Form 8959

Department of the Treasury 

Internal Revenue Service 

Additional Medicare Tax

If any line does not apply to you, leave it blank. See separate instructions.

Attach to Form 1040, 1040-SR, 1040-NR, 1040-PR, or 1040-SS.

Go to www.irs.gov/Form8959 for instructions and the latest information.

OMB No. 1545-0074

2022

Attachment 

Sequence No. 71

Name(s) shown on return Your social security number

Part I Additional Medicare Tax on Medicare Wages

1 Medicare wages and tips from Form W-2, box 5. If you have more than one

Form W-2, enter the total of the amounts from box 5 . . . . . . . . 1

2 Unreported tips from Form 4137, line 6 . . . . . . . . . . . . . 2

3 Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . 3 

4 Add lines 1 through 3 . . . . . . . . . . . . . . . . . . . 4 

5 Enter the following amount for your filing status:

Married filing jointly . . . . . . . . . . . . . . . $250,000

Married filing separately . . . . . . . . . . . . . . $125,000

Single, Head of household, or Qualifying surviving spouse . . . $200,000 5 

6 Subtract line 5 from line 4. If zero or less, enter -0- . . . . . . . . . . . . . . . . . 6 

7 Additional Medicare Tax on Medicare wages. Multiply line 6 by 0.9% (0.009). Enter here and go to 

Part II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 

Part II Additional Medicare Tax on Self-Employment Income

8 Self-employment income from Schedule SE (Form 1040), Part I, line 6. If you 

had a loss, enter -0- (Form 1040-PR or 1040-SS filers, see instructions.) . . 8 

9 Enter the following amount for your filing status:

Married filing jointly. . . . . . . . . . . . . . . . $250,000

Married filing separately . . . . . . . . . . . . . . $125,000

Single, Head of household, or Qualifying surviving spouse . . . $200,000 9

10 Enter the amount from line 4 . . . . . . . . . . . . . . . . 10 

11 Subtract line 10 from line 9. If zero or less, enter -0- . . . . . . . . . 11 

12 Subtract line 11 from line 8. If zero or less, enter -0- . . . . . . . . . . . . . . . . . 12 

13 Additional Medicare Tax on self-employment income. Multiply line 12 by 0.9% (0.009). Enter here and 

go to Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 

Part III Additional Medicare Tax on Railroad Retirement Tax Act (RRTA) Compensation

14 Railroad retirement (RRTA) compensation and tips from Form(s) W-2, box 14 

(see instructions) . . . . . . . . . . . . . . . . . . . . 14 

15 Enter the following amount for your filing status:

Married filing jointly . . . . . . . . . . . . . . . $250,000

Married filing separately . . . . . . . . . . . . . . $125,000

Single, Head of household, or Qualifying surviving spouse . . . $200,000 15

16 Subtract line 15 from line 14. If zero or less, enter -0- . . . . . . . . . . . . . . . . 16 

17 Additional Medicare Tax on railroad retirement (RRTA) compensation. Multiply line 16 by 0.9% (0.009). 

Enter here and go to Part IV . . . . . . . . . . . . . . . . . . . . . . . . . 17 

Part IV Total Additional Medicare Tax

18 Add lines 7, 13, and 17. Also include this amount on Schedule 2 (Form 1040), line 11 (Form 1040-PR 

or 1040-SS filers, see instructions), and go to Part V . . . . . . . . . . . . . . . . . 18 

Part V Withholding Reconciliation

19 Medicare tax withheld from Form W-2, box 6. If you have more than one Form

W-2, enter the total of the amounts from box 6 . . . . . . . . . . 19

20 Enter the amount from line 1 . . . . . . . . . . . . . . . . 20

21 Multiply line 20 by 1.45% (0.0145). This is your regular Medicare tax 

withholding on Medicare wages . . . . . . . . . . . . . . . 21

22 Subtract line 21 from line 19. If zero or less, enter -0-. This is your Additional Medicare Tax 

withholding on Medicare wages . . . . . . . . . . . . . . . . . . . . . . . 22

23 Additional Medicare Tax withholding on railroad retirement (RRTA) compensation from Form W-2, box 

14 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

24 Total Additional Medicare Tax withholding. Add lines 22 and 23. Also include this amount with

federal income tax withholding on Form 1040, 1040-SR, or 1040-NR, line 25c (Form 1040-PR or 

1040-SS filers, see instructions) . . . . . . . . . . . . . . . . . . . . . . . 24

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 59475X Form 8959 (2022)