Health insurance premiums are deductible — but the rules are completely different depending on whether you’re self-employed or a W-2 employee. Self-employed workers get a powerful above-the-line deduction that reduces AGI directly. Employees face a much harder path. Here’s how each scenario works.
Self-Employed Health Insurance Deduction: The Better Deal
If you’re self-employed — a sole proprietor, single-member LLC, partner, or S-corp shareholder who owns more than 2% of the company — you can deduct 100% of health insurance premiums you paid for yourself, your spouse, and your dependents as an above-the-line deduction on Schedule 1 of Form 1040.
Above-the-line means it reduces your Adjusted Gross Income before you even get to itemized deductions. You don’t need to itemize to claim it, and it doesn’t count against the 7.5% medical expense floor. It comes directly off the top of your income.
What Qualifies for the Self-Employed Deduction
- Medical insurance premiums (individual or family plans)
- Dental insurance premiums
- Vision insurance premiums
- Medicare Parts B and D premiums
- Medicare supplement (Medigap) premiums
- Qualified long-term care insurance premiums (subject to age-based limits)
The Net Profit Limitation
The deduction cannot exceed your net self-employment income. If your business earned $8,000 net profit and your health insurance premiums were $12,000, your deduction is capped at $8,000. The remaining $4,000 can potentially be included in your medical expense deduction on Schedule A (subject to the 7.5% floor).
You Cannot Deduct If You Were Eligible for Employer Coverage
If you or your spouse were eligible to participate in a subsidized employer health plan at any point during a given month, you cannot take the self-employed health insurance deduction for that month. “Eligible” means the employer plan was available to you — even if you chose not to enroll.
W-2 Employees: The Harder Path
If you’re a W-2 employee and your premiums come out of your paycheck pre-tax through your employer’s Section 125 cafeteria plan, your premiums are already excluded from your taxable income. You cannot deduct them again — that would be double-dipping.
If you pay health insurance premiums with after-tax dollars — for example, buying coverage on the ACA marketplace while employed, or paying COBRA premiums — those premiums do count as qualifying medical expenses on Schedule A. But they’re subject to the 7.5% AGI floor, and you must itemize to benefit.
ACA Marketplace Coverage: The Premium Tax Credit Interaction
If you received Premium Tax Credits (subsidies) through the ACA marketplace to reduce your monthly premiums, you can only deduct the out-of-pocket portion you actually paid — not the subsidy portion. The premium tax credit and the health insurance deduction cannot both apply to the same dollars.
S-Corporation Owners (More Than 2%)
If you’re a more-than-2% S-corporation shareholder, the company can pay your health insurance premiums and include them as W-2 wages to you. You then deduct those premiums as the self-employed health insurance deduction on your personal return. The premiums need to be included in your W-2 wages in Box 1 but not Box 3 or Box 5 (they’re exempt from Social Security and Medicare taxes). This is a common setup but easy to get wrong — work with your CPA to make sure the payroll is handled correctly.
Long-Term Care Insurance: Age-Based Limits
Qualified long-term care insurance premiums are deductible as either a self-employed health insurance deduction or a Schedule A medical expense, but they’re capped based on your age at year-end:
| Age at Dec 31, 2025 | Maximum Deductible Premium |
|---|---|
| 40 or under | $480 |
| 41–50 | $900 |
| 51–60 | $1,800 |
| 61–70 | $4,810 |
| 71 or over | $6,020 |
Medicare Premiums for the Self-Employed
If you’re 65 or older, self-employed, and paying Medicare Part B and Part D premiums, those premiums qualify for the self-employed health insurance deduction. This is often overlooked by seniors who continue working or run a business after enrolling in Medicare.
For the complete picture of deductible healthcare costs — including out-of-pocket medical expenses, dental, and prescription drugs — see the medical deductions guide and use the medical expense calculator to see if your total expenses clear the 7.5% AGI threshold.