Stacking Deductions: Combining ADA Credits with 100% Depreciation for Your Practice

For private medical practices, staying at the forefront of patient care often requires a constant cycle of reinvestment. Whether it is a new high-resolution ultrasound, a state-of-the-art MRI suite, or advanced surgical lasers, the sticker price of clinical excellence is formidable. Historically, the U.S. tax code forced practitioners to recover these costs slowly over five to seven years, creating a significant lag between cash outlay and tax relief.

However, the passage of the One Big Beautiful Bill Act (OBBBA) in mid-2025 has fundamentally rewritten the economics of medical practice expansion. By permanently reinstating 100% bonus depreciation and doubling Section 179 limits, the federal government has created a windfall environment for independent physicians. For a private practice, this means the IRS is effectively subsidizing a portion of every equipment purchase through immediate, bottom-line tax savings.

The OBBBA Revolution: 100% Expensing Returns

The most significant shift for 2026 is the permanent restoration of 100% bonus depreciation. Under the previous regime, bonus depreciation had begun a scheduled phase-down, dropping to 40% in early 2025. The OBBBA intervened, resetting the rate to 100% for qualifying property acquired and placed in service after January 19, 2025.

According to analysis from BDO on the OBBBA expansion, this applies to most tangible property with a recovery period of 20 years or less. For a medical practice, this includes almost every clinical asset, X-ray machines, EKG monitors, exam tables, and even office furniture. If you purchase $250,000 in diagnostic equipment this year, you can deduct the full $250,000 against your practice income immediately, rather than spreading that deduction out over the next decade.

Section 179: The $2.5 Million Deduction Limit

While bonus depreciation is a powerful tool, Section 179 remains the preferred choice for many small-to-medium-sized practices due to its flexibility. The OBBBA has increased the Section 179 expensing limit to a staggering $2.5 million for 2025 and 2026, with a phase-out threshold starting at $4 million. This represents a massive leap from the previous $1 million limit.

As noted by Crowe LLP regarding healthcare tax changes, Section 179 allows you to pick and choose exactly how much you want to deduct for specific assets. This is vital for practices that need to manage their taxable income precisely to stay within certain brackets or to preserve Qualified Business Income (QBI) deduction eligibility. By using Section 179 first and then applying bonus depreciation to any remaining balance, practitioners can virtually eliminate their federal tax liability during years of heavy expansion.

“Placed in Service”: The Critical Deadline

The Medical Equipment Windfall is contingent on one specific IRS requirement, the asset must be placed in service by December 31st of the tax year. In the eyes of the IRS, placed in service does not mean ordered or delivered. It means the equipment is installed, tested, and ready for its intended clinical use.

For large-scale installations, such as a new oncology center or a complex laboratory setup, this timeline is critical. If a $1 million MRI is delivered on December 20th but isn’t calibrated and ready for patients until January 5th, the deduction is lost for the current tax year. Practitioners should coordinate closely with equipment vendors to ensure that delivery and installation schedules align with their year-end tax planning goals.

Synergy with the ADA Accessibility Credit

Many private practices overlook the potential to stack their equipment deductions with the Section 44 Disabled Access Credit. If your practice has 30 or fewer full-time employees or less than $1 million in total revenue, you may qualify for a credit of up to $5,000 for purchasing ADA-compliant equipment, such as height-adjustable exam tables.

When you combine the Section 44 credit with 100% depreciation, the after-tax cost of modernizing your practice drops significantly. You essentially receive a direct dollar-for-dollar reduction in your tax bill via the credit, while the remaining cost of the equipment is wiped out via the 100% deduction. This one-two punch is particularly effective for primary care and pediatric practices looking to improve patient accessibility while maximizing their ROI.

The Impact on Cash Flow and Financing

One of the most compelling reasons to utilize 100% depreciation in 2026 is its impact on leveraged purchases. If you finance $500,000 in equipment with a low-interest loan, you still get to claim the full $500,000 deduction in Year One. In many cases, the tax savings generated in the first year are significantly higher than the first year’s worth of equipment payments.

This cash flow positive scenario allows practices to upgrade their technology without depleting their operating reserves. According to Plante Moran’s guide to bonus depreciation, the ability to deduct the full cost of used equipment (a provision permanently restored by the OBBBA) further expands these opportunities. A practice can purchase certified refurbished imaging equipment and still capture the full 100% write-off, provided the original use requirements are met.

Top Assets Eligible for 100% Expensing in 2026:

• Diagnostic Imaging: MRI, CT, Ultrasound, and X-ray systems.
• Surgical Hardware: Lasers, robotic-assisted systems, and anesthesia machines.
• Health IT: Servers, workstations, and high-end software integration.
• Facility Upgrades: ADA-compliant exam tables, specialized medical lighting, and cabinetry.

Sophisticated Tax Planning for the Modern Practice

The 100% depreciation rules under the OBBBA are a powerful tool, but they are not a one size fits all solution. For high-earning practitioners, taking a massive deduction in one year could potentially create a Net Operating Loss (NOL). While NOLs can be carried forward to future years, they are often subject to an 80% income limitation.

Strategic tax planning involves modeling your practice’s income over a multi-year period to decide whether to take the full 100% bonus depreciation now or elect to use standard MACRS depreciation to spread the benefits into future years when your tax bracket might be higher. This is especially true for younger practitioners who expect their income to scale significantly over the next five years.

Find Your Medical Tax Partner Today

Maximizing the Medical Equipment Windfall requires more than just buying new tools, it requires a sophisticated understanding of Section 179 limits, bonus depreciation thresholds, and the interplay with QBI deductions. At Top Tax Planners, we specialize in connecting healthcare professionals and private practice owners with the nation’s leading medical tax strategists. Our vetted directory features professionals who understand the unique financial cycles of a medical practice and can help you navigate the complexities of the OBBBA to ensure your clinical investments deliver the highest possible tax ROI. Visit the Top Tax Planners Directory today to find a qualified tax professional who can build a customized depreciation strategy for your practice’s growth.