Yes. Medicare premiums are a qualifying medical expense, including the IRMAA surcharge. The catch is that there are two ways to claim them and only one tends to be worth anything. The itemized route is blocked for most retirees by a floor set at 7.5% of income. The self-employed route works far better, and it is the only one that also lowers your future IRMAA.
There are two separate ways to deduct a Medicare premium, and they are not alternatives you get to pick between. Which one applies depends on whether you have self-employment income.
The first is the itemized medical expense deduction on Schedule A. It is open to everyone, and it almost never pays off, for reasons the next sections walk through. The second is the self-employed health insurance deduction. It is open only to people with net self-employment income, and for those who qualify it is much better: it comes off your income before your AGI is set, so it also trims the MAGI that drives your Medicare surcharge two years later.
Nearly all of them. The IRS treats premiums you pay for a policy covering medical care as a qualifying medical expense, and Medicare coverage qualifies.
Premiums withheld from your Social Security check still count. The money was yours before it was withheld, and the total shows up on your SSA-1099.
Yes. This trips people up because IRMAA feels like a penalty rather than a premium. The Part B surcharge is folded into your Part B premium. The Part D surcharge is billed separately by Medicare rather than by your drug plan, but both are premiums for medical coverage, so both count.
So a couple in the first IRMAA tier for 2026 is paying $284.10 a month each for Part B instead of the standard $202.90, plus $14.50 a month each on Part D. All of it counts. Whether counting it produces an actual deduction is a different question, and the answer is usually no.
Itemized medical expenses only count to the extent they exceed 7.5% of your adjusted gross income. That floor is doing enormous work, and it is the reason most articles on this topic are more optimistic than your tax return will be.
Take a married couple, both over 65, with $220,000 of income, enough to put them in the first IRMAA tier, assuming their income has been steady, since the tier comes from MAGI two years back. Their Part B premiums come to $6,818.40 for the year, and the Part D surcharge adds $348, for $7,166.40 of Medicare premiums before their Part D plan premiums, which vary by plan. Their floor is 7.5% of $220,000, which is $16,500. They are thousands short, and no Part D plan premium closes a gap that size. Unless they had a heavy year of other medical costs, their Medicare premiums produce a deduction of exactly nothing.
A single filer with $110,000 of income lands in the same place. Roughly $3,583 of premiums against a floor of $8,250.
The reverse case is the interesting one. If a one-year spike put you in a bracket but your income has since dropped, your floor drops with it and your premiums can clear it.
There is a second bar behind the first. Itemizing only helps if your itemized total beats your standard deduction, and the standard deduction is generous for people over 65. For 2026 it is $16,100 for a single filer and $32,200 for a married couple filing jointly, plus $2,050 more if you are unmarried and 65 or older, or $1,650 per spouse for a married couple, which is $3,300 when both are over 65. So our couple would need more than $35,500 of total itemized deductions before any of this mattered.
This is worth knowing before you spend an evening collecting receipts. It is also why reducing your MAGI is a better lever than chasing deductions: deductions come off after your AGI is set, so they do nothing for your Medicare surcharge.
If you have net self-employment income, the picture changes completely. Medicare premiums can be claimed under the self-employed health insurance deduction, taken on Schedule 1 of Form 1040, line 17.
Two things make this far better than the Schedule A route. There is no 7.5% floor, so the first dollar counts. And you do not have to itemize, so you keep your full standard deduction on top of it.
There is a third benefit that matters more here than anywhere else. This deduction is taken above the line, which means it reduces your adjusted gross income itself. Your IRMAA is set from the MAGI built on that AGI, and Medicare looks back two years. So deducting your Medicare premiums this way can lower your Medicare surcharge two years down the road. It is the rare move that cuts your tax bill and your future premium with the same dollars.
That makes it the exception to the rule stated on our how to reduce your MAGI guide, where ordinary deductions do not touch MAGI. Above-the-line deductions do. For what else feeds the number, see what counts as MAGI, and check the thresholds you are working against on the 2026 IRMAA brackets.
The limits are real, so confirm them against your own return. The deduction cannot exceed your net self-employment income, and you cannot take it for any month you were eligible for a subsidized health plan through an employer, including your spouse's employer. This is a good question for a tax preparer rather than a guess.
There is a newer deduction worth knowing about, mostly because of who it leaves out. For tax years 2025 through 2028, people aged 65 and over can claim an extra $6,000 deduction, $12,000 for a couple where both qualify. Unusually, you can take it whether you itemize or not.
The catch is the income test. It begins to phase out once modified adjusted gross income passes $75,000 for a single filer or $150,000 for a couple filing jointly. Now compare those to the IRMAA thresholds. In 2026, IRMAA starts at $109,001 for single filers and $218,001 for joint filers.
The phase-out therefore begins well before IRMAA does. For a reader whose income is steady and who holds no tax-exempt bonds, paying IRMAA means being at least $34,001 past the phase-out start as a single filer, or $68,001 as a couple. Two things change that. A one-year spike breaks the first condition: because IRMAA looks back two years, a 2024 Roth conversion can put you in a bracket today while your current income sits below the phase-out entirely. Municipal bonds break the second: IRMAA counts tax-exempt interest and this deduction's income test does not, so every dollar of it shrinks your real margin. Outside those cases, this is a benefit aimed at retirees below IRMAA, not at the people reading this page.
Sources: IRS Publication 502 and Topic no. 502 (medical and dental expenses), IRS Instructions for Form 7206 (self-employed health insurance deduction), IRS Form 1040-ES (2026) for standard deduction amounts, and SSA POMS HI 01101.020 for 2026 Medicare premiums. Senior deduction figures per IRS newsroom guidance on the new and enhanced deductions. Informational only, not financial, tax, or medical advice. Last verified August 2026.
IRMAA looks back two years, so your 2025 income sets your 2027 premium. See the projected 2027 IRMAA brackets →