Deducting Health Insurance Premiums on Your Tax Return

This deduction benefited from the new tax least for a while

a blood pressure unit on a desk with a doctor and patient in the background
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It's always nice to get a tax break for something you have little or no choice about paying. Carrying health insurance is mandatory under the terms of the Affordable Care Act, at least if you don't want to pay a tax penalty in the 2018 tax year. The Tax Cuts and Jobs Act (TCJA) repeals the penalty beginning in 2019.

The 2018 penalty isn't tax-deductible, but some taxpayers can deduct the cost of the health insurance premiums they pay. Eligibility depends on whether you’re an employee or self-employed, and whether you paid for your insurance using pre-tax dollars or post-tax dollars. It can also depend on whether you take the standard deduction or itemize. 

The Medical Expense Deduction

Health insurance costs are included among expenses that are eligible for the medical expense deduction. You must itemize to take this deduction, and it’s limited to the total amount of your overall costs that exceed 7.5% of your adjusted gross income (AGI) in 2019.

This is another change brought about by the TCJA. The threshold used to be 10%.

This rule is typically disadvantageous mathematically unless you have significant other medical expenses in addition to your insurance premiums. You can include these to help you get over the 7.5% threshold.

An Example of the Percentage Threshold

If your AGI was $60,000 in 2018 and you paid $4,500 in health insurance premiums over the course of the tax year, you can’t deduct your premiums. You didn’t pay anything in excess of 7.5% of your AGI, which works out to $4,500.

But if you also paid $3,000 in additional uninsured medical expenses, you’ve now spent a cumulative total of $7,500. This is $3,000 more than your 7.5% threshold. You can, therefore, claim that the entire $3,000 as a tax deduction. 

A Little History

The threshold was only 7.5% prior to 2013 when it increased to 10%. Even so, it remained at 7.5% for taxpayers who were age 65 or older, at least for a little while. Then, as of Dec. 31, 2016, all taxpayers were supposed to meet the 10% threshold to be able to claim this deduction regardless of age.

The TCJA restored the threshold to 7.5% retroactively for 2017 and going forward through 2018. This provision would have expired on Jan. 1, 2020, but was extended by Congress in 2019.

The Threshold Doesn't Apply to All Your Income

The good news is that this percentage does not apply to your total income, but only to your AGI. This is the number that's arrived at after you've taken certain above-the-line deductions on your 2018 and 2019 Schedule 1, reducing your total income to your taxable income.

Above-the-line deductions include things like alimony you paid—although this changes, too, in 2019 due to the TCJA. They also include certain retirement plan contributions, tuition, and student loan interest.

Your AGI will typically be less than your overall income if you can claim any of these deductions. For example, maybe you earned $60,000, but you paid your ex $16,000 in alimony in 2018. Your AGI is therefore $44,000, not $60,000, and your 7.5% threshold drops from to $4,500 to $3,300. 

Your AGI appears on line 7 of the 2018 Form 1040 before you get around to claiming itemized deductions or the standard deduction for your filing status on line 8 of the return. The IRS has revised Form 1040 to accommodate some of the changes made by the TCJA.

A Tax Deduction vs. a Pre-Tax Salary Deduction

Employees who pay for health insurance with pre-tax dollars through payroll deductions aren’t eligible to take a further deduction for these same expenses. Check your pay stubs if you’re unsure how you’re paying for insurance that's available through your employer. You're using pre-tax dollars if the deductions for insurance are made before your employer calculates your tax withholding on the balance.

This isn’t necessarily a bad thing. Paying for health insurance as a pre-tax salary deduction is actually more advantageous and will probably save you more money than taking the itemized deduction for medical expenses. Pre-tax health benefits reduce your taxable salary, and the income tax, Social Security tax, and Medicare tax that you must pay are all a percentage of that taxable salary.

So this employee benefit is effectively triple tax-free when your taxable salary is reduced by the amount of your health insurance premiums. It might even be quadruple tax-free if your state allows for pre-tax health insurance benefits at that tax level as well.

The Deduction If You’re Self-Employed

Self-employed persons can take a deduction for health insurance premiums that they pay for themselves and their dependents directly on line 16 of the 2019 Schedule 1. This is another above-the-line adjustment to income. You can enter the total of what you paid on line 16 on the first page of your 2019 tax return.

This is one of those deductions that can reduce your AGI from the total of your gross income, and you don't have to itemize your deductions to take it. It's not limited by the 7.5-percent-of-AGI rule—you can claim the entirety of what you spent on premiums, although you can’t add in any uninsured medical costs unless you also itemize—you would claim these on Schedule A along with all your other itemized deductions.

The Bottom Line

Employees benefit when health insurance premiums are deducted tax-free from their salaries without any of the limitations associated with the itemized deduction. Self-employed persons can deduct health insurance "above the line" on the first page of their 2018 Schedule 1, which also eliminates the hassle and limitations of itemizing.

Other taxpayers can deduct the cost of health insurance as an itemized deduction only if their overall medical and dental expenses exceed 7.5% of their adjusted gross incomes in 2018.

Tax laws change periodically, and you should consult with a tax professional for the most up-to-date advice. The information contained in this article is not intended as tax advice and is not a substitute for tax advice.   

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