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Medicare Tax Implications of the Affordable Care Act


Michael J. Rowe, CPA

Michael J. Rowe, CPA

The Affordable Care Act (ACA), signed into law in 2010, made two significant changes to Medicare tax for high-income taxpayers for years beginning after 2012. This article will provide a broad overview of the changes, explain how to reflect the additional taxes on an individual’s personal tax returns, and provide possible strategies to mitigate these taxes.

New 3.8% Surtax on Net Investment Income
Before the ACA, there was no Medicare tax on unearned income. The ACA imposes an additional Medicare tax of 3.8% of the lesser of: (1) net investment income, or (2) the excess of modified adjusted gross income over a threshold amount ($250,000 for joint returns or surviving spouses, $125,000 for a married individual filing a separate return, or $200,000 for all other taxpayers).
The threshold amounts are not indexed for inflation, so as time passes, more taxpayers will be subject to the tax.
Modified adjusted gross income is adjusted gross income increased by any amount excluded from income as foreign earned income, net of deductions and exclusions disallowed with respect to the foreign earned income. As a practical matter, most U.S. residents do not have foreign earned income, so modified adjusted gross income would be the same as adjusted gross income.
Net investment income is the excess of the following items over deductions allocable to those items:
• Gross income from interest, dividends, annuities, royalties, and rents, unless they are derived in the ordinary course of a trade or business to which the 3.8% surtax does not apply;
• Other gross income derived from a trade or business to which the 3.8% surtax does apply; and
• Net gain attributable to the disposition of property other than property held in a trade or business to which the 3.8% surtax does not apply.
Gross income does not include items that are not included in gross income for income-tax purposes.
The 3.8% surtax applies to a trade or business only if it is considered a passive activity or if it is a trade or business of trading in financial instruments or commodities.
The additional Medicare tax is considered a tax for estimated payment purposes. An individual cannot request additional withholding specifically for the additional Medicare tax, but may increase his or her overall withholding using Form W-4.
The 3.8% surtax is calculated on Form 8960, which will be included in the individual’s tax return.
There are a few potential strategies to minimize additional net investment income in the current year:
• Consider taking taking capital losses to offset capital gains;
• Consider the installment method of reporting gains, if possible;
• If salary and other non-investment earnings plus net investment income approximate the threshold above, try to avoid, if feasible, additional income before year-end. This will defer, and possibly eliminate, the 3.8% surtax;
• If you have a one-time significant gain which brings you close to the threshold, try to defer, if possible, the recognition of additional income; and
• The surtax applies to passive activities, but not income from an activity in which a person is a material participant. It may be possible, with the advice of a tax advisor knowledgeable in the passive-activity rules, to increase participation in an activity in order to qualify as a material participant.

New 0.9% Medicare Tax on Wages and Self-Employment Income
The ACA increases the employee portion of the Medicare tax by an additional tax of 0.9% of wages and self-employment income received in excess of the threshold amounts as follows: $250,000 for joint returns, $125,000 for a married individual filing a separate return; or $200,000 for all other taxpayers.
As with the threshold amounts for the 3.8% surtax discussed above, these threshold amounts are not indexed for inflation, so as time passes, more taxpayers will be subject to the tax.
Unlike the current 1.45% Medicare tax on wages, the additional tax on a joint return is on the combined wages of the employee and the employee’s spouse.
The employer is required to withhold the additional 0.9% Medicare tax on wages in excess of $200,000, regardless of the person’s filing status or wages paid by another employer. It is possible that the person will owe more than the amount withheld. In that case, the employee should consider making estimated tax payments or increasing their withholding using Form W-4. If the person is self-employed, then he or she should consider increasing estimated tax payments.
If an employer withholds more than is required (for example, if an employee earns more than $200,000 but the joint return has total wages less than $250,000), then the excess withholding can be claimed as a credit on the employee’s income-tax return.
The 0.9% Medicare tax is calculated on Form 8959, which will be included in the individual’s tax return. To reduce or defer this 0.9% Medicare tax, consideration should be given to deferring income, if possible, to next year if income is above the threshold, especially if a non-recurring event occurred this year that increases wage and/or self-employment income above the threshold amount.

These new Medicare taxes will impact most high-income taxpayers. This has been a broad overview of the rules and planning strategies. There are more complicated rules and strategies beyond the scope of this article, especially with regard to investments in partnerships and subchapter S corporations.
For more information, you can go to and search for “net investment income tax” or “additional Medicare tax,” or contact your tax advisor.

Michael J. Rowe is a principal with Wolf & Co., P.C., which has offices in Boston, Springfield, and other locations; (617) 428-5437;

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