2026 Tax Law Changes That Affect Physicians
Key takeaways
- The current individual brackets were made permanent, with the top rate staying at 37%.
- The SALT cap rose to $40,400 for 2026 but phases down to $10,000 for higher incomes, and reverts to $10,000 in 2030.
- Itemized charitable gifts must exceed 0.5% of AGI, and itemized deductions are capped at 35% in the 37% bracket.
- 100% bonus depreciation is permanent for property acquired after January 19, 2025; the estate exemption is $15 million.
Individual rates and deductions
- The 10% to 37% bracket structure is now permanent. For 2026 the 37% bracket starts at $640,600 (single) and $768,700 (joint).
- Standard deduction: $16,100 single, $32,200 joint, $24,150 head of household.
- The suspension of miscellaneous itemized deductions, including unreimbursed employee expenses, is permanent.
SALT
The SALT cap is $40,400 for 2026 ($20,200 married filing separately), reduced by 30% of modified AGI above $505,000 but not below $10,000. The higher cap is scheduled to revert to $10,000 in 2030. For most practice-owning physicians, the state PTET remains the better tool.
Charitable giving
- Itemizers can deduct charitable gifts only to the extent they exceed 0.5% of AGI.
- Taxpayers in the 37% bracket have itemized deductions reduced so that each dollar saves at most 35 cents.
- Non-itemizers can deduct up to $1,000 ($2,000 joint) of cash gifts to public charities.
Business and practice provisions
- 100% bonus depreciation is permanent for qualifying property acquired after January 19, 2025.
- Section 179 expensing is $2,560,000 for 2026, phasing out above $4,090,000.
- The QBI deduction is permanent, with wider phase-in ranges; specified service businesses such as medical practices still lose it above $276,750 (single) or $553,500 (joint).
- The excess business loss limit is permanent: $256,000 (single) and $512,000 (joint) for 2026.
Retirement and family
- 401(k) deferral $24,500; catch-up $8,000; ages 60 to 63 $11,250. Catch-up must be Roth for employees with prior-year wages over $150,000.
- 529 plans: the federal limit for K-12 expenses rises to $20,000 in 2026, and qualified expenses now include more K-12 costs and credentialing programs.
Estate and gift
The estate and gift tax exemption is $15 million per person for 2026 and indexed after that; the annual gift exclusion is $19,000.
State changes
Several states cut income tax rates for 2026, including Indiana (2.95%), Kentucky (3.5%), Mississippi (4%), Montana (5.65%), Nebraska (4.55%), North Carolina (3.99%), Ohio (2.75% flat) and Oklahoma (4.5%). See your state page.
Frequently asked questions
Did the 2025 tax law raise taxes on doctors?
For most physicians the bracket structure stayed the same. The higher SALT cap phases out for high earners, and the new charitable floor and 35% itemized deduction cap slightly reduce deductions for top earners.
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Sources
- IRS: 2026 inflation adjustments (IR-2025-103)
- IRS Revenue Procedure 2025-32
- Charles Schwab: the SALT deduction
- The Tax Adviser: planning for new charitable contribution limits
- U.S. Bank: One Big Beautiful Bill Act quick reference
- IRS: 2026 401(k) and IRA limits (IR-2025-111)
- IRS: What's new, estate and gift tax
- Tax Foundation: 2026 state tax changes
This article is for general educational purposes and is not tax, legal or investment advice. Tax law changes often and its application depends on your facts. Figures reflect 2026 rules as published by the sources listed above. Consult a qualified professional before acting. See our editorial policy.