Medicare Tax Explained (2026): The 1.45% Rate, the 0.9% Surtax, and How to Check Your Pay Stub

Medicare tax is one of those paycheck line items you ignore… until it changes and you think payroll messed up.

Here’s the clean explanation: most workers pay 1.45% Medicare tax on every dollar of wages. No cap. And if your income is high enough, you may also owe an extra 0.9% called the Additional Medicare Tax.

This guide gives you the exact numbers, what to look for on a pay stub, and how to avoid the “wait, why do I owe?” surprise at tax time.

Medicare tax in plain English (what it is and where you see it)

Medicare tax is part of FICA. On most pay stubs it shows up as a separate line item labeled something like:

• Medicare
• MED or HI (Hospital Insurance)
• FICA-Medicare

If you want the full picture of your take-home pay (including state taxes), run your numbers in a state calculator like California and Texas. State income tax changes the story much more than Medicare does.

The Medicare tax rate (1.45%) and the 0.9% surtax

There are two Medicare-related taxes that can show up in your life:

• Medicare tax (base): 1.45% of wages for employees. No wage cap.
• Additional Medicare Tax: an extra 0.9% on wages above certain thresholds.

Here’s the part that confuses people: payroll withholding rules and tax-return thresholds don’t match perfectly.

When you file your tax return, the Additional Medicare threshold depends on filing status:

• $200,000 — single / head of household
• $250,000 — married filing jointly
• $125,000 — married filing separately

What Medicare tax costs at common salary levels

Below is the employee Medicare tax estimate at common salary levels. Biweekly assumes 26 paychecks/year. (Additional Medicare is shown where it can apply.)

*Additional Medicare example assumes your wages cross $200,000 with one employer. Your actual liability depends on your filing status and total combined wages.

Why your Medicare withholding might look “wrong”

If you multiply your gross pay by 1.45% and your pay stub doesn’t match perfectly, it doesn’t automatically mean payroll is wrong. The most common reasons are boring:

• Rounding: payroll systems round to the nearest cent each paycheck.
• Bonuses: Medicare applies to bonus wages too, so a bonus check makes the Medicare line jump.
• Different taxable wage base: some benefits can change the “Medicare wages” number used for withholding (don’t guess—look at the wage base line on your stub if it’s shown).

Two jobs + married couples: the most common surprise

This is where people get hit.

Two jobs: If you have two employers paying you $150,000 each, neither employer will cross $200,000 on their own — so no one withholds the extra 0.9%. But when you file, your total wages are $300,000, and you may owe Additional Medicare Tax (depending on filing status).

Married filing jointly: You might have one spouse earning $230,000 and the other earning $30,000. Payroll will start withholding the extra 0.9% once the $230,000 earner crosses $200,000 — but your real joint threshold is $250,000, so you might end up with some of that extra withholding refunded.

How to put this to work (3 quick steps)

1) Find the Medicare line on your pay stub. It may say Medicare, MED, HI, or FICA-Medicare. Verify it’s there.

2) Do the quick math. Medicare-taxable wages × 0.0145 should be close. If your year-to-date wages with this employer are over $200,000, expect the extra 0.9% to start showing up.

3) If you have multiple incomes, plan for the gap. If you’re near (or above) the thresholds, consider adding a little extra withholding on your W-4 so you don’t get surprised. And run a full take-home estimate in your state: California and Texas are easy comparisons.