Self-Employed Health Insurance Deduction — the Iterative Calculation

This post is my continuing effort to translate an IRS regulation  from legalese  into English.  The source document is here:   26 CFR 601.105: Examination of returns and claims for refund, credit, or abatement;

The IRS has figured out that the interplay between the ACA premium tax CREDIT and the self-employed health insurance DEDUCTION is “circular” –the amount of each is influenced by changes in the amount of the other.   IRS says that taxpayers can use any approach they choose to figure this out, but IRS suggests two possible approaches.  The first is called the “Iterative Calculation”

IRS says:

Specified premiums are premiums for a specified qualified health plan or plans for which the taxpayer may otherwise claim a deduction under § 162(l). A specified qualified health plan is a qualified health plan, as defined in §1.36B-1(c), covering the taxpayer, the taxpayer’s spouse, or a dependent of the taxpayer (enrolled family member) for a month that is a coverage month within the meaning of § 1.36B-3(c) for the enrolled family member

This means:

The SPECIFIED PREMIUM amount is the actual total premiums charged for health insurance coverage from a qualified health plan.  For our purposes we will assume a single taxpayer, buying insurance via an exchange, and that if the taxpayer paid the full cost of the premium, it would cost $8000 for a year of coverage.

IRS says:

(2) A taxpayer’s § 162(l) deduction may not exceed the lesser of:
(A) The taxpayer’s earned income (within the meaning of § 401(c)) derived by the taxpayer from the trade or business with respect to which the health insurance is established; and
(B) The sum of (1) the specified premiums not paid through advance credit payments, and (2) the limitation on additional tax determined under § 1.36B-4T(a)(3)(iii).

This means:

There might be some limits on the $8000 SPECIFIED PREMIUM amount.

So start by figuring out total earned income derived from self employment (SE INCOME)– this will ordinarily be the amount reflected on Schedule C. If that is less than $8000, then the taxpayer’s TENTATIVE DEDUCTION is limited to the SE INCOME figure. (This situation could come up if you are claiming a large number of business expenses, or if you had a particularly bad year. )

Then, if you received an ADVANCE PREMIUM CREDIT via the exchange, look at the total you actually paid out-of-pocket for your qualified heath plan, and add to that the maximum possible clawback based on your income level. So if total income after other deductions is less 400% of the Federal Poverty line, use the Additional Tax Limit table to figure out the maximum clawback for for excess tax credits you might have received, and add that to the premium total.

Let’s say income from self-employment was $42,000, which puts your income between the 300% and 400% percent mark of the federal poverty line, which in turn limits maximum clawback for single taxpayer to $1250.  That means that even if it turns out that the credit you received was too high, you may not be able to claim the $8000 SPECIFIED PREMIUM amount simply because the total of your actual out-of-pocket insurance costs plus he maximum clawback will still be less than $8000.

Let’s assume that you received $5000 in advance premium tax credits, and actually paid $3000 in premiums;  we’ll also assume that you you are using the $1250 clawback limitation number from the chart – your TENTATIVE DEDUCTION would then be $4250 (the $3000 you actually paid plus the $1250 maximum deduction.)

Just for purposes of comparison, we’ll also assume that you have a friend who has the same income and insurance premium level as you; and your friend bought insurance from the exchange, but the friend chose to defer receiving any advance premium tax credits and paid the full amount for insurance.   Since FRIEND did not receive “advance credit payment”, the specified premiums were $8000, and there is no potential clawback because no money was paid out.  So FRIEND’s TENTATIVE DEDUCTION is $8000 — the dollars FRIEND actually paid for insurance coverage.

IRS says: 

Step 1: Determine adjusted gross income, modified adjusted gross income,
and household income by taking a § 162(l) deduction for the amount of specified
premiums after applying the limit in section 5.03;

This means:

You’ll need to figure out the rest of your taxes first– so total up all of your income and all possible above-the-line deductions (on the first page of the 1040), and use the TENTATIVE DEDUCTION figure to come up with a TENTATIVE MAGI. (Don’t forget to add back any numbers for untaxed income specified in Figuring your household income (Part One).

We’ll continue to assume that the figure for MAGI is $42,000. We’ll also assume that the total amount of money actually spent on premiums was $3000 and you chose to use the $1250 limitation number from the chart (based on guessing that your income is between 300-400% of the FPL) — so you used $4250 as the TENTATIVE DEDUCTION.

IRS says:

(2) Step 2: Compute the premium tax credit using the adjusted gross income, modified adjusted gross income, and household income determined in Step 1;

This means:

You are going to figure out a TENTATIVE CREDIT, based on an assumption that you can take the maximum allowable DEDUCTION.  To figure your tax credit amount you are also going to need other information — you will need to know the Federal Poverty Line,  the “benchmark” premium rate for your state, the total cost of premiums for the policy you selected, etc.  Some of this information might be available on forms sent to you by your state’s exchange.   We’ll assume for now that you can find the information needed to a calculate this amount.  We’ll assume for purposes of an example that the tax credit allowed is $3500.

But let’s look at FRIEND.  Remember — we assumed that you both earned $42K. But for the preliminary calculation, you are deducting $4250 from that amount and FRIEND can deduct $8000.  So now your MAGI is $37,750 and your FRIEND’s MAGI is $34,000.  (For purposes of this calculation we are assuming that neither you or FRIEND have any other deductions or add backs to change the MAGI, or any other sources of income other than self-employment)

IRS says:

(3) Step 3: Determine the § 162(l) deduction by subtracting the Step 2 premium
tax credit amount from the specified premiums and then applying the limit in section

This means:

OK, we are now going to subtract $3500 – your actual tax credit – from the $8000 actual premium, and also applying the clawback limit.  In other words, now that you know that your tax credit should have been $3500 instead of the $5000 you took, you know that you actually should have paid $4,500 for health insurance.  But because of the clawback limits, the total you can be expected t pay is $4250, so you are going to continue to use that figure as your ADJUSTED TENTATIVE DEDUCTION.

On the other hand, let’s say that after doing the math, FRIEND is entitled to a $3860 credit. Why a higher credit than you? Because FRIEND actually paid full cost for her insurance, which gives her a bigger deduction, reducing her MAGI to something lower than yours.  So with the anticipated tax credit, FRIEND’s insurance cost will be reduced to $4200:  the $8000 FRIEND paid for insurance, minus the $3800 credit FRIEND is going to get when she files her tax return.

IRS says:

Step 4: Compute the premium tax credit using the adjusted gross income, modified adjusted gross income and household income determined by taking into account the § 162(l) deduction in Step 3;

This means:

If your ADJUSTED TENTATIVE DEDUCTION is different from the original TENTATIVE DEDUCTION, you are going to runt the calculation again.  Since your $4250 hasn’ t changed, there is no more math for you to do.

But your FRIEND needs to reduce her DEDUCTION from $8000 to $4200, which will cause her MAGI to go up to $37,800 — $50 more than yours.  So FRIEND needs to recalculate her tax credit based on the new MAGI.  Let’s say that now the calculation says she is owed a tax credit of  $3495.   (It’s now less than you, because her MAGI was $50 higher than  yours– I’m getting my new tax credits by applying a 9.5% multiplier to the income differential, based on the assumption that is the percentage used to calculate credits at that income level. See Computing the Premium Assistance Credit Amount.)

IRS says:

Step 5: Repeat Step 3 by substituting the Step 4 premium tax credit for the Step 2 premium tax credit.

This means:

Your friend now has to do the same thing again, but now with the assumption that her DEDUCTION will be $4505 based on the reduced CREDIT  she calculated in Step 4.  Now her MAGI is $37,495 – $255 less than yours — and I’m guessing that her CREDIT will come to $3524.  Her income went down, so credit has gone up again.  (This is kind of like one of those old Three Stooges routines where when one drawer is shut, another one pops open.)

IRS says:

Step 6: If changes in both the § 162(l) deduction and the premium tax credit
from Steps 2 and 3 to Steps 4 and 5 are less than $1, use the section 162(l) deduction
and premium tax credit amounts for the specified premiums determined in Steps 4 and
5. If the change in either the § 162(l) deduction or the premium tax credit from Steps 2
and 3 to Steps 4 and 5 is not less than $1, repeat Steps 4 and 5 (using amounts
determined in the immediately preceding iteration) until changes in both the § 162(l)
deduction and the premium tax credit between iterations are less than $1.

This means:

Your friend needs to calculate once more, now with the assumption that her tax CREDIT  is $3524, reducing her DEDUCTION to $4476, and producing a MAGI figure of  $37,524 — now $226 less than yours, bumping her credit up to $21 more than yours — and meaning that she is going to have to do the math once more,  this time assuming a CREDIT of $3521.   Basically, following the IRS Iteration Calculation, your friend will have to repeat this exercise, with figures seesawing back and forth, until the numbers come out to something less than a dollar.

I don’t think that its rocket science to figure out that your friend will get to that point when her CREDIT number comes out to something within $10 of yours – so let’s assume she’s gone through several more cycles and ends up with a MAGI of $37,740 and a tax credit of $3500.95 – which is less than a dollar, so a stopping point for her.

IRS says:

The taxpayer may claim a premium tax credit and § 162(l) deduction for the specified premiums equal to the amounts determined under Step 6. If a taxpayer is unable to complete Step 6 because changes between iterations always exceed $1, the
taxpayer should not use the iterative calculation method, but may use the alternative calculation method in section 5.03 or another method that produces amounts that satisfy applicable tax law.


This means:

Even IRS isn’t sure that their math sequence will work.

But let’s go back to they hypothetical you and your friend. In the end, in my hypothetical, the friend did get within that $1 limit – so lets say that she ends up taking a DEDUCTION of $4499 and a CREDIT of  $3501 (rounded up from the $3500.95 that is acceptable to IRS).

Your FRIEND gets a refund on her taxes of $3501.  She paid $8000 for insurance, so her net cost for health insurance came to $4499.

You owe IRS $1250 — they can’t get more from you because your income is still under the 40% FPL level and there is a limit on the clawback — and you paid $3000 in insurance — bringing your net cost for health insurance to $4,250 – so you saved $249 on insurance compared to your friend by opting for advance payments.

It won’t seem that way in April because your FRIEND will be dancing happily with her big fat IRS refund check and you’ll be stuck casting about for the $1250 you owe IRS … but in this case those clawback limits mean you come out ahead.

I”d point out that there will be no such happy ending if your final MAGI exceeds the 400% FPL mark — if you have another friend who estimated the same lower income figure as you did (with a +$5000 tax credit), but ends up with $60,000 in self-employment income instead — then there is no cap on the clawback, and that other friend will owe IRS $5000.   But that friend will also be able to deduct that amount ($3000 out of pocket plus $5000 tax clawback), reducing the friend’s MAGI to $52,000 — still too much to qualify for a tax credit, but you can see how confusing this might be for a person who earns, say, $53,000.   Subtracting the full $8000 premium would yield a $45,000 MAGI, which does qualify for a credit, but by my math I’m guessing the credit is $2811 – the $1250 clawback provision leaves the friend’s deduction at $4250 — and subtracting $4250 from $53,000 results in an income too high to qualify for subsidies or any sort of clawback limitation.





14 thoughts on “Self-Employed Health Insurance Deduction — the Iterative Calculation

  1. Thank you for explaining. It is crazy-making. I hope that TurboTax has this programmed properly before taxes are due. I don’t have much hope, though. Last year they automatically defaulted to using the simplified method for home office depreciation and it took forever to figure out what was wrong.

    Again, thank you for explaining. I will come back here near the end of the year and try to figure it out (with hopefully a properly functioning version of tax software for comparison). I know I will be borderline, but I also have the choice on when to bill my customers to make it work out the best.

  2. Do you know if IRA withdrawals are included by IRS in the MAGI? Normally these are in the AGI.
    Since these could affect the income and thus the subsidy and all calculations.

  3. Thank you for your thoughtful treatment of this topic! Glad I stumbled in here and I will definitely check back at tax time. What a mess!

  4. Hi, maybe someone has addressed this and I just haven’t found it yet.
    How do I fill out the Schedule K-1s line 4 = line 13 (M) amounts paid for medical insurance? Do I do the iterative or alternate calculation, then go back to my form 1065 k-1s and use the newly calculated number? Any suggestions?

    • The iterative calculation is only done against the amount entered on line 1040, line 28. If you are preparing a K-1, that is totally separate — that is a return prepared on behalf of the partnership and has nothing to do with the calculation of adjustments and credits on your personal return. I think that if you are confused you should work with a tax professional to make sure you are doing things right, and to verify whether you qualify to take the self-employed health insurance discussion in your circumstances.

      • Thanks! I have been worrying about the iterative calculation process for months, but hadn’t found any information until today on your blog on if the IRS even had a process or allowed for adjustments. Does the IRS expect to “see our work” for calculating our entries on lines 29 and 46?

      • No, IRS doesn’t require a worksheet to be filed. But some of our site visitors have created spreadsheets to help with the process. You can find links to this in the comments under the topic Tax Software – Fail?

        I think doing the complete iterative calculation will give you the best possible combination to maximize the tax benefits.

  5. Let’s say I underestimated my income and now I have to give back all the advanced premium tax credits. Fair enough. But now what’s my self-employed health care premium deduction? For example, say I paid $2000 premiums out of pocket and now the IRS is clawing back $4000 that the government paid in advanced premium tax credits for me. That is reasonable. But it seems unfair that I should not now be allowed to claim all $6000 as my health care premium deduction – because that, after all, is exactly what it is. Both the $2000 (paid out of pocket) and the $4000 (paid in 2015 on my 2014 taxes) are 2014 health care premiums. Yet I see no provision for this on the Form 1040 calculations.

    • But you will get your full SEHI because, in your example, you would have started by entering $6000 as your SEHI amount on line 29. If, after including that amount and all other adjustments to your income, that leaves you with an AGI in excess of 400% of the federal poverty line (for example, single taxpayer, AGI $48,000) — then there is no need to do the iterative calculation. You AGI shows you ineligible for a tax premium credit, so no calculation needed. Your excess advance premium tax credit is reflected in line 46; and line 69 (net premium tax credit) should be 0.

      When you are completing your form, the amount that you should start with on line 29 should ordinarily include the full amount reflected on line 33A on line 1095A (less any amount of premiums that was pre-paid and claimed as an SEHI adjustment on your 2013 tax return).

      • That is certainly what I would _like_ the rules for line 29 to be, and it is certainly what I was _expecting_ the rules for line 29 to be. But it is not at all clear from the 1040 instructions describing what goes on line 29 that it _is_ what the rules _are_. 😦

    • I don’t think there are any changes to the process related to ACA & the self-employed health insurance deduction.

      The good news for the self-employed for the coming year is that I think most of the people whose incomes are at the level to qualify for ACA subsidies will probably also qualify for the 20% pass-through deduction. Good explanation here:

      I think this a deduction rather than adjustment, so it won’t impact AGI or the basic math for reconciling the ACA subsidy. So basically, as I understand it, if you are a single taxpayer with $40,000K of self-employment income, after you are done doing the math for your ACA subsidy, you will get to take another deduction of $8000 — plus the standard deduction of $12,000 — reducing your taxable income to $20,000.

      • WOW.
        Thank you!!!!

        Now if I can get through reconciling the ACA subsidy.
        Your explanation is better than everything I have found so far, but it is still very confusing to me. I guess I will have to it once to understand the steps better.

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