Medical Expense Deduction for the Self-Employed: The 7.5% AGI Floor After Health Insurance and HSA (2026)

Published: October 7, 2026 · Reading time: 13 min

TL;DR: The medical expense deduction is the last place a freelancer's health costs can go, and usually the least valuable one. §213(a) allows medical expenses "to the extent that such expenses exceed 7.5 percent of adjusted gross income," but only on Schedule A. Premiums you deduct on Schedule 1, line 17 are barred from Schedule A by §162(l)(3), HSA contributions and bills paid with tax-free HSA money cannot be counted either, and AGI has already been lowered by those deductions, so what is left is thin. Then it has to beat the 2026 standard deduction: $16,100 unmarried, $32,200 joint. In our 2026 example, a married couple with $100,000 of Schedule C profit, $14,400 of premiums and a maxed $8,750 family HSA had $69,785.22 of AGI, a $5,233.89 floor and $2,250 of includable medical bills, so the medical deduction was $0. In a $38,000 medical year they needed $18,433.89 of includable spending just to break even with the standard deduction, and itemizing saved $1,670.65 of federal income tax. Counting the premiums twice would have understated tax by $1,152.00.

Why This Is a Different Question From the Health Insurance Deduction

The self-employed health insurance deduction is the headline health benefit for freelancers. It is an adjustment to income, so it works even if you take the standard deduction. The HSA is a second adjustment. Between them they remove the biggest health costs most freelancers have, the premiums, from the Schedule A conversation entirely.

That is why "can I deduct my medical expenses?" gets a different answer for a freelancer than for an employee. The employee's premiums may be pre-tax or on Schedule A. Yours were most likely deducted above the line already, and the 7.5% floor is then tested against the leftover bills: deductibles, copays, dental work, glasses, prescriptions and anything the plan does not cover.

This guide covers what is left, what counts under IRS Publication 502, why the floor is so hard to clear against the 2026 standard deduction, and a worked 2026 household that shows the arithmetic, including the cost of the most common mistake, counting premiums twice. For the general itemize-or-not decision, see standard vs. itemized deductions; this post does not repeat it.

The Rule: §213(a) and the 7.5% Floor

§213(a) reads:

"There shall be allowed as a deduction the expenses paid during the taxable year, not compensated for by insurance or otherwise, for medical care of the taxpayer, his spouse, or a dependent (as defined in section 152, determined without regard to subsections (b)(1), (b)(2), and (d)(1)(B) thereof), to the extent that such expenses exceed 7.5 percent of adjusted gross income."

How this was verified: the text of 26 U.S.C. §213 was fetched raw from Cornell LII to a temporary file on October 7, 2026 and searched for the exact string after normalising whitespace and punctuation. The same site carries the 2025 One Big Beautiful Bill Act figures in §164(b)(7), so the 7.5 percent floor in that text is the current one.

Three words in that sentence do most of the work for a freelancer:

• "Paid." Medical expenses count in the year you pay them. Publication 502 says: "You can include only the medical and dental expenses you paid this year but generally not payments for medical or dental care you will receive in a future year."
• "Not compensated for by insurance or otherwise." Anything the plan, an HRA or another source reimbursed does not count. The Schedule A instructions tell you to reduce expenses by payments received from insurance or other sources.
• "Exceed 7.5 percent of adjusted gross income." Only the slice above the floor is deductible, and the floor is figured on AGI, the number after your above-the-line deductions. Every dollar of premium, HSA contribution, retirement contribution and half of self-employment tax you deduct on Schedule 1 lowers AGI and therefore lowers the floor. That helps a little, but those same dollars are no longer available to count.

Publication 502 and the Schedule A instructions both state it the same way: you can deduct only the part of your medical and dental expenses that exceeds 7.5% of your AGI.

Verified from the raw Publication 502 (2025) and Instructions for Schedule A (2025) pages. Both are 2025 editions; the 2026 editions and forms may renumber lines, so check the current form before filing.

The Order of Operations: Where Each Health Dollar Goes

For a self-employed person the sequence matters, because each step removes dollars from the next one.

The line 17 and Schedule A line 1 references are from the 2025 forms and instructions and may change for 2026.

The premium rule, in the statute's own words

§162(l)(3) is titled "Coordination with medical deduction":

"Any amount paid by a taxpayer for insurance to which paragraph (1) applies shall not be taken into account in computing the amount allowable to the taxpayer as a deduction under section 213(a)."

The Schedule A instructions repeat it as a line-1 instruction: "However, if you claimed the self-employed health insurance deduction on Schedule 1 (Form 1040), line 17, reduce the premiums by the amount on line 17." The Form 7206 instructions add: "Don't include the amount on line 14 when figuring any medical expense deduction on Schedule A (Form 1040)." (Line 14 there is the Form 7206 line that carries to Schedule 1, line 17.)

Verified from the raw Cornell LII text of §162(l)(3), the raw Instructions for Schedule A (2025) and the raw Instructions for Form 7206 (2025).

The HSA rule

Publication 502, under "Health Savings Accounts":

"You can't include in medical expenses amounts you contribute to a health savings account. You can't include expenses you pay for with a tax-free distribution from your health savings account. You also can't use other funds equal to the amount of the distribution and include the expenses."

The last sentence closes the workaround of paying from checking and then taking the HSA money out to reimburse yourself while still counting the bill. You get one benefit per dollar: the HSA's, or the floor's. See HSA vs. FSA for the self-employed for what the account can pay.

Verified from the raw Publication 502 (2025) page.

What Counts: A Pub. 502 Checklist for Freelancers

The Schedule A instructions list what you can include "to the extent you weren't reimbursed." The items freelancers most often have:

The includable column is from the Schedule A instructions, "Examples of Medical and Dental Payments You Can Include." The not-includable column is from "Examples of Medical and Dental Payments You Can't Include" in the same instructions and from Publication 502 (health club dues, premium tax credit, retirement-plan-paid premiums). Both pages were read raw.

Details that trip up freelancers:

• Your self-employment tax is not a medical expense. The Schedule A instructions list "The Medicare tax on your wages and tips or the Medicare tax paid as part of the self-employment tax or household employment taxes" among the payments you cannot include.
• Health club dues. Publication 502: "You can't include in medical expenses health club dues or amounts paid to improve one's general health or to relieve physical or mental discomfort not related to a particular medical condition."
• Premium tax credit. Publication 502: "You can't include in medical expenses the amount of health insurance premiums paid by or through the premium tax credit." See premium tax credit for freelancers for how the credit and the line 17 deduction interact.
• Medicare premiums. The Schedule A instructions list Part B and Part D premiums as includable. The Form 7206 instructions say "Medicare premiums you voluntarily pay to obtain insurance in your name that is similar to qualifying private health insurance can be used to figure the deduction." If you run a business and pay Medicare premiums, work out with a CPA whether they belong on line 17 first, because a premium used there cannot also be counted on Schedule A.
• Mileage for medical trips. The medical mileage rate differs from the business rate. See business vs. medical vs. charity mileage rates and use the rate that applies to the date of your trip.
• Long-term care insurance. Only an age-based amount counts. For 2026 Rev. Proc. 2025-32 sets the limits at $500 (age 40 or less), $930 (over 40, up to 50), $1,860 (over 50, up to 60), $4,960 (over 60, up to 70) and $6,200 (over 70). §162(l)(2)(C) applies the same eligible-premium cap to the line 17 deduction.

Verified from the raw Rev. Proc. 2025-32 (section 4.27) and the raw §162(l) text.

Why the Floor Rarely Clears: The 2026 Standard Deduction

The medical deduction is an itemized deduction, so it competes with the standard deduction. Rev. Proc. 2025-32, section 4.14, sets the 2026 amounts:

The additional standard deduction for the aged or blind is $1,650, or $2,050 if the individual is unmarried and not a surviving spouse. These amounts reflect the OBBBA's permanent increase of the base amounts, which the revenue procedure describes in section 2.08.

Verified from the raw Rev. Proc. 2025-32 PDF (converted with pdftotext and the table read directly), not from a summary.

The break-even test. Itemizing helps only when medical-above-the-floor plus your other itemized deductions exceed the standard deduction. So the includable medical spending needed for a tie is:

7.5% of AGI + (standard deduction − other itemized deductions), counting the second term as zero if other itemized deductions already exceed the standard deduction.

Every figure is computed with the 2026 standard deductions above ($16,100 single, $32,200 joint). The joint $69,785.22 row is the household in the worked example below. When "other itemized" already exceeds the standard deduction (the single rows with $19,000 other), the break-even is just the floor, because every medical dollar above it adds to a total that already beats the standard deduction.

Notice what the table says about a typical freelancer: a household with no mortgage and modest state taxes needs tens of thousands of includable medical spending before the deduction produces any benefit at all. The self-employed health insurance deduction and the HSA are where a freelancer's health money actually earns a tax break.

Worked Example: A Married Couple With a Heavy Medical Year (2026)

Facts. A married couple files jointly for 2026. One spouse is a freelancer with $100,000 of Schedule C net profit and no other income. The other spouse has no income and no access to an employer health plan, and there are no dependents. They buy $14,400 of family health coverage, an HSA-eligible high deductible plan, for the year. They fund the family HSA to the limit of $8,750 (Rev. Proc. 2025-19, neither spouse 55 or older). They have $11,000 of state income and property tax and $8,000 of mortgage interest assumed deductible in full, and no charitable gifts. No premium tax credit is involved, there is no retirement contribution and no capital gain.

Rates and limits come from Rev. Proc. 2025-32 (standard deduction $32,200; joint brackets 10% to $24,800 and 12% to $100,800; §199A threshold $403,500) and the statute: the state and local tax limit is $40,400 for 2026 under §164(b)(7), well above their $11,000. Each was read from the raw document.

AGI, derived step by step:

• Self-employment tax: $100,000 × 92.35% × 15.3% = $14,129.55. Half, $7,064.78, is deductible. The wage base is not reached, so 15.3% applies in full.
• Self-employed health insurance deduction: $14,400, under the limit of earned income from the business ($100,000 − $7,064.78 = $92,935.22, §162(l)(2)(A)).
• HSA deduction: $8,750.
• AGI: $100,000 − $7,064.78 − $14,400 − $8,750 = $69,785.22.
• Medical floor: 7.5% × $69,785.22 = $5,233.89.
• QBI before any itemized deduction: $100,000 − $7,064.78 − $14,400 = $78,535.22, of which 20% is $15,707.04. Treas. Reg. §1.199A-3(b)(1)(vi) treats the §164(f) deduction, the §162(l) deduction and §404 contributions as attributable to the business, so those reduce QBI. The regulation does not name the HSA deduction, so this example does not reduce QBI for it.

The §199A(a) text was read raw: the deduction is the lesser of the combined QBI amount and 20 percent of taxable income over net capital gain, and §199A(e)(1) computes that taxable income "without regard to any deduction allowable under this section." Taxable income here is far below the $403,500 joint threshold, so the SSTB and W-2 wage limits do not apply. The taxable-income limit does, and it binds in every scenario below.

Scenario 1: A typical year

The couple's out-of-pocket medical spending is $11,000: deductibles, prescriptions, dental and vision. They pay $8,750 from the HSA with a tax-free distribution and $2,250 from checking.

• Includable medical expenses: $2,250 (the HSA-paid $8,750 cannot count).
• Medical deduction: $2,250 is below the $5,233.89 floor, so $0.
• Itemized total: $11,000 + $8,000 = $19,000, below the $32,200 standard deduction, so they take the standard deduction.

Nothing here changes anything. The medical deduction was never in play, and the premiums and HSA did all the work above the line.

Scenario 2: A heavy medical year

Suppose they have a year with $17,000 of covered cost sharing, the family out-of-pocket limit an HDHP may have under Rev. Proc. 2025-19, plus $29,750 of care the plan does not cover, such as extensive dental work and an out-of-network procedure. They pay $8,750 of the covered cost from the HSA and the rest from checking.

• Includable: ($17,000 − $8,750) + $29,750 = $8,250 + $29,750 = $38,000.
• Medical deduction: $38,000 − $5,233.89 = $32,766.11.
• Itemized total: $32,766.11 + $19,000 = $51,766.11, which is $19,566.11 more than the standard deduction.

The saving is $1,670.65, not $38,000 times a bracket. Three things shrink it:

1. Only the excess over the standard deduction is new. Without the medical bills they would have taken $32,200. Itemizing adds $19,566.11 of deduction, not $51,766.11.
2. The QBI limit claws part of it back. A bigger itemized deduction lowers taxable income before QBI, and the QBI deduction is capped at 20% of that figure. Taxable income fell by $15,652.89, not $19,566.11, because the QBI deduction fell by $3,913.22. Check this against your own facts: it binds here because QBI is large relative to taxable income.
3. It crosses brackets. The $15,652.89 drop straddles the 10%/12% boundary at $24,800: $5,268.18 of it was taxed at 12% ($632.18) and $10,384.71 at 10% ($1,038.47), for $632.18 + $1,038.47 = $1,670.65, an average of 10.7 cents per dollar of taxable income removed ($1,670.65 ÷ $15,652.89). Applying one rate to the whole deduction would be wrong.

The saving equals 4.4% of the $38,000 of includable spending. Self-employment tax is $14,129.55 in both columns, since Schedule A does not change Schedule C profit.

The break-even. Their other itemized deductions are $19,000, so itemizing starts to pay when includable medical exceeds $5,233.89 + ($32,200 − $19,000) = $18,433.89. Past that point each extra dollar of includable medical saves 9.6 cents (12% × 80%) while their taxable income is in the 12% band and 8 cents (10% × 80%) in the 10% band, because the QBI limit gives back 20 cents of each deduction dollar.

Scenario 3: The double count

A filer who also lists the $14,400 of premiums on Schedule A line 1 in Scenario 2 would claim $47,166.11 of medical deduction instead of $32,766.11 and an itemized total of $66,166.11. Taxable income before QBI would be $3,619.11, the QBI deduction $723.82, taxable income $2,895.29 and tax $289.53, which is $1,152.00 less than the correct $1,441.53. That is a real understatement, an overclaimed deduction on a return that already carries a Form 7206.

In Scenario 1, adding the premiums to the $2,250 would have produced a $11,416.11 medical deduction and a $30,416.11 itemized total, still below $32,200. The error would have changed nothing that year, which is exactly why it survives until a heavy year makes it expensive.

Side by side

Scenario 3's includable figure is $38,000 + $14,400 = $52,400, and $52,400 − $5,233.89 = $47,166.11, which ties to the row above.

Every figure in this example was computed with a script and re-added: for instance $8,250 + $29,750 = $38,000, $632.18 + $1,038.47 = $1,670.65 and $3,112.18 − $1,441.53 = $1,670.65. The example is federal only, ignores state tax and assumes the stated facts.

When Premiums Spill Onto Schedule A

Premiums that do not qualify for line 17 are not lost. The Form 7206 instructions say "any medical insurance payments not deductible on Schedule 1 (Form 1040), line 17, can be included as medical expenses on Schedule A (Form 1040) if you itemize deductions." Publication 502 says to include them "with all other medical expenses on Schedule A (Form 1040) subject to the 7.5% limit." The usual causes:

• The earned income limit. §162(l)(2)(A) denies the deduction to the extent it exceeds earned income from the business that established the plan. A low-profit year leaves part of the premium for Schedule A.
• A month of eligibility for a subsidized employer plan. §162(l)(2)(B) turns the deduction off for any calendar month in which you could have joined a plan subsidized by your or your spouse's employer, even if you did not.
• A nondependent child under 27. Publication 502's Example 1: self-only coverage at $5,000 becomes family coverage at $10,000 to add a 26-year-old nondependent child, so the Form 1040 deduction is $4,000, the $5,000 for your own coverage goes on Schedule A, and the $1,000 excess for the child cannot be claimed. In Example 2, with family coverage already in place and no increase in premium, $4,000 goes on Form 1040 and $6,000 on Schedule A.

Premiums paid by or through the premium tax credit are excluded from the pool altogether, and the Schedule A instructions say to fill out Form 8962 before Schedule A, line 1 if advance payments were made.

Verified from the raw Form 7206 instructions (2025), Publication 502 (2025), Instructions for Schedule A (2025) and the raw §162(l) text.

Timing, Bunching and Records

Payment date. Publication 502: "If you use a credit card, include medical expenses you charge to your credit card in the year the charge is made, not when you actually pay the amount charged." A check counts when you mail or deliver it.

You cannot buy future care. Prepayment for care you will receive in a future year generally does not count. Medical care you actually receive, such as dental work or an elective procedure, can be scheduled into the same year, which is the idea behind bunching deductions. As the worked example shows, the benefit is modest and the cost is real, so health decisions come first.

Filing status. The floor is a percentage of the AGI on the return you file, so a joint or separate return changes the number it is tested against. See married filing jointly vs. separately before choosing on that basis alone.

High earners. §68, as amended by the OBBBA, reduces itemized deductions generally by 2/37 of the lesser of the deductions or the income above the 37% bracket threshold, and its text carves out no category for medical expenses. See the §68 itemized deduction limit. Also read above-the-line vs. below-the-line deductions for why the order of deductions matters.

Alternatives that make medical costs deductible without the floor. A Section 105 HRA for a spouse-employee, a QSEHRA or ICHRA or a Direct Primary Care arrangement paired with an HSA change the character of some costs. They have their own rules and conditions, which those guides cover.

Records. Publication 502 asks you to keep records of medical and dental expenses to support the deduction and not to send them with a paper return. Keep the provider statement, the insurance explanation of benefits and proof of payment, and mark which bills the HSA paid.

Common Mistakes to Avoid

1. Counting premiums twice. Premiums on Schedule 1, line 17 cannot go on Schedule A. §162(l)(3) says so, and the double count cost $1,152.00 in the example.
2. Counting HSA-paid bills. A bill paid with a tax-free HSA distribution is out, and so is a bill paid from other funds "equal to the amount of the distribution."
3. Counting HSA contributions as medical expenses. The contribution is a Schedule 1 deduction.
4. Using gross medical spending instead of the excess. Only the amount above 7.5% of AGI is deductible, and AGI is the figure after above-the-line deductions.
5. Forgetting to compare with the standard deduction. In 2026 that is $16,100 unmarried or $32,200 joint. A medical deduction that does not lift you past it saves nothing.
6. Applying one tax rate to the whole benefit. The example's saving crossed the 10%/12% boundary and was reduced by the QBI limit.
7. Treating self-employment tax as a medical expense. The Schedule A instructions say it is not.
8. Counting reimbursed amounts. §213(a) allows only expenses "not compensated for by insurance or otherwise."
9. Paying for future care to bunch. Publication 502 generally does not allow it.
10. Counting wellness spending. Health club dues, diet food, general vitamins and cosmetic procedures without a qualifying medical need are out.

How CentSense Helps

CentSense is built around Schedule C: it is not tax-preparation software and it does not track Schedule A medical expenses or compute your itemized deduction. What it does help with is the number the floor depends on, because AGI starts with an accurate net profit.

• Scan business receipts with AI the day you pay them, categorized to the matching Schedule C line, so net profit and the AGI built from it are not understated or overstated
• Keep personal medical statements out of your business categories so Schedule C stays clean
• Log mileage by date for business trips, a separate record from any medical-trip mileage you track yourself
• Export your categorized year as CSV for your CPA, who can then work out line 17, the HSA and Schedule A against a reliable profit figure

The free tier includes 10 AI receipt scans a month, and the Solo plan is $5/month for unlimited scans, mileage tracking and CSV export. CentSense does not decide whether premiums fit on line 17 or whether itemizing wins. It gives you the business records those calculations start from.

Frequently Asked Questions

Can a self-employed person deduct medical expenses beyond health insurance premiums?

Yes, but only on Schedule A and only if you itemize. Section 213(a) allows a deduction for medical care expenses paid during the year, not compensated for by insurance or otherwise, to the extent they exceed 7.5 percent of adjusted gross income. The self-employed health insurance deduction on Schedule 1 (Form 1040), line 17 is separate and is not subject to that floor, but premiums you deduct there cannot be counted again on Schedule A. For 2026 the standard deduction is $16,100 for an unmarried individual and $32,200 for a joint return (Rev. Proc. 2025-32), so itemizing only helps when your total itemized deductions, including the medical amount above the floor, exceed it.

Can I count the same premiums for the self-employed health insurance deduction and on Schedule A?

No. Section 162(l)(3) says any amount paid for insurance to which the self-employed deduction applies shall not be taken into account in computing the section 213(a) medical deduction, and the Schedule A instructions say to reduce the premiums by the amount on Schedule 1, line 17. Only premiums that did not fit on line 17, for example because of the earned income limit, a month in which you could have joined a subsidized employer plan, or, when adding a nondependent child under 27 raises the premium, the portion for your own coverage (the excess attributable to the child cannot go on Schedule A), can go on Schedule A, and then they are still subject to the 7.5 percent floor. In the worked example, counting $14,400 of premiums twice would have understated federal income tax by $1,152.00.

Do HSA contributions or HSA-paid medical bills count toward the 7.5% floor?

No on both. Publication 502 says you can't include in medical expenses amounts you contribute to a health savings account, you can't include expenses you pay for with a tax-free distribution from your HSA, and you also can't use other funds equal to the distribution and include the expenses. The contribution is deducted on Schedule 1 instead (subject to the 2026 limits of $4,400 self-only and $8,750 family coverage in Rev. Proc. 2025-19 and to HSA eligibility), and a bill paid from the HSA is already tax-free. Only medical bills you pay from other money, after insurance, can count toward the floor.

Why does the 7.5% floor rarely produce a deduction for freelancers?

Two hurdles stack. First, only the medical spending above 7.5 percent of AGI counts, and AGI is already lowered by the self-employed health insurance deduction, the half of self-employment tax deduction and any HSA or retirement deduction, so the premiums and HSA dollars that would have filled the floor are removed before it is tested. Second, the result only matters if your itemized total beats the 2026 standard deduction of $16,100 (unmarried) or $32,200 (joint). In the worked example, a joint household with $69,785.22 of AGI and $19,000 of other itemized deductions needed $18,433.89 of includable medical spending before itemizing broke even, and the $38,000 medical year saved only $1,670.65 of federal income tax. Your numbers will differ with your income, filing status and other itemized deductions.

What medical expenses count toward the Schedule A deduction?

Publication 502 and the Schedule A instructions list expenses for the diagnosis, cure, mitigation, treatment or prevention of disease: doctors, dentists, eye doctors and therapists, prescription medicines and insulin, hospital care, medical aids such as eyeglasses and hearing aids, qualified long-term care services, Medicare Part B and Part D premiums, and travel to get medical care. They do not count if reimbursed by insurance or an HRA, if paid through a tax-free HSA distribution, or if they are nonprescription medicines other than insulin, cosmetic surgery without a qualifying medical need, health club dues, diet food or the Medicare tax paid as part of self-employment tax. Long-term care insurance premiums count only up to age-based limits, which for 2026 run from $500 (age 40 or less) to $6,200 (over 70) under Rev. Proc. 2025-32.

What happens to health insurance premiums that don't fit under the self-employed deduction?

They may be deductible on Schedule A, but only if you itemize and only above the 7.5 percent floor. The Form 7206 instructions say medical insurance payments not deductible on Schedule 1, line 17 can be included as medical expenses on Schedule A if you itemize, and Publication 502 says to include any remaining premiums with all other medical expenses subject to the 7.5% limit. Exceptions apply: Publication 502 says that if the premium increase is attributable to a nondependent child under 27 and you cannot claim 100 percent on line 17, the excess attributable to that child is not eligible for Schedule A, and premiums paid by or through the premium tax credit cannot be included.

Can I prepay or bunch medical bills into one year to clear the floor?

You can time payment of care you actually receive, but not buy future care. Publication 502 says you can include only the medical and dental expenses you paid this year, but generally not payments for care you will receive in a future year, and that credit card charges count in the year the charge is made. Clustering a planned procedure, dental work or other covered expenses into one year can lift the total above the floor and the standard deduction, as the bunching guide explains, but in the worked example the whole $38,000 year saved only $1,670.65 of federal income tax, so do not schedule care around the tax benefit and confirm the numbers with a CPA or EA first.

Authoritative References

• 26 U.S.C. §213 — Medical, dental, etc., expenses (Cornell LII)
• 26 U.S.C. §162 — Trade or business expenses, including subsection (l) (Cornell LII)
• 26 U.S.C. §164 — Taxes, including the 2026 state and local tax limit in subsection (b)(7) (Cornell LII)
• 26 U.S.C. §199A — Qualified business income (Cornell LII)
• 26 CFR §1.199A-3 — Qualified business income, qualified REIT dividends, and qualified PTP income (Cornell LII)
• IRS — Publication 502, Medical and Dental Expenses
• IRS — Instructions for Schedule A (Form 1040)
• IRS — Instructions for Form 7206, Self-Employed Health Insurance Deduction
• IRS — Rev. Proc. 2025-32 (2026 standard deduction, brackets, long-term care limits and §199A thresholds)
• IRS — Rev. Proc. 2025-19 (2026 HSA limits and HDHP definition)

For related reading, see Self-Employed Health Insurance Deduction, HSA for Freelancers, Standard vs. Itemized Deduction, Bunching Deductions, SALT Cap Increase After OBBBA, QBI Deduction for Freelancers and Self-Employment Tax Explained.

Start with an accurate net profit. Start a free CentSense account, scan business receipts with AI, log mileage by date, and export a CPA-ready category breakdown at tax time. The free tier includes 10 AI receipt scans a month, no credit card required, and the Solo plan is $5/month for unlimited scans, mileage tracking and CSV export. CentSense does not track Schedule A medical expenses.

This guide is general education for U.S. freelancers filing in 2026. It is not personalized tax advice. Whether premiums qualify for the self-employed health insurance deduction, whether an expense is medical care, whether itemizing beats the standard deduction and how the QBI limit applies turn on facts a CPA or EA should confirm. The worked example is federal only, ignores state tax, and assumes the stated facts; the form and line numbers cited are from the 2025 forms and instructions and may change for 2026.