C-corp (or spouse-hired setup) can reimburse 100% of family medical expenses tax-free — bypasses 7.5% AGI floor.
IRC §105 lets a C-corp reimburse employee (and family) medical expenses tax-free with full corporate deduction. In S-corps and LLCs, similar effect via hiring spouse as W-2 employee with §105(h) plan — spouse's family = professional's family. Reimburse dental, vision, orthodontia, LASIK, mental health, deductibles, co-pays, prescription glasses, long-term care premiums, and other medical costs not covered by insurance. §105(h) nondiscrimination rules apply if practice has other employees; ICHRA/QSEHRA variants may fit small practices.
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Practice pays $2.85M/yr premium to owner-controlled captive; captive receives tax-free (small insurance co election).
Combine a defined-benefit cash balance plan with 401(k)+profit share — total deductible contributions $400K+/yr for older owners.
Professional practice (PLLC) contracts with owner's Management LLC for admin, IP, real estate — shifts income to lower-rate entity.
Practice rents from professional's own real estate LLC — rent flows to owner tax-favored, building appreciates outside practice.
At sale, allocate purchase price to professional's PERSONAL goodwill (patient/client relationships) — capital gain, one level of tax.
MSO owned by non-professionals contracts with PC for management — recapitalize practice with outside capital legally.
Pass-Through Entity Tax lets practice deduct 100% of state income tax federally, bypassing $10K SALT cap.
Solo practitioner uses solo 401(k) with after-tax contributions + in-plan Roth conversion = $69K/yr into Roth (2024).