Additional Medicare Tax is an extra 0.9% on wages and self-employment income above $200,000 for single filers, $250,000 for married couples filing jointly and $125,000 for married filing separately. Employers start withholding it once they pay you more than $200,000 in a year, whatever your filing status.
Those two numbers rarely line up, which is why the tax surprises people. Withholding follows each paycheck from each employer; the tax follows your whole household’s income. You settle the difference on Form 8959 when you file.
Who owes Additional Medicare Tax
You owe it when your Medicare wages, tips and self-employment income for the year, combined with your spouse’s if you file jointly, pass the threshold for your filing status. Only the amount above the threshold is taxed, at 0.9%.
| Filing status | Owed on income above | Compared with withholding |
|---|---|---|
| Single | $200,000 | Same as the withholding threshold |
| Head of household | $200,000 | Same as the withholding threshold |
| Qualifying surviving spouse | $200,000 | Same as the withholding threshold |
| Married filing jointly | $250,000 | Higher: withholding can start before any tax is owed |
| Married filing separately | $125,000 | Lower: tax can be owed before any is withheld |
Married couples are where it gets tricky. Two earners can each stay under the withholding trigger while together they pass the joint threshold. One high earner can pass the trigger while the couple stays under it. Married filing separately has the lowest threshold of all.
It sits on top of the regular Medicare tax of 1.45%, which applies to every dollar with no cap. Together, someone well over the threshold pays 1.45% on their first wages and a higher rate on the rest.
How employers withhold it
An employer must withhold Additional Medicare Tax in the pay period when it first pays you more than $200,000 for the calendar year, and on every dollar after that. It does not look at your filing status, your spouse’s pay or a second job, and it does not have to tell you when it starts.
- No employer match. Unlike regular Medicare, the employer pays nothing extra.
- Each employer counts separately. Two jobs paying under the trigger each mean no withholding, however high the total.
- You cannot ask them to stop. Even if your household will owe nothing, the employer must keep withholding above the trigger.
- A big payment is not taxed in full. Only the part of a bonus or other payment that takes the year’s pay past the trigger is subject to the extra withholding.
Five households, five outcomes
Here is how withholding and the real tax compare for five invented households. Each has the same thing withheld from every paycheck as payroll requires; only the year’s total and the filing status differ.
| Household | Medicare wages by job | Withheld by employers | Owed on the return | At filing |
|---|---|---|---|---|
| Single, one job | $260,000 | $540.00 | $540.00 | Settled by withholding |
| Married, both work | $180,000 + $120,000 | $0.00 | $450.00 | Owes $450.00 more with the return |
| Married, one earner | $230,000 | $270.00 | $0.00 | Gets $270.00 back as a credit |
| Single, two jobs | $150,000 + $90,000 | $0.00 | $360.00 | Owes $360.00 more with the return |
| Married filing separately | $150,000 | $0.00 | $225.00 | Owes $225.00 more with the return |
Only the single person with one job comes out even. The two-earner couple and the person with two jobs have nothing withheld but owe tax, so they pay it with the return. The one-earner couple had tax withheld they do not owe, and get it back as a credit on Form 8959.
Paying it without a surprise at tax time
You cannot ask an employer to withhold extra for Additional Medicare Tax specifically. What you can do is ask for extra federal income tax to be withheld, in Step 4(c) of your Form W-4. That extra amount counts toward every tax on your return, including this one.
Self-employed people, or anyone whose wages are not withheld on, can cover it through estimated tax payments instead. You cannot earmark a payment for this tax; estimated payments apply to the whole return.
For the two-earner couple above, adding a modest amount per paycheck on one spouse’s W-4 would spread the year’s bill across their pay. The IRS online estimator shows how much, from your latest pay stubs.
Form 8959: settling up when you file
Form 8959 works out the tax you owe and the amount your employers withheld, and both go on your Form 1040. You must file it if you owe the tax, or if any was withheld from your pay, even when you end up owing none.
The withholding figures come from your W-2s. Box 6 includes any Additional Medicare Tax withheld, and box 5 shows the Medicare wages it was based on. Self-employment income goes in its own part of the form, and railroad retirement compensation is figured separately again.
How it appears on a pay stub
Some payroll systems print Additional Medicare Tax as its own line; others add it to the regular Medicare line, which then jumps on the paycheck that crosses the trigger. Either way, you will see it only once your year-to-date pay from that employer passes $200,000.
Medicare on a pay stub explains the regular Medicare line and the labels it goes by, and our FICA guide covers how Medicare and Social Security fit together.
Sources: IRS Questions and answers for the Additional Medicare Tax and Topic no. 560, Additional Medicare tax; Publication 15 (2026). Checked October 26, 2026.
