Quick Answer
The Additional Medicare Tax is an extra 0.9% tax on wages over $200,000 (single) or $250,000 (married filing jointly). For example, someone earning $220,000 pays the additional 0.9% on $20,000 of income, adding roughly $180 annually to their Medicare tax burden.
Best Answer
Sarah Chen, CPA
Best for high-income earners who are approaching or exceeding the Additional Medicare Tax thresholds
How the Additional Medicare Tax works
The Additional Medicare Tax is a 0.9% tax that applies to wages, railroad retirement compensation, and self-employment income above specific thresholds. This is in addition to the regular 1.45% Medicare tax that everyone pays.
The thresholds for 2026 are:
Example: $220,000 salary calculation
Let's say you're single and earn $220,000 annually. Here's how your Medicare taxes break down:
Regular Medicare Tax: $220,000 × 1.45% = $3,190
Additional Medicare Tax: ($220,000 - $200,000) × 0.9% = $20,000 × 0.9% = $180
Total Medicare Tax: $3,190 + $180 = $3,370
Your employer withholds the Additional Medicare Tax once your year-to-date wages exceed $200,000, regardless of your filing status or spouse's income.
Why withholding might not match your actual tax
Here's where it gets tricky: your employer starts withholding when your wages hit $200,000, but the actual tax depends on your combined household income if you're married.
Scenario 1 — Underwithholding: You earn $180,000, your spouse earns $120,000. Your employer withholds $0 for Additional Medicare Tax, but you owe it on $50,000 ($300,000 total - $250,000 threshold) = $450.
Scenario 2 — Overwithholding: You earn $220,000, your spouse earns $20,000. Your employer withholds $180, but you only owe Additional Medicare Tax on $0 ($240,000 total - $250,000 threshold).
Key factors that affect your Additional Medicare Tax
What you should do
1. Calculate your household's total income to determine if you'll owe Additional Medicare Tax
2. Adjust your W-4 if withholding won't match your liability (use additional withholding on line 4c)
3. Consider quarterly payments if you're significantly underwithholding
4. Plan for year-end — this tax isn't matched by employers like regular Medicare tax
Use our W-4 optimizer to ensure proper withholding for your situation, especially if you're married or have multiple income sources.
Key takeaway: The Additional Medicare Tax adds 0.9% to high earners' Medicare burden, but employer withholding may not match your actual liability due to filing status and spouse income considerations.
Key Takeaway: The Additional Medicare Tax adds 0.9% to Medicare taxes for high earners, but withholding complications often require W-4 adjustments for married couples.
Additional Medicare Tax thresholds and calculations by filing status
| Filing Status | Threshold | Tax Rate | Example: $300K Income |
|---|---|---|---|
| Single | $200,000 | 0.9% on excess | $900 additional tax |
| Married Filing Jointly | $250,000 | 0.9% on excess | $450 additional tax |
| Married Filing Separately | $125,000 | 0.9% on excess | $1,575 additional tax |
More Perspectives
Sarah Chen, CPA
Best for typical employees who want to understand when this tax applies and how to recognize it
When the Additional Medicare Tax affects you
Most W-2 employees won't encounter the Additional Medicare Tax because it only kicks in at high income levels — $200,000 for single filers or $250,000 for married couples filing jointly.
How to spot it on your pay stub
If you do hit these thresholds, you'll see the Additional Medicare Tax as a separate line item on your pay stub, usually labeled "Add'l Medicare" or "Medicare Surtax." It appears once your year-to-date wages exceed $200,000.
Your regular Medicare tax (1.45%) continues unchanged — this is simply an additional 0.9% on income above the threshold.
Example for a $210,000 earner
If you earn $210,000 annually:
This means an extra $90 per year, or about $3.50 per biweekly paycheck once withholding starts.
What this means for your withholding
Unlike other taxes, there's no employer matching for the Additional Medicare Tax — you pay the full 0.9%. Your employer automatically starts withholding once your wages cross $200,000, regardless of your marital status or spouse's income.
If you're approaching these income levels, monitor your pay stubs in the fourth quarter to see if this tax appears.
Key takeaway: The Additional Medicare Tax only affects high earners ($200K+ single, $250K+ married), appearing as an extra 0.9% withholding once you cross the threshold.
Key Takeaway: The Additional Medicare Tax only affects high earners and appears automatically on pay stubs once wages exceed $200,000.
Marcus Rivera, CFP
Best for older workers concerned about Medicare taxes and retirement timing
How Additional Medicare Tax affects retirement planning
If you're in your peak earning years before retirement, you might be encountering the Additional Medicare Tax for the first time. This 0.9% surtax applies to high earners and has important implications for retirement timing and income planning.
Impact on pre-retirement years
Many professionals see their highest earnings in their 50s and early 60s. If your income exceeds $200,000 (single) or $250,000 (married), you'll pay an extra 0.9% in Medicare taxes — money that doesn't get matched by your employer.
For someone earning $280,000 in their final working years:
Retirement income considerations
Here's the key insight: retirement income typically isn't subject to Medicare taxes at all. 401(k) distributions, traditional IRA withdrawals, and pension payments don't trigger Medicare tax withholding.
However, if you continue working part-time in retirement and your combined wage income still exceeds the thresholds, you'll still owe Additional Medicare Tax on those wages.
Strategic timing considerations
Roth conversions: Large Roth conversions can push you over the Additional Medicare Tax threshold, but the tax isn't withheld automatically. Plan for quarterly payments.
Retirement timing: If you're right at the threshold, retiring mid-year might help you avoid the Additional Medicare Tax for that tax year.
Deferred compensation: Be aware that deferred compensation payouts in retirement could trigger Additional Medicare Tax if they're substantial enough.
Key takeaway: The Additional Medicare Tax mainly affects peak earning years before retirement, since most retirement income sources aren't subject to Medicare taxes.
Key Takeaway: The Additional Medicare Tax primarily impacts peak pre-retirement earnings, as most retirement income sources aren't subject to Medicare taxes.
Sources
- IRS Publication 15-T — Federal Income Tax Withholding Methods - includes Additional Medicare Tax withholding tables
- IRS Topic No. 560 — Additional Medicare Tax information and thresholds
Related Questions
Reviewed by Sarah Chen, CPA on February 28, 2026
This content is for educational purposes only and is not a substitute for professional tax advice. Consult a qualified tax professional for advice specific to your situation.