Premiums for Medicare health insurance can add up to a substantial sum. That’s especially true if

• you have a high income, and

• you’re married and both you and your spouse are paying premiums.

Fortunately, the premiums can potentially help your tax situation. The dollar benefit of Medicare tax deductions depends greatly on where you can deduct the premiums:

• The business deduction produces the maximum tax benefit.

• The self-employed health insurance deduction on line 29 of Schedule 1 of your Form 1040 produces the second-best benefit.

• The itemized deduction is either useless or produces the third-best benefit.

Number 1: The Business Deduction

You flat out get the best dollar benefit from your Medicare and supplemental insurance premiums when you can deduct them as business deductions.

You can make this happen when:

• You are the sole owner and only employee of your C corporation.

• You operate as a sole proprietorship or single-member LLC, and your spouse is your only employee.

• You operate as a C corporation and have 20 or fewer employees to whom you offer group health insurance.

• You operate as a C corporation, either you or your spouse is an employee, and you offer a qualified small employer health reimbursement arrangement (QSEHRA).

Second Best: Self-Employed Health Insurance Deduction

If you are self-employed as a sole proprietor, an LLC member treated as a sole proprietor for tax purposes, a partner, an LLC member treated as a partner for tax purposes, or an S corporation shareholder-employee, you can potentially claim an above-the-line deduction for your health insurance premiums—including Medicare premiums.

You don’t need to itemize deductions to get the tax-saving benefit from this above-the-line self-employed health insurance deduction. According to IRS Publication 535 (Business Expenses), the health insurance coverage must be established or considered to be established for your business as per the following explanations.

If You Are a Sole Proprietor 

If you are a sole proprietor or an LLC member treated as a sole proprietor for tax purposes who files Schedule C, a health insurance policy can be in the name of your business or in your own name. Premiums you pay for Medicare health insurance in your name can be used to figure the above-the-line deduction for self-employed health insurance.

If You Are a Partner 

If you are a partner or an LLC member treated as a partner for tax purposes, a health insurance policy can be either in the name of the partnership (LLC) or in your own name. You can pay the premiums yourself, or the partnership (LLC) can pay them and report the premium amounts on your Schedule K-1 as guaranteed payments that you must include as income on your Form 1040.

But if the policy is in your name and you pay the premiums yourself, the IRS says the partnership (LLC) must reimburse you and report the premium amounts on your Schedule K-1 as guaranteed payments that you must include as income on your Form 1040. Otherwise, the IRS says the insurance won’t be considered established for your business and you will not qualify for the deduction. The tax code allows the partnership (LLC) to deduct its guaranteed payments.

If You Are an S Corporation Shareholder-Employee 

If you are a shareholder-employee who owns more than 2 percent of the S corporation, a health insurance policy can be either in the name of the S corporation or in your own name. You can pay the premiums yourself, or the S corporation can pay them and report the premium amounts on your Form W-2 as additional taxable wages.

But if the policy is in your name and you pay the premiums yourself as you would for your Medicare coverage, the IRS says the S corporation must reimburse you and report the premium amounts on your Form W-2 as additional taxable wages. Otherwise, the IRS says the insurance won’t be considered established for your business.

What about a Spouse’s Medicare? 

In guidance, the IRS makes it clear that the S corporation and the partnership can reimburse to the shareholder-employee the spouse’s Medicare payments, and that reimbursement establishes the insurance in the business’s name. The S corporation then adds the reimbursement to the shareholder’s W-2, and the partnership treats the reimbursement to the partner as a guaranteed payment.

The treatment described above creates the tax deuction for the spouse’s cost of Medicare (including supplemental insurance). If you operate as a proprietorship, we recommend having the proprietorship reimburse the nonowner spouse to establish the Medicare insurance in the name of the business.