Is IRMAA tax deductible?

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.

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 floor uses AGI, the same Form 1040 line 11 figure that IRMAA's MAGI is built from.

How does the Schedule A medical-expense deduction actually work?

The rule is a threshold, quoted straight from Pub 502: "You can deduct on Schedule A (Form 1040) only the part of your medical and dental expenses that is more than 7.5% of your adjusted gross income (AGI)." Everything up to that 7.5% line is yours to pay with no tax benefit; only the dollars past it enter the deduction. Schedule A also has to earn its place: its medical line reaches the return only when your itemized deductions add up to more than the standard deduction, so itemizing is the gate that opens before the 7.5% floor even matters.

One more clause in Pub 502 governs the rest of this page: "You can't include in medical expenses insurance premiums that were paid and for which you are claiming a credit or deduction." A premium already deducted somewhere else cannot be counted a second time on Schedule A. Hold that thought for the self-employed route below.

Put real figures against the floor. Take a single filer who itemizes, AGI $80,000, so the 7.5% floor is $6,000. Say their income lands them in the second IRMAA tier: 2026 Part B runs $405.80 a month, or $4,869.60 across the year, and on top of a Part D plan premium comes the tier-2 Part D surcharge of $37.50 a month. Add those premiums together and they still fall below $6,000, so the premiums on their own deduct nothing. The deduction opens only once they combine with other medical spending, dental work, long-term-care premiums, out-of-pocket bills, and the running total pushes past $6,000; the amount above the line is what Schedule A allows. Drop the identical premiums onto a filer whose AGI is $40,000, and the floor is only $3,000, which the premiums clear on their own.

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. §1395r(i)). SSA computes it from MAGI figures the IRS supplies, 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.

What Pub 502 leaves unstated, the Form 7206 instructions (2025 edition, last reviewed 30 April 2026) answer. Form 7206 is the form that computes this deduction, and it says: "Medicare premiums you voluntarily pay to obtain insurance in your name that is similar to qualifying private health insurance can be used to figure the deduction." Medicare premiums here reach Part B and Part D, and because the amount paid for each already has any IRMAA folded into it (the table above shows CMS billing one combined number), the surcharge rides along inside the premium the form points to. The result reports on Schedule 1 (Form 1040), line 17, an adjustment taken before AGI is set, so the 7.5% floor never enters. The wording is "Medicare premiums," not "IRMAA"; the form reaches no conclusion about the surcharge by name, and neither do we past what the premium arithmetic already shows.

Here the anti-double-dip clause earns its keep. A premium taken on line 17 has been deducted once, and Pub 502 forbids counting it again on Schedule A. Run the tier-2 case a second time from the self-employed side: the $4,869.60 of annual Part B, IRMAA included, plus the Part D plan premium and its $37.50 monthly surcharge, come off income in full on line 17, limited only by earned income from the business, with no floor to clear first. The same dollars on Schedule A mostly disappeared under the $6,000 threshold. One filer, one premium bill, and the result turns on which line of the return carries the deduction.

Can you pay Medicare premiums (and their IRMAA) from an HSA?

Yes, if you were 65 or older, with one named exception. IRS Publication 969 (2025 edition) lists what a health savings account is allowed to cover, and the list includes "Medicare and other health care coverage if you were 65 or older (other than premiums for a Medicare supplemental policy, such as Medigap)." Applied to Medicare, that makes an HSA distribution used to pay a Part B or Part D premium, and the IRMAA carried inside it, a tax-free qualified distribution at 65 or older. The exception the text names is Medigap: premiums for a Medicare supplement policy cannot be paid tax-free from an HSA.

This is a payment source, not a deduction, which makes it a third mechanism apart from the two above. You are spending pre-tax dollars on the premium bill rather than writing the premium off, and a premium paid with tax-free HSA money is not then available to deduct on Schedule A or line 17. It is also a different lever from the other place HSAs meet IRMAA: a qualified HSA distribution stays out of the MAGI that fixes your tier, which the guide to lowering IRMAA handles on the income side. That is about the income the surcharge is measured against; this is about paying the bill it produces.

The quotations here come word for word from three IRS documents, each for the 2025 tax year: Publication 502, "Medical and Dental Expenses"; the Instructions for Form 7206, "Self-Employed Health Insurance Deduction"; and Publication 969, "Health Savings Accounts and Other Tax-Favored Health Plans." All three are reissued every year, and each quote gets checked again as the next edition of each one posts. The combined-premium figures come from the CMS fact sheet dated November 14, 2025.