What is the Additional Medicare Tax for high earners?

Written by: Holly Bengfort
Published on June 23, 2023.

High-wage earners pay more than the standard tax payment for Medicare. If you employ highly compensated employees, you must ensure you withhold the correct amount for Medicare taxes. The Additional Medicare Tax is an extra 0.9% on earned income beyond a specific threshold amount. This additional payment has been around since 2013 as part of the Affordable Care Act (ACA).

The Additional Medicare Tax helps fund some parts of ACA, including premium tax credits (PTC). PTCs help lower-income Americans buy affordable individual or family health insurance.

In this article, we'll go over how the Additional Medicare Tax works and the income levels it applies to.

Make sure you're following the employment rules for your business size. Download our company size compliance checklist

What is the Medicare tax used for?

Medicare is a federal health insurance program. All employee and employer taxable earnings are subject to the standard Medicare tax. This includes several types of income like salary and wages, overtime, and paid time off (PTO).

The standard Medicare tax covers Medicare Part A. This is what provides medical insurance for senior citizens and people who live with disabilities. Medicare Part A pays for things like hospital stays, hospice, nursing facility care, and home health services. According to ValuePenguin1, the tax collected for Medicare funds 88% of Medicare Part A.

While Medicare is in its name, the Additional Medicare Tax goes toward the ACA, not Medicare Part A.

Who pays the Additional Medicare Tax?

The Internal Revenue Service2 (IRS) reports the current rate for the standard Medicare tax is 2.9% of an employee's taxable income. Self-employed individuals pay the total amount on their own. In other cases, employers and employees split the 2.9% tax equally, each paying 1.45%.

High-income earners subject to the Additional Medicare Tax pay an additional 0.9% on earnings beyond a set threshold.

A person is liable for the Additional Medicare Tax if their wages, compensation, or self-employment income (together with their spouse if filing a joint return) exceeds the applicable threshold for the individual's filing status.

According to the IRS, there are no special rules for nonresident aliens and U.S. citizens living abroad.

This chart provided by the IRS breaks it down.

Filing status

Annual income threshold amount

Married filing jointly


Married filing separately


All other taxpayers, including single filers


It’s important to note that the additional 0.9% tax only applies to earnings made beyond the threshold amount. For example, if a self-employed single filer earns $250,000 in a year, they would pay 2.9% on the first $200,000 of their earnings, then 3.8% (2.9% + 0.9%) on the remaining $50,000.

How are employers responsible?

Employers aren’t subject to the Additional Medicare Tax. However, they must withhold the additional 0.9% for employees who earn more than $200,000 in a calendar year. An employer who fails to deduct and withhold the Additional Medicare Tax is liable for it unless the employee eventually pays the tax. Even if not liable for the tax, the IRS3 states that an employer who doesn't meet withholding, deposit, reporting, and payment responsibilities for the Additional Medicare Tax may be subject to other penalties.

There's no requirement that an employer must notify an employee of the tax, and they can't honor an employee's request to cease withholding it. There's also no employer match for the Additional Medicare Tax.

How to make corrections

If an employer doesn't withhold the correct amount, they can correct the error.

If an employer realizes they are under-withholding the Additional Medicare Tax, they should deduct the correct amount4 from other wages they pay to the employee by the end of the year. If the employer doesn’t correct withholding by the end of the year, the employer may be liable for the amount it failed to withhold

If the employer is over-withholding the Additional Medicare Tax, they should repay or reimburse the amount to the employee before the end of the year. They also need to make an interest-free adjustment on the appropriate corrected form.

Who benefits from the Additional Medicare Tax?

As mentioned above, the Additional Medicare Tax pays for some elements of the ACA. When the ACA went into effect, it provided additional benefits to Medicare enrollees.

According to Healthline5, the Additional Medicare Tax helps cover the cost of these new benefits as well. They include:

  • Free vaccines
  • Free preventive care services
  • Free health screenings for depression, heart disease, diabetes, and some cancers
  • Increased chronic care management programs
  • Lower prescription drug costs
  • Closure of the Part D benefit gap


On top of the standard Medicare tax, high-income earners pay the Additional Medicare Tax of 0.9%. The IRS has several rules to determine who qualifies based on filing status and income thresholds. So married taxpayers filing together have a different threshold than separate filers.

This article contains information that's meant to be informative and shouldn’t be taken as legal advice. Contact a tax or financial professional to determine your organization’s tax obligations.

This blog article was originally published on January 20, 2014. It was last updated on June 23, 2023.

Originally published on June 23, 2023. Last updated June 23, 2023.


Additional Resources

View All Resources