Employer-paid premiums for health insurance are exempt from federal income and payroll taxes. Additionally, the portion of premiums employees pay is typically excluded from taxable income. The exclusion of premiums lowers most workers’ tax bills and thus reduces their after-tax cost of coverage. This tax subsidy partly explains why most American families have health insurance coverage through employers.
Other factors play a role though, notably the economies of group coverage.
ESI Exclusion is Worth More to Taxpayers in Higher Tax Brackets
Because the exclusion of premiums for employer-sponsored insurance (ESI) reduces taxable income, it is worth more to taxpayers in higher tax brackets than to those in lower brackets. Consider a worker in the 12 percent income-tax bracket who also faces a payroll tax of 15.3 percent (7.65 percent paid by the employer and 7.65 percent paid by the employee). If his employer-paid insurance premium is $1,000, his taxes are $254 less than they would be if the $1,000 were paid as taxable compensation. His after-tax cost of health insurance is thus $1,000 minus $254, or $746. In contrast, the after-tax cost of a $1,000 premium for a worker in the 22 percent income-tax bracket is just $653 ($1,000 minus $347). Savings on state and local income taxes typically lower the after-tax cost of health insurance even more.
These examples assume that workers bear the full burden of employer payroll taxes. Note that the effective marginal tax rates (25.4 percent for the worker in the 12 percent income-tax bracket and 34.6 percent for the worker in the 22 percent income-tax bracket) are less than the sum of the income-tax and payroll-tax rates (27.3 percent and 37.3 percent, respectively) because those rates are applied to compensation after the employer’s share of payroll taxes has been deducted. Thus, for example, if the employer increases compensation by $1,000, cash wages only increase by $929 [calculated as $1,000 / (1 + employer payroll tax rate)], because the employer would have to pay additional employer payroll taxes of $71. The lower-wage worker’s resulting combined income and payroll tax would be 27.3 percent of $929, or $254. The higher-wage worker’s resulting combined income and payroll tax would be 37.3 percent of $929, or $347. The example assumes the higher-wage worker has earnings below the maximum amount subject to Social Security taxes.
ESI Exclusion is Costly
The ESI exclusion will cost the federal government an estimated $299 billion in income and payroll taxes in 2022, making it the single largest tax expenditure. Note, too, that the open-ended nature of the tax subsidy has likely increased health care costs by encouraging the purchase of more comprehensive health insurance policies with lower cost sharing or with less tightly managed care.
Replacing the ESI exclusion with a tax credit would equalize tax benefits across taxpayers in different tax brackets, as well as between those who get their insurance through their employers and those who obtain coverage from other sources. Making the credit refundable would extend that benefit to those whose tax liability falls below the value of the credit. And designing the credit so that it does not subsidize insurance on the margin (i.e., to be a fixed dollar amount as opposed to a percentage of the premium) could lower health care costs. However, removing the link between the subsidy and employment status may weaken the incentive for firms to provide health insurance coverage for their employees.
Updated January 2024
Further Reading
Burman, Leonard E., and Jonathan Gruber. 2005. “Tax Credits for Health Insurance.” Tax Policy Center Issues and Options Brief 11. Washington, DC: Urban-Brookings Tax Policy Center.
Burman, Leonard E., Jason Furman, Greg Leiserson, and Roberton Williams. 2007. “The President’s Proposed Standard Deduction for Health Insurance: An Evaluation.” Washington, DC: Urban-Brookings Tax Policy Center.
Gruber, Jonathan. 2011. “The Tax Exclusion for Employer-Sponsored Health Insurance.” National Tax Journal 64 (2, part 2): 511–30.
Joint Committee on Taxation. 2022. “Estimates of Federal Tax Expenditures for Fiscal Years 2022-2026.” JCX-22-22. Washington, DC.
FAQs
Employers deduct premium payments from your paycheck before taxes, which lowers your taxable income. Contact Covered California for help getting enrolled or if you have other questions.
What is the tax advantage to obtaining health insurance through the employer? ›
Advantages of an employer plan: Your employer often splits the cost of premiums with you. Your employer does all of the work choosing the plan options. Premium contributions from your employer are not subject to federal taxes, and your contributions can be made pre-tax, which lowers your taxable income.
What is the tax liability for employer contributions in health? ›
Generally, contributions made by an employer to the health savings account (HSA) of an eligible employee are excludable from an employee's income and are not subject to federal income tax, Social Security or Medicare taxes. In addition, employer contributions are deductible as a business expense to the company.
Can you deduct employer health insurance premiums on taxes? ›
If you paid the premiums for a policy you obtained yourself, your health insurance premium is deductible when they are out-of-pocket costs. If your insurance is through your employer, you can only deduct these: Amounts you paid with after-tax funds.
What are cons of employer sponsored health care? ›
Lack of flexibility
Because the employer chooses group insurance, employees don't have a say in what network they'll be on, the deductible they'll need to meet, or the premium they'll have to pay. Samuel Greene, insurance broker and CEO of Blue Insurance said, “Sometimes, group coverage can be limited.
How does tax credit on health insurance work? ›
Your tax credit is based on the income estimate and household information you put on your Marketplace application. Income between 100% and 400% FPL: If your income is in this range, in all states you qualify for premium tax credits that lower your monthly premium for a Marketplace health insurance plan.
Does health insurance lower your taxable income? ›
It's an adjustment to your taxable income. When you have medical insurance through the ACA marketplace, you use pre-tax dollars to pay the premiums. As a result, anyone who has ACA coverage can deduct the full cost of their annual health insurance premium on their taxable income, using Form 1040.
Why do I owe taxes because of health insurance? ›
If there's a difference between the amount of the premium tax credit you used during the year and the amount you actually qualify for, it will impact your refund or the amount of taxes you owe. You'll include Form 8962 with your federal tax return. Get details on how to reconcile.
What is employer-sponsored health insurance? ›
Employer-sponsored health plans are health insurance that is offered to employees and their dependents (and in most cases, spouses) as a benefit of employment.
Are health insurance premiums reimbursed by the employer taxable? ›
When an HRA complies with federal rules, employers can reimburse medical expenses, such as health insurance premiums, with money free of payroll taxes for both the employer and employee. An HRA is also free of income tax for the employee.
Fringe benefits such as bonuses or reimbursem*nts that are paid in cash are likely to be subject to income tax. Benefits received in-kind are usually not subject to taxation. Employers often provide other employee benefits such as health plans, unemployment insurance, and worker's compensation.
Do employees pay taxes on employer HSA contributions? ›
Contributions to your HSA made by your employer (including contributions made through a cafeteria plan) may be excluded from your gross income. The contributions remain in your account until you use them. The interest or other earnings on the assets in the account are tax free.
How much of my health insurance premiums can I deduct if I am self-employed? ›
If you're a self-employed person, you may deduct up to 100% of the health insurance premiums you paid during the year. To take the deduction, you must meet certain criteria. We'll go over those rules in this post and explain how you can deduct them on your return.
Is it worth claiming medical expenses on taxes? ›
Normally, you should only claim the medical expenses deduction if your itemized deductions are greater than your standard deduction (TurboTax can also do this calculation for you). If you elect to itemize, you must use IRS Form 1040 to file your taxes and attach Schedule A.
Can an employer deduct health insurance premiums from the last paycheck? ›
Unfortunately, it is likely legal to deduct a pro-rated amount for the premium from your final paycheck if you leave employment during a time where the employer has paid the premium but you will not work for the entire amount of time for which that premium was paid.
Does having health insurance affect your tax return? ›
Key Takeaways: Health insurance can impact your tax return in several ways, including through the Premium Tax Credit (PTC) and the Individual Shared Responsibility Payment (ISRP). The Premium Tax Credit can lower your out-of-pocket health insurance costs if you meet certain income and coverage criteria.
How do employer contributions to a health savings account affect insurance taxes? ›
Contributions made to your HSA by your employer may be excluded from your gross income. The contributions remain in your account until you use them. The earnings in the account aren't taxed. Distributions used to pay for qualified medical expenses are tax-free.
Do employer HSA contributions go on W-2? ›
Employers must report all employer and employee Health Savings Account (HSA) contributions made through payroll as a single aggregated amount on the employee's form W-2 in Box 12 using code W.
Is employer reimbursem*nt for health insurance premiums taxable? ›
When an HRA complies with federal rules, employers can reimburse medical expenses, such as health insurance premiums, with money free of payroll taxes for both the employer and employee. An HRA is also free of income tax for the employee.
