Navigating S-Corp Owners Medical Costs: Payroll Considerations and IRS Compliance

Navigating S-Corp Owners Medical Costs: Payroll Considerations and IRS Compliance

As a shareholder-employee of an S-corporation, understanding how to handle medical insurance premiums can be crucial for tax planning and compliance. For those who own more than 2% of the corporation’s stock, treating medical insurance premiums is unique and requires careful attention.

This article will guide you through the process of adding these costs to your payroll, discuss their tax implications, and explain how this can support your stance on reasonable compensation with the IRS.

Adding Medical Costs to Payroll

Adding Medical Costs to Payroll

For 2% shareholders, the cost of their medical insurance premiums paid by the S-corporation should be added to their W-2 wages to tax them correctly.

Here’s how to do it:

1. Determine Eligibility:

Verify that the medical insurance premiums are for a policy that the S-corporation has established.

This policy can be in the name of the S-corporation or the shareholder, as long as the S-corporation either pays the premiums itself or reimburses the shareholder and counts the reimbursement as taxable income.

2. Calculate the Premiums:

2. Calculate the Premiums:

Total the amount of the medical insurance premiums paid during the tax year.

3. Include in Wages:

For federal income tax purposes, add the premium amount to the shareholder’s W-2 wages in Box 1. However, these amounts should not be included in Boxes 3 or 5, as they are not subject to Social Security or Medicare taxes (FICA).

4. Shareholder’s Tax Return:

The shareholder can then deduct the premiums from their tax return up to the limits set for self-employed individuals with health insurance.

Tax Implications: FICA and FUTA

Tax Implications: FICA and FUTA

The inclusion of medical insurance premiums in wages has specific tax implications:

FICA Taxes:

The premiums are added to the shareholder’s taxable wages but are not subject to Federal Insurance Contributions Act (FICA) taxes.

This means that while the amount will be subject to federal income tax withholding, it will not be subject to Social Security and Medicare taxes.

FUTA Taxes:

Similarly, the premiums are not taxed under the Federal Unemployment Tax Act (FUTA). The overall employment tax burden is reduced, which benefits both the S-corporation and the shareholder.

Benefits Regarding Reasonable Compensation

Benefits Regarding Reasonable Compensation

Incorporating medical insurance premiums into the shareholder’s compensation can also play a strategic role in demonstrating reasonable compensation.

Supporting Compensation:

By including the cost of medical insurance in wages, the S-corporation can provide evidence of additional compensation to the shareholder. When the IRS looks into whether the shareholder’s salary is too low, this can be very helpful.

Reasonable Compensation:

Reasonable Compensation:

The IRS requires that shareholder-employees receive reasonable compensation for services rendered to the S-corporation.

The S-corporation further supports its claim that the shareholder receives fair compensation by including medical insurance premiums in the compensation package.


For 2% of S-corp shareholders, properly handling medical insurance premiums is essential for tax planning and compliance.

For the S-corporation and its shareholders, including these costs in the payroll can help with tax benefits while supporting reasonable compensation.

It’s essential to follow the correct procedures to ensure that these premiums are reported accurately and in compliance with IRS regulations.

As with all tax-related matters, consulting with a CPA or tax advisor familiar with S-corporation taxation is advisable to ensure that you’re meeting all requirements and maximizing your tax benefits.