Medical insurance premiums can normally be claimed as an itemized deduction. Itemized medical expense deductions are subject to a limitation of 7.5% of adjusted gross income. But for the self-employed, there is a special deduction that can be taken as an adjustment to income for adjusted gross income. So it is not subject to a limitation, and directly reduces the amount of your income subject to tax.
There is a worksheet in the instructions for Form 1040 to figure the amount you can deduct. This worksheet is basically for separating regular health insurance premiums from long-term care premiums, subject to the limitations per person mentioned below, and then determining the maximum amount you can deduct based on your net earnings from the business under which the health insurance plan is established. If you have more than one health insurance plan established under different businesses, you need to complete a separate worksheet for each one to determine the amount you can deduct for that particular plan.
If any of the following apply, you will need to see the instructions in IRS Publication 535 – Business Expenses, instead of the worksheet in the instructions for Form 1040:
You had more than one source of income subject to self-employment tax.
You file Form 2555 or 2555-EZ (exclusion of foreign-source earned income).
You are using amounts paid for qualified long-term care insurance to figure the deduction.
If you cannot claim a deduction for 100% of the cost of your health insurance coverage as an adjustment to income (because it exceeds your earned income), you can include any remaining premiums along with all your other deductible medical care expenses as an itemized deduction. The amount you can claim as an itemized deduction would be subject to the limit of 7.5% of adjusted gross income.
Long-term Care Insurance
Your deduction for self-employed health insurance can include premiums for qualified long-term care insurance for you, your spouse, and your dependents. But there are limits for the long-term care portion of the insurance that are defined based on each person’s age. You can claim the smaller of the actual amount you spent for each person’s coverage or the amounts established by the IRS. These limitation amounts are progressive, increasing based on the person’s age. You can find these amounts in IRS Publication 535 – Business Expenses, in the chapter on insurance expense deductions.
In general terms, in order to qualify, the long-term care insurance contract must meet the following conditions:
It must be guaranteed renewable.
It must provide that any refunds or dividends under the contract can only be used to reduce future premiums or increase future benefits.
It must not provide for a cash surrender value.
It must not pay or reimburse expenses that would normally be reimbursed by Medicare, except where Medicare is a secondary payer.
In order for the long-term care services to qualify, they must be for the diagnosis, prevention, or treatment of illnesses or medical conditions, or for the maintenance or personal care services of a chronically ill person, and must be prescribed by a licensed health care practitioner. A chronically ill individual for these purposes is someone who for at least 90 days, due to a loss of functional capacity, has been unable to perform daily living activities without substantial assistance from another person.