Additional Medicare Tax 2026: The 0.9% Surtax on High Earners, Explained

The Short Answer

Additional Medicare Tax is an extra 0.9% tax on wages above $200,000 in a calendar year. Your employer must start withholding it in the pay period your year-to-date wages cross $200,000 — no matter what your filing status is or what you put on your W-4. Regular Medicare tax (1.45%) continues on top, so high earners pay 2.35% Medicare tax on wages over the threshold.

The Thresholds by Filing Status

Withholding starts at $200,000 for everyone, but the tax you actually owe depends on your tax return:

• Single, head of household, qualifying surviving spouse: $200,000
• Married filing jointly: $250,000 (combined wages)
• Married filing separately: $125,000

This mismatch matters. A married couple filing jointly with two incomes of $150,000 each will have Additional Medicare Tax withheld once each spouse individually crosses $200,000 — but they owe the tax on combined wages above $250,000. The difference is settled on Form 8959 when they file.

A Worked Example

You earn a salary of $190,000 and pick up heavy overtime in December, adding $25,000 — total wages of $215,000.

• Regular Medicare tax: 1.45% × $215,000 = $3,117.50
• Additional Medicare Tax: 0.9% × ($215,000 − $200,000) = $135

Your employer withholds the extra $135 automatically once you cross $200,000. Overtime, bonuses and commissions all count toward the threshold — this is how hourly and overtime-heavy workers sometimes hit it unexpectedly in a strong year.

What Additional Medicare Tax Is NOT

• It does not apply to your employer — there is no employer match on the 0.9%. It comes entirely out of your pay.
• It is not the same as the Net Investment Income Tax (3.8%), though both were created by the same law and use the same thresholds.
• It has no wage cap — unlike Social Security tax, which stops at the annual wage base, Medicare taxes every dollar you earn.

Frequently Asked Questions

Can I ask my employer not to withhold the extra 0.9%?

No. Withholding at $200,000 is mandatory for the employer, even if you won't actually owe the tax (for example, a married-filing-jointly couple under $250,000 combined). You claim any over-withholding back on your tax return.

Does overtime count toward the $200,000 threshold?

Yes. Additional Medicare Tax applies to total Medicare wages — salary, hourly pay, overtime, bonuses, commissions and tips all count.

I'm self-employed. Does this apply to me?

Yes, but there is no employer to withhold it. You calculate Additional Medicare Tax on your self-employment income (combined with any wages) over your filing-status threshold using Form 8959, and pay it with your return or estimated taxes.

Where do I see it on my pay stub?

Usually as a separate line like "Medicare Addl" or "Addl Medicare 0.9%". If your year-to-date wages are under $200,000 and you see it, ask payroll — it may be an error.

Calculate It Yourself

Use our Medicare Tax Calculator to see both the regular 1.45% and the additional 0.9% on your wages, or the FICA Calculator for your full Social Security + Medicare picture. If overtime is what pushed you over the threshold, the Overtime Tax Calculator shows the full tax impact of those extra hours.