Additional Medicare tax: the 0.9% surtax on high wages in 2026

The additional Medicare tax is 0.9% of wages above $200,000, or $250,000 on a joint return. Here is who owes it, how it is withheld, and how to plan for it.

Vishant Mehta, CPA, Ex-Big 4

Published October 28, 2026

Additional Medicare Tax
Form 8959
withholding
high earners

The additional Medicare tax is an extra 0.9% on wages and self-employment income above a threshold. The threshold is $200,000 for a single filer, $250,000 on a joint return and $125,000 if you are married filing separately. These amounts are not indexed for inflation.

Your employer withholds it only on what it pays you above $200,000 in a year, whatever your filing status. So two-earner couples and people who changed jobs can owe more than was withheld. You settle the difference on Form 8959 with your return.

Rate	0.9%, on top of the regular 1.45%
Single or head of household	Earnings above $200,000
Married filing jointly	Combined earnings above $250,000
Married filing separately	Earnings above $125,000
Employer withholds	On its pay above $200,000
Employer share	None
Indexed for inflation	No
Form	Form 8959, filed with Form 1040
Rules checked	October 28, 2026

What is the additional Medicare tax rate?

The rate is 0.9%, and it applies only to the part of your earnings above your threshold. Below the line, an employee pays the regular Medicare tax of 1.45% on wages. Above it, the employee rate is 2.35%.

Your employer does not match the extra 0.9%. If you are self-employed, your Medicare rate rises from 2.9% to 3.8% above the line. Unlike the rest of your self-employment tax, no part of the 0.9% is deductible.

For example, a single filer with $300,000 of wages owes 0.9% of $100,000, which is $900.

Why am I charged additional Medicare tax?

You are charged because your wages, your self-employment income or both passed the threshold for your filing status. These all count toward it:

Salary and bonuses. Medicare tax has no wage cap, so every dollar counts.
Equity pay. RSUs when they vest and the spread on nonqualified stock options when you exercise are Medicare wages. ISO exercises and qualified ESPP purchases are not.
Your 401(k) deferrals. They lower your income tax, but they still count as Medicare wages.
Self-employment income. Your wages are counted first and lower the threshold left for it. A self-employment loss does not reduce your wages.
Your spouse's earnings, on a joint return. The $250,000 line applies to the two of you together.

Investment income does not count. Gains, dividends and rent fall under the separate 3.8% net investment income tax instead. The IRS says you can owe both taxes, but never on the same type of income.

Why can your withholding fall short?

Withholding falls short because each employer looks only at what it pays you. It starts the extra 0.9% in the pay period your wages from it pass $200,000. It never adds your spouse's pay or another job's pay.

Two earners. You earn $400,000 and your spouse earns $100,000. Together you owe 0.9% of $250,000, or $2,250. Your employer withholds $1,800, so you pay $450 with your return.
Two jobs in one year. A single filer earns $150,000 at each of two employers. Neither withholds the extra tax, yet the filer owes 0.9% of $100,000, or $900.
Self-employment on the side. No one withholds tax on it. You cover the 0.9% with estimated payments or extra withholding at your job.

You cannot ask your employer to stop withholding it, or to withhold more of it in particular. You can ask for extra income tax withholding on Form W-4, and that counts toward your whole tax bill.

Do I get my Medicare tax withheld back?

Only the extra 0.9%, and only if more was withheld than you owe. That happens when one spouse earns over $200,000 but the couple's joint total stays under $250,000.

For example, you earn $230,000 and your spouse has no wages. Your employer withholds 0.9% of $30,000, or $270. On a joint return you owe none of it, and Form 8959 adds the $270 to your withholding on Form 1040.

The regular 1.45% does not come back. Medicare tax has no wage cap, so a second employer's withholding is never too much, as Social Security withholding can be.

How to avoid the additional Medicare tax?

You cannot avoid it on earnings above the line, but you can shrink the earnings it counts and avoid a penalty on top. These levers work:

A health savings account through payroll. HSA contributions from your pay through a cafeteria plan are free of Medicare tax. The 2026 limits are $4,400 for self-only and $8,750 for family coverage.
An S corporation salary. An owner who works in the business pays Medicare tax on salary, not on distributions. The salary must still be reasonable for the work, or the IRS can tax distributions as wages.
Not filing separately. It does not help, because each spouse's threshold drops to $125,000.
Paying it during the year. The extra tax that is not withheld counts toward the penalty for underpaying estimated tax. Extra W-4 withholding avoids that.

Withholding counts as paid evenly through the year, even if you add it in December. An estimated payment counts only from the day you make it. So a late-year W-4 change can cure a shortfall that a January payment cannot fully cure.

When is the additional Medicare tax due?

It is due with your 2026 return, filed by April 15, 2027.

When	What happens
The pay period your wages pass $200,000	Your employer starts withholding 0.9%
Your last 2026 paycheck	Last chance for extra W-4 withholding
January 15, 2027	Fourth 2026 estimated payment due
April 15, 2027	File Form 8959 with your 2026 return

What should you do now?

Add up your 2026 wages, including bonuses and RSU vests, and your spouse's if you file jointly.
Compare the total with your threshold and with the Medicare tax withheld on your pay stubs.
If you will owe more than was withheld, raise your W-4 withholding before your last 2026 paycheck.
If you are self-employed, include the 0.9% in your January 15, 2027 estimated payment.

For the other taxes that start at these income levels, see our tax planning for high earners.