Most Medicare tax is simple: 1.45% of every dollar of wages, no cap, matched by your employer. The Additional Medicare Tax is a separate, extra 0.9% that only applies above a certain income level — and it works differently in two important ways.
The thresholds
| Filing status | Threshold |
|---|---|
| Single | $200,000 |
| Head of household | $200,000 |
| Married filing separately | $125,000 |
| Married filing jointly | $250,000 |
Wages above your threshold are taxed an extra 0.9%, on top of the standard 1.45% Medicare rate — so income above the threshold is effectively taxed at 2.35% for Medicare, not 1.45%.
Two things that make it different from regular Medicare tax
It’s employee-only. Regular Medicare tax is matched dollar-for-dollar by your employer. The Additional Medicare Tax isn’t — only the employee pays it, with no employer match at all.
The thresholds don’t move. The Social Security wage base gets adjusted for inflation most years. The Additional Medicare Tax thresholds don’t — they’ve been fixed at these exact numbers since the tax was introduced in 2013, and stay there until Congress changes them by statute.
A worked example
A single filer earning $220,000:
- Income below the $200,000 threshold: taxed at the standard 1.45% Medicare rate
- Income from $200,000 to $220,000 ($20,000): taxed at 1.45% + 0.9% = 2.35%
- Additional Medicare Tax portion alone: 0.9% × $20,000 = $180
That $180 comes straight off net pay, the same way every other line in Gross Pay vs. Net Pay does.
One filing-status wrinkle worth knowing
Because the married filing jointly threshold ($250,000) applies to combined household income, two spouses each earning $150,000 ($300,000 combined) would cross the threshold and owe Additional Medicare Tax on $50,000 of it — even though neither spouse individually earns above $200,000. This is a common surprise for dual-income households at that income level.
For the full picture of how this fits into total FICA tax, see FICA Tax Explained, or run your own numbers through the Paycheck Calculator.