover Part B, Part D, and Medicare Advantage premiums.
Medigap premiums are the exception. They’re deductible on your tax return, but they are not a qualified HSA expense.8Internal Revenue Service. Publication 969 – Health Savings Accounts and Other Tax-Favored Health Plans HSA funds also work for Medicare deductibles and copays, including the $283 Part B deductible in 2026.
Whatever you pay with tax-free HSA money cannot also be claimed as an itemized medical deduction. The same principle blocks any deduction for expenses reimbursed by insurance or an employer Health Reimbursement Arrangement.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses If a retiree HRA covers your Part B premiums, those premiums drop out of your 7.5% calculation. You get the tax benefit once.
How to Claim It
Itemizers put the total of qualifying medical expenses on Schedule A of Form 1040 and subtract 7.5% of AGI on that same form. Self-employed filers calculate the health insurance deduction on Form 7206 and carry the result to Schedule 1, line 17, which flows to the front page of Form 1040.7Internal Revenue Service. Instructions for Form 7206
Keep documentation. Form SSA-1099 from the Social Security Administration reports Part B premiums withheld from your benefits. If you pay Medicare directly, keep the billing statements and payment confirmations. Private insurers providing Part D, Medigap, or Medicare Advantage coverage send annual premium summaries. Any late enrollment penalties built into your monthly premium count toward the deductible total.