Is IRMAA tax deductible?
Generally yes, within narrow limits, and only for filers who itemize. IRS Publication 502 (2025 edition, for 2025 returns) treats premiums paid for Medicare Part B and Part D as medical expenses, and the Part B premium you actually pay includes any IRMAA: CMS's 2026 table shows a single combined amount per tier, running from $284.10 to $689.90 a month across the five surcharge levels. The deduction happens on Schedule A, where only the portion of total medical expenses above 7.5% of adjusted gross income counts, so a filer taking the standard deduction cannot use it at all. Pub 502 never mentions IRMAA by name; this page reports what the document says and shows the arithmetic, and a tax professional applies it to your return.
Are Medicare premiums tax deductible in general?
Mostly yes, with Part A as the exception. On Part B, Pub 502 is direct: "Premiums you pay for Medicare Part B are a medical expense." On Part D, equally direct: "You can include as a medical expense premiums you pay for Medicare Part D." Part A splits in two: the payroll tax that funded most people's coverage "isn't a medical expense," while the narrow group who enroll in Part A voluntarily, lacking the covered work history, can count what they pay for it.
| Payment | Medical expense under Pub 502? |
|---|---|
| Part A funded by payroll tax | No; the payroll tax is excluded outright. |
| Part A premium, voluntary enrollee | Yes, for those not covered under Social Security who enroll voluntarily. |
| Part B premium ($202.90 standard in 2026) | Yes, named a medical expense in so many words. |
| Part D plan premium | Yes, can be included as a medical expense. |
| Part B IRMAA | Never named. CMS bills it inside one combined Part B premium; the IRS document draws no IRMAA-specific conclusion. |
| Part D IRMAA | Unresolved. Collected separately from the plan premium, an amount Pub 502 never addresses. Ask a tax professional. |
Source: IRS Pub 502 (2025); CMS 2026 fact sheet for the premium structure.
Now the arithmetic most deductibility articles skip. Take an AGI of $60,000; the Schedule A floor is 7.5% of it, or $4,500. Twelve months of 2026's standard Part B rate come to $2,434.80 ($202.90 x 12), well short of $4,500. Even a first-tier IRMAA payer's full 2026 Part B cost, $3,409.20 ($284.10 x 12), still sits under the floor. Someone at that income whose only medical expense is the premium deducts zero; the deduction turns real when premiums stack with other large medical costs, or when AGI is low relative to the spending. The floor uses AGI, the same Form 1040 line 11 figure that IRMAA's MAGI is built from.
Can you write off IRMAA on taxes?
For Part B IRMAA, the pieces line up, though the IRS never assembles them. Pub 502 counts Part B premiums as medical expenses. And what you pay for Part B is one number, not two: CMS's 2026 table lists a first-tier total of $284.10, the $202.90 standard premium and the $81.20 surcharge combined, so the surcharge is baked into the Part B amount you hand over. What Pub 502 does not contain is any ruling on IRMAA itself: the word appears nowhere in the document. A site claiming "the IRS says IRMAA is deductible" is quoting a sentence that does not exist.
Part D IRMAA is genuinely unresolved. Unlike the plan premium you send your drug plan, Medicare collects the Part D surcharge itself through a separate channel, and Pub 502 says nothing about whether that separately collected amount counts as a Part D premium. We will not guess, and neither should any website; bring this one to a tax preparer.
Is IRMAA a tax?
No, despite how it feels. IRMAA is an adjustment to Medicare premiums created by the Social Security Act (42 U.S.C. ยง1395r(i)). SSA computes it from MAGI figures the IRS supplies, Medicare collects it through Social Security withholding or its own billing, and no line of any tax return reports or pays it. People searching for "IRMAA tax brackets" usually want the income tiers, which are laid out in full on the 2026 IRMAA brackets page. What the surcharge itself costs at each income level, before any deduction question, is what the IRMAA calculator shows, while the 2026 Part B premium page charts the standard rate's year-by-year record.
Is there a different rule for the self-employed?
Pub 502 describes a second route with no 7.5% floor. A self-employed person with a net profit "may be able to deduct, as an adjustment to income, amounts paid for health insurance," subject to conditions the publication spells out: the plan must be established under the trade or business, the deduction cannot exceed earned income from that business, and no month counts in which a subsidized employer plan was available.
Whether Medicare premiums travel that route is the part Pub 502 leaves blank; its self-employed section never names Medicare. The Form 7206 instructions and a preparer are the places to settle it.
Every quotation on this page is verbatim from IRS Publication 502 (2025), "Medical and Dental Expenses," for use in preparing 2025 returns. The IRS revises the publication annually; these quotes get re-checked when each new edition posts. The combined-premium structure is documented in the CMS fact sheet dated November 14, 2025.