Newsroom · Grand Junction

Can I Deduct Medicare Premiums on My Taxes in 2026?

The premiums qualify. Whether you get to deduct them is a different question — and for most retired households the answer turns on one number.

Medicare On Main Data Desk

Published August 13, 2026 · 9 min read · Reviewed by Brian Penner

Every year around now, somebody sits down across from me in Grand Junction with a shoebox and a reasonable question: I paid Medicare more than two thousand dollars this year — do I get to write that off? The internet answers with a cheerful "yes!" and stops there, which is how people end up disappointed at the CPA's office in March.

The premiums genuinely qualify. The IRS is not ambiguous about it. What the cheerful articles leave out is that qualifying is step one of three, and most retired households stop at step two. So here is the whole staircase, with the numbers, and then the two side doors that a lot of higher-income retirees on the Western Slope can actually use.

Step one: which Medicare premiums count

Nearly all of them, with one exclusion that catches people off guard. Publication 502 handles Schedule A; Publication 969 handles what a health savings account can pay for. They don't agree on everything:

Sources: IRS Publication 502: Medical and Dental Expenses · IRS Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans.

Two lines deserve a second look. Part A is only deductible if you actually pay a premium for it — Pub. 502 covers the case where you "aren't covered under social security" and "voluntarily enroll in Medicare Part A." If you have your 40 quarters and Part A is premium-free, there is nothing there. And the Medicare tax that came out of every paycheck for forty years is a tax, not a premium; it never appears on Schedule A.

Medigap is the other one. It's perfectly deductible on Schedule A, and it is specifically excluded from what an HSA can pay tax-free — Pub. 969 lists "premiums for a Medicare supplemental policy, such as Medigap" as not qualifying. A Medicare Advantage premium can come out of an HSA; a supplement premium can't. If you're weighing Medigap against Medicare Advantage and you carry an HSA balance into retirement, that asymmetry is a real line item, not a footnote.

Step two: the 7.5% floor, which is where most people stop

IRS Topic 502 sets the rule plainly: you may deduct medical and dental expenses "to the extent these expenses exceed 7.5% of your adjusted gross income for the year." Everything under that line is invisible. Here's what the line actually is at incomes we see across Mesa County, next to what a couple pays in Part B premiums alone at the standard 2026 rate:

Floor per IRS Topic No. 502, Medical and Dental Expenses. Part B figured at the standard 2026 premium of $202.90/month per person, per CMS: 2026 Medicare Parts A & B Premiums and Deductibles; your premium may differ with IRMAA.

What 7.5% of AGI costs you before the first deductible dollar

Calculated from the 7.5% threshold in IRS Topic No. 502, Medical and Dental Expenses.

Notice the shape of it. The floor rises with income, but Medicare premiums don't rise nearly as fast — so the more comfortable the household, the harder this deduction is to reach on premiums alone. A couple at $60,000 is most of the way there with Part B by itself. A couple at $200,000 needs to find $15,000 of medical spending before anything counts, and even a full year of Part B, IRMAA, two Plan G supplements and two drug plans may not get there without a hospital-sized event on top.

Step three: itemizing has to beat the standard deduction

This is the gate almost nobody accounts for. Clearing the 7.5% floor gets you a number to put on Schedule A. It does you no good unless everything on Schedule A together — medical above the floor, state and local taxes, mortgage interest, charitable gifts — comes out larger than the standard deduction you'd get for free.

For 2026 the IRS set the standard deduction at $16,100 for single filers and married filing separately, $32,200 for married filing jointly, and $24,150 for heads of household. Taxpayers 65 and older add a further amount on top of that, and separately, the enhanced senior deduction enacted in 2025 gives an additional $6,000 per qualifying individual age 65 or older for tax years 2025 through 2028 — available whether you itemize or not, and phasing out once modified AGI passes $75,000 for a single filer or $150,000 for joint filers.

Read that last clause carefully if you're a higher-income retiree, because it cuts in an unhelpful direction: the households most likely to have the income to itemize are the same households phasing out of the senior deduction. Two different rules, moving opposite ways, on the same tax return. That's the sort of thing worth modeling with a CPA in November rather than discovering in April.

The first side door: self-employment

Here's the one that pays, and it's more common on the Western Slope than the national coverage suggests. Plenty of people around Grand Junction, Fruita and Palisade never fully stopped working — the consultant who kept three clients, the couple still running orchard acreage, the tradesman who held onto his license. If you have net self-employment income, the rules change entirely.

IRS Topic 502 describes the self-employed health insurance deduction as "an adjustment to income, rather than an itemized deduction, for premiums you paid on a health insurance policy covering medical care." Two words there carry the whole benefit. Adjustment to income means it comes off before AGI is calculated, which means you take it whether or not you itemize, and you never confront the 7.5% floor at all. Medicare premiums can be included.

The limits are real and they're where this gets decided in practice: the deduction can't exceed your net earnings from that business, and it's unavailable for any month you were eligible to participate in a subsidized health plan through an employer — including your spouse's employer. If your spouse is still at a job with coverage, that alone can close the door. Take the specifics to your tax preparer; this is a question with a right answer, and it's theirs to give.

There's a bonus buried in it, too. Because an adjustment to income reduces AGI, and because IRMAA is calculated from AGI two years back, this is one of the few Medicare-related deductions that can actually move your future Medicare premium. An itemized medical deduction on Schedule A cannot — it lands after AGI is already fixed.

The second side door: your HSA

If you carried a health savings account into retirement, it can pay Medicare premiums with money that was never taxed going in and isn't taxed coming out. Publication 969 permits tax-free distributions at 65 or older for "Medicare and other health care coverage," naming Parts B, C and D — with the Medigap exclusion noted above.

The constraint is on the other end, and it's absolute: "Beginning with the first month you are enrolled in Medicare, your contribution limit is zero." Once you're on Medicare, the account stops growing from contributions and becomes a spend-down bucket. That makes the timing of enrollment consequential for anyone still working past 65 with an HSA-qualified plan — including the six months of retroactive Part A that can attach when you claim Social Security. We walk through that trap in our HSA and Medicare coordination guide.

Why Mesa County households do sometimes clear the floor

None of the above means the deduction is theoretical. The households that reach it are the ones with a genuinely expensive medical year — and the local health picture explains why that's not rare here:

Chronic-condition rates among Mesa County, Colorado adults

Source: CDC PLACES, 2023 — via the Medicare On Main Data Desk. Model-based prevalence among adults, 2023.

About one in four Mesa County adults lives with high blood pressure (26.6%), 8.1% have diagnosed diabetes, and 5.2% have coronary heart disease. A year that includes a cardiac procedure, a joint replacement, months of skilled rehabilitation, or the kind of dental and hearing work Medicare doesn't cover at all can push a household well past 7.5% — and past the standard deduction with it. Keep every receipt during a year like that, because you won't know until December whether it mattered.

And note what's not on the list of qualified expenses: long-term custodial care isn't covered by Medicare in the first place, though qualified long-term care insurance premiums are deductible up to an age-indexed annual cap. That's a separate planning conversation, and we keep it here.

What to actually do before you file

1. Total your real Medicare cost for the year — Part B (including any IRMAA), Part D, and your supplement or Advantage premium. Your Social Security benefit statement shows what was withheld.
2. Do the 7.5% math on your own AGI before you organize anything else. If your total medical spending isn't near that line, you can stop here with a clear conscience.
3. Ask your preparer about the self-employed deduction if you have any net self-employment income at all. It's the version of this that doesn't require itemizing.
4. If you have an HSA, use it for premiums — Parts B, C and D, not Medigap — and stop contributing the month Medicare starts.
5. Check Colorado separately. The state has its own subtractions for retirement income; the Colorado Department of Revenue keeps the current rules on its retirees page. State treatment doesn't follow federal automatically.
6. Send your CPA real premium figures, not estimates. We'll produce them for you in an afternoon at no charge.

How we know all this: the Medicare On Main Data Desk frames every article with public data — here, IRS Publication 502 for the treatment of Medicare Part A, Part B and Part D premiums and qualified long-term care insurance premiums as medical expenses; IRS Topic No. 502 for the 7.5%-of-AGI threshold, the Schedule A itemizing requirement, and the self-employed health insurance deduction as an adjustment to income; IRS Publication 969 for what an HSA may pay tax-free at 65 or older, the Medigap exclusion, and the zero contribution limit once Medicare begins; the IRS tax year 2026 inflation adjustments for the standard deduction amounts and the IRS guidance on the enhanced senior deduction, its $6,000 amount, its 2025–2028 window and its modified-AGI phase-out; CMS for the standard 2026 Part B premium of $202.90; and CDC PLACES (2023) for Mesa County chronic-condition prevalence. Medicare On Main is an insurance agency, not a tax firm, and nothing here is tax advice — the limits, phase-outs and interactions above turn on facts specific to your return, so confirm all of it with a licensed tax professional. This is education, not advice; confirm your plan, costs, and eligibility with a licensed agent or Medicare.gov. We take no payment from any carrier to feature a plan.