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Medicare premiums can be tax deductible, but the route depends on how you earn your living. A self-employed person still working past 65 can often deduct every Medicare premium above the line, including Medigap and the IRMAA surcharge. A retired person with no self-employment income can deduct premiums only by itemizing, and only on medical costs above 7.5% of adjusted gross income. Someone who takes the standard deduction and has no self-employment income gets no tax benefit from Medicare premiums at all. The premiums are the same. The tax result is not.
This guide explains each route using the IRS rules in Publication 502 and the self-employed health insurance deduction, so you can see which one fits your return.
The self-employed deduction
The self-employed health insurance deduction lets you deduct premiums for yourself, your spouse, and your dependents as an adjustment to income. You do not need to itemize to claim it. The IRS treats Medicare as health insurance for this purpose, so the deduction covers premiums for Part A if you pay one, Part B, Part D, Medicare Advantage, and Medigap policies. IRMAA surcharges count too, because they are part of the premium.
Three limits apply. The deduction cannot exceed the net profit from the self-employment activity under which the plan is established. You cannot claim it for any month you were eligible to participate in a subsidized employer health plan, including one offered by a spouse’s employer. And you cannot deduct the same premiums twice: amounts deducted here cannot also appear as itemized medical expenses on Schedule A. Excess premiums above your net profit can still go on Schedule A, subject to the 7.5% floor below.
At 2026 prices the stakes are easy to see. Part B at the standard rate is $2,434.80 a year. Add a Medigap Plan G policy at $180 a month and a Part D plan at $35 a month and the household premium total passes $5,000 a year. Deducted above the line, that reduces taxable income dollar for dollar and also lowers the adjusted gross income that other parts of your return depend on.
The itemized route: Schedule A and the 7.5% floor
Retirees without self-employment income use the medical expense deduction. Medicare premiums for Parts A, B, and D, Medicare Advantage premiums, and Medigap premiums all count as medical expenses under IRS Publication 502. So do your deductibles, coinsurance, dental work, hearing aids, and long-term care services that qualify.
The catch is the floor. You deduct only the total that exceeds 7.5% of your adjusted gross income, and only if all your itemized deductions together beat the standard deduction. A retiree with $60,000 of adjusted gross income gets no benefit from the first $4,500 of medical expenses. Premiums alone rarely clear the floor. Premiums plus a year with dental implants, hearing aids, or a hospital stay often do. This is why bunching discretionary medical spending into a single tax year is a standard planning move for retirees near the threshold. It is also worth checking whether premiums paid by direct bill get counted even when they are deducted from a Social Security check. They do. The deduction follows who bears the cost, not the payment method.
Paying premiums from an HSA
If you built a health savings account while working, you can no longer contribute once you enroll in Medicare, but the balance remains available. HSA money comes out tax-free when it pays for qualified medical expenses, and Medicare premiums for Part A, Part B, and Part D, including IRMAA amounts, qualify. You can reimburse yourself years later for premiums you already paid, as long as the HSA existed when the expense was incurred and you kept records.
One premium does not qualify: Medigap. The IRS excludes Medicare supplemental policies from HSA payment, so Medigap premiums must be paid from regular funds even if every other premium comes from the HSA. Do not deduct premiums you paid with HSA money. Tax-free payment and a deduction cannot both apply to the same dollar.
What does not work
Premiums you did not pay cannot be deducted. If a Medicare Savings Program pays your Part B premium, that amount is not your expense. Premiums paid with pre-tax money through an employer plan were never in your taxable income, so there is nothing to deduct. And life insurance, disability insurance, and hospital indemnity policies that pay fixed cash amounts are not deductible medical insurance under these rules, no matter how they were marketed. Our guide to Medicare Savings Programs covers the help available if premiums strain the budget in the first place.
Keeping the records
Save your Social Security statement showing Part B premiums deducted, your Part D and Medigap premium notices, and any IRMAA determination letters. If you are self-employed, keep the Schedule C or other proof of net profit that supports the deduction amount. Tax software handles the arithmetic, but it cannot reconstruct a premium total you never documented. If your situation mixes self-employment income, a working spouse with employer coverage, and IRMAA, the interactions are fiddly enough that a tax professional earns their fee. The premium amounts themselves are in our guides to Part B premiums in 2026 and total Medicare costs in 2026.
