Self-Employed Health Insurance Tax Deductions: What You Need to Know

Self-employed independent contractors, referred to as sole proprietors by the Internal Revenue Service, enjoy their fair share of tax advantages. One of the nicest might be the health insurance tax deduction that the IRS reserves exclusively for them.

This isn't a deduction in the typical meaning of the term. It’s actually better than that. It’s technically an "adjustment to income." You literally pay no income tax on adjustments to income, and this one is equal to the portion of your earnings that you use to pay your health insurance premiums.

Subtracting adjustments to income from your gross income results in your adjusted gross income or AGI, and a lower AGI can qualify you for other tax breaks.

The IRS always imposes multiple qualifying rules whenever it offers tax breaks. You can’t just hang out your shingle, declare that you’re self-employed and claim the self-employed health insurance deduction. Your business must actually show a net profit on Schedule C of your tax return.

Neither can you say, “No thanks” to paying for any other insurance coverage for which you might qualify. You can't pay for your own so you can claim this adjustment to income if you have other options. You won’t qualify for the self-employed health insurance tax deduction if you additionally hold down a regular job and your employer is willing to provide you with insurance coverage. You’re obligated to accept that perk rather than purchase your own self-employed policy.

The same applies if you’re married and you could be covered on a policy provided to your spouse through their employer. COBRA insurance availability will disqualify you, too, because that medical insurance is an offshoot of your previous employment.

On the bright side, a single month of available employment coverage won’t steal your self-employed health insurance adjustment to income for the whole year. You can still claim the deduction for premiums paid from February through December if you had alternate options in January, or in any other number of months. You can claim it for a single month if that’s the only period of time when you had to pay for your own coverage.

The rules for qualifying coverage are rather generous. Insurance policies covering medical, vision and dental care are obviously included, but so are certain long-term care policies, subject to an additional rule. Medical care policies can cover your child up to ​27 years​ of age, even if they’ve aged out from qualifying as your dependent for other tax purposes. They can cover your spouse and younger children as well.

You can purchase the health insurance policy personally, or you can do it in the name of your business.

An additional rule applies to long-term care policy coverage. Yes, this coverage is eligible for the self-employment health insurance adjustment to income, but it’s one of those issues where youth is not on your side. Older is better.

These premiums can be limited depending on your age. For example, you can only deduct ​$450​ of payments you make toward this coverage if you’re age ​40​ or younger as of tax year 2021, the return you'll file in 2022. This increases to:

• ​$850​ up to age ​50​
• ​$1,690​ up to age ​60​
• ​$4,520​ up to age ​70​
• ​$5,640​ if you’re age ​71​ or older

These limits are per year, not per month.

You’re not limited to operating as a sole proprietor or an independent contractor in order to claim this tax break. The scope of the self-employed health insurance deduction reaches to a couple of other business entities as well.

You can claim it if you’re a partner in a partnership or you’re a member of an LLC. These types of businesses don’t technically pay income taxes of their own. Their profits and losses trickle down or “pass through” to their partners and members, who must then report the income or losses on their own personal tax returns. This rule qualifies them for the health insurance adjustment to income.

You might also qualify if you own more than ​2 percent​ of an S corporation and you were paid wages, but check with a tax professional to be sure because various complicated rules apply here.

Health insurance premiums have been 100 percent deductible for the self-employed since 2003, which isn’t the case for taxpayers who work for an employer. You can deduct ​$500​ a month if you spend ​$500​ a month on qualifying insurance premiums – the full ​100 percent​ of what you spent – but subject to that net income rule.

You can’t claim a ​$6,000​ deduction for paying ​$6,000​ in premiums if your business’s net income for the year was just ​$5,000​. That other ​$1,000​ can potentially go unused, although you have one more option to try to claim a portion of that as well.

The IRS imposes one more limitation here. You can’t add their net profits together to reach ​100 percent​ deductibility of your premiums if you’re lucky enough to have two or more self-employment gigs. The adjustment to income isn’t based on the net profit you show on Schedule C with your Form 1040 tax return for all your businesses collectively. You would have to apply the adjustment to income to just one of your enterprises, whichever has sufficiently high net income to take advantage of the ​100-percent​ deduction.

Your AGI is a direct reflection of your taxable income. You would be taxed on only ​$50,000​ of earnings if your gross income is ​$75,000​ but you’re eligible to claim ​$25,000​ in these income adjustments “above the line." You can then ​additionally​ itemize other deductions or claim the standard deduction for your filing status after you arrive at your AGI, further reducing that $50,000.

Other expenses that fall into this category include a portion of your self-employment tax, alimony you might have paid under a divorce decree or order that was entered prior to 2019, student loan interest and contributions you made to an IRA.

Qualifying for numerous other tax breaks can depend on your AGI. You can be prohibited from claiming them if your AGI is too high. Some of these affected deductions and credits include:

• The Lifetime Learning education tax credit
• The American Opportunity education tax credit
• The Child Tax Credit
• The Child and Dependent Care Tax Credit
• The Earned Income Tax Credit
• The Savers Tax Credit
• The itemized medical expense deduction

​Read more:​ What Are Self-Employed Taxes?

You must file Schedule 1 with your tax return to claim the self-employed health insurance adjustment to income, but this isn’t really a challenge. Simply enter the total of your qualifying premiums on ​line 17​ in Part II of the tax year 2021 tax schedule, then transfer the total of Part II, found on ​line 26​ of Schedule 1, to ​line 10​ of your 2021 Form 1040 tax return. Submit Schedule 1 with your tax return.

That’s it. You don’t have to deal with this deduction on your Schedule C, which you’d also have to file as a self-employed taxpayer to report your gross income from self-employment less certain allowable business expenses. The downside to this is that the deduction won’t reduce your self-employment taxes, but only your income tax liability.

Compare this adjustment to income to the deduction you would be entitled to claim for insurance premiums if you worked for someone else. You could still deduct your health insurance premiums in this case, but you'd have to itemize your deductions, forgoing the standard deduction for your filing status which could very well be higher.

The standard deductions increased pretty significantly under the terms of the Tax Cuts and Jobs Act, effectively doubling back in 2018. You’re entitled to a standard deduction of ​$12,550​ for the 2021 tax year if you’re single, so you’d need at least ​$12,551​ in overall itemized deductions to make itemizing worth your while. Otherwise, you’d be paying tax on more income than you have to.

And you can only claim a deduction for your premiums and your actual medical expenses that exceed ​7.5 percent​ of your AGI. Yes, your AGI factors in here, too, so higher isn’t better. Your deduction would be limited to ​$2,250​ of that ​$6,000​ you spent on insurance premiums all year if your AGI was ​$50,000​. The ​7.5 percent​ of your AGI threshold works out to ​$3,750​, and you can only claim a deduction for the costs of your premiums in excess of this amount if you're not self-employed.

​Read more:​ Are Medical Expenses Deductible? What You Need to Know

There’s no rule that says you can’t deduct up to the amount of your net business profit as an adjustment to income on Schedule 1, then apply anything that's left over to an itemized deduction on Schedule A, the tax form you’d have to file if you were going to itemize. And you can include any unreimbursed medical expenses you paid on Schedule A as well, increasing the odds that you can surpass that ​7.5 percent​ of your AGI when everything’s added together.

There’s an important caveat here, however. You can’t deduct ​$5,000​ of your insurance premiums as a Schedule 1 self-employed health insurance adjustment to income, then claim the full ​$6,000​ in premiums as an itemized deduction on Schedule A as well. That’s double-dipping. You’re limited to claiming the first ​$5,000​ as a self-employed adjustment to income, then applying the ​$1,000​ balance to your itemized medical expenses deduction on Schedule A.

And, of course, you’d need enough in the way of itemized deductions overall to exceed the available standard deduction for your filing status.

​Read more:​ Schedule A: Instructions on How to Itemize Deductions