The Internal Revenue Service takes the position that when spouses file a joint married return, they become one taxpaying entity. Spouses are "jointly and severally liable," which means that the IRS can go after either or both of them for the entire tax due. The IRS coaxes spouses into filing this way by putting some tax credits and other advantages off limits to spouses who file separately, but you can take health insurance deductions regardless of which filing status you choose.
You must itemize your deductions to claim a tax break for your health insurance premiums. This involves filing Schedule A and giving up the standard deduction – $12,200 for married couples who file jointly as of 2013. Claiming a deduction for your premiums only makes sense if this deduction, plus others such as mortgage interest and charitable donations, exceeds $12,200.
Health insurance premiums are included in medical and dental expense deductions. Other costs in this category include unreimbursed expenses for care, treatment and prevention of disease or injury, as well as insurance premiums for long-term care. You can deduct what you spend on yourself, your spouse and your dependents, so this can add up. If your employer contributes anything to your insurance, or if you participate in a plan where you contribute pre-tax dollars, you can't claim that portion of the premiums.
The 10 Percent Rule
As of 2013, you can only deduct expenses that exceed 10 percent of your adjusted gross income. Therefore, if you earn $150,000 and your spouse earns $30,000, you'll need $18,000 in total medical expenses, including insurance, before you could deduct the balance. If you and your spouse file separately, you would personally need $15,000 in expenses, but your spouse would need only $3,000 before she could deduct the remaining costs, assuming she paid for them. If your premiums and other costs add up, this could be more advantageous – at least for your spouse – than claiming the standard deduction, which is $6,100 for a spouse filing separately. One caveat exists to this approach, however: If your spouse itemizes on a separate return, you must do so also.
If you're self-employed, the rules change for the better. You can deduct your insurance premiums without itemizing, provided you have no access to coverage through a former employer or your spouse's employer. Better yet, you can take the deduction on the first page of your tax return, which reduces your AGI. Several other tax perks begin phasing out if your AGI is too high, so this could be to your benefit. Filing jointly doesn't affect your ability to do this.
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