Know tax in insurance

No one wants to be ill, but at least Uncle Sam gives Americans a little relief in the form of federal income-tax deductions for medical expenses.

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"Medical bills can be a huge expense, so the Internal Revenue Service gives people a break so they can recoup some of that money," says Lisa Greene-Lewis, a certified public accountant with TurboTax.

But who can deduct what can be complicated, and experts say few taxpayers fully understand the rules.

Here's a look at the basics of deducting medical expenses from your federal income taxes. Consult your tax adviser for specifics regarding your personal situation.

Who qualifies for medical-expense tax deductions?

The Internal Revenue Code includes two important rules that can limit who truly qualifies for relief from medical expenses:

• You must generally itemize deductions on Form 1040 Schedule A rather than take the "standard deduction" if you want a break on medical expenses. If what you plan to deduct for everything (from medical bills to mortgage interest) adds up to less than the standard deduction ($6,350 for singles, $9,350 for heads of household and $12,700 for married joint filers for tax year 2017), there's no point in itemizing.
• Taxpayers can only deduct allowable medical expenses that exceed 7.5 percent of "adjusted gross income" (AGI). That's the amount you earn in a given year from wages, investments and other sources minus what you paid for alimony, student-loan interest and a few other things. So, if a married couple has $100,000 AGI and $8,000 of qualified medical expenses, they can deduct only $500--$8,000 minus $7,500 (7.5 percent of their $100,000 AGI).

Are health insurance premiums tax deductible?

Yes, in certain circumstances, you can deduct your health insurance premiums as part of your overall medical expenses.

But you can deduct only premiums that you pay with after-tax money from your own pocket. For example:

• If your health insurance premiums are paid entirely by your employer or the government, you cannot deduct the cost.
• If you have health insurance through your employer and your share of the premium is deducted from your paycheck pre-tax, you cannot deduct the cost because the premiums were tax-free already.  If you don’t know whether you pay pre-tax or after-tax, ask your human resources department.
• If you buy health insurance through the state- or federally run health insurance marketplaces, you can deduct only the portion of the premium you pay out of your own pocket. You cannot deduct the amount of any subsidy.
• If you buy an individual or family health insurance plan, either on the open market or through a marketplace, and you pay all of the cost out of pocket, then the whole amount is deductible.
• Your total medical expenses, including premiums, must surpass 7.5 percent of your adjusted gross income to be deductible.

For 2017, the self-employed have several deductions and tax credits they can use. For detailed information, visit the self-employed health insurance deduction 2017 section of the federal Affordable Care Act website.

What other medical costs are tax deductible?

Assuming you pass the above tests, the IRS lets you write off pretty much every out-of-pocket medical expense that's ordered by a doctor or other health care professional. (See IRS Publication 502 for a list.)

Common items you can deduct from taxes include medical appointments, tests, prescription drugs and durable items like wheelchairs and prescription glasses. In fact, you can even write off unusual expenses if they're medically necessary.

You can also deduct transportation expenses for going to the doctor -- parking, tolls, mileage, cab or bus fares -- and even air fare and certain lodging costs for out-of-town treatments.

But remember, you can only write off out-of-pocket expenses -- copays, deductibles, etc. -- not bills that your insurance covers.

What heath expenses are not tax deductible?

There's a wide list of things you can't deduct, from medical marijuana to over-the-counter vitamins and drugs (except insulin). Hair transplants and cosmetic surgery are also out, unless procedures correct underlying medical problems (like breast-reconstruction surgery following mastectomies).

As noted above, you also can't deduct expenses that your insurance covers, nor things you paid for with money from a flexible spending account or health savings account. If you get insurance through work, you typically can't write off your share of the premiums because your employer won't normally withhold taxes on the money in the first place.

Writing off health insurance for the self-employed

One big exception to the above rules involves health insurance premiums paid by self-employed people. You can write those off as adjustments to income even if you don't itemize your deductions. The adjustment to income cannot exceed what you earned, though.

Self-employed people can deduct health insurance premiums directly on Form 1040 (Line 29 on returns for the 2017 tax year). You deduct all other qualified medical expenses on Schedule A, Line 1.

How to maximize your health care deductions

You obviously can't control when you get sick, but Greene-Lewis says Americans who are close to meeting the annual AGI threshold should "bunch up" procedures to maximize any deductibility.

For instance, if one family member has a major illness in a given year and rings up big hospital bills, everyone else in the family should get any needed dental work, prescription eyeglasses, etc., during the same year in order to boost the available tax break.

"You should look at anything you were putting off and bump it up [to the current tax year] if that's going to put you over the AGI threshold," she says.

You don't need to attach receipts to your 1040, but it's a good idea to keep them for three years after filing your return just in case the IRS audits you.