Is Pretax Medical Subject to Fica

Whether pretax medical deductions are subject to FICA (Federal Insurance Contributions Act) depends on the type of medical expense. FICA taxes, including Medicare and Social Security, are generally not levied on pretax medical, dental, or vision expenses. These deductions, such as those made through a flexible spending account (FSA), lower an employee’s taxable income before FICA calculations, resulting in a reduced tax burden. However, if an employee receives reimbursement for medical expenses exceeding the pretax deduction amount, the excess reimbursement is considered taxable income and subject to FICA taxes. Additionally, FICA taxes typically apply to employer-provided health insurance premiums, regardless of whether they are paid pre- or post-tax.

Payroll Deduction Classification

Payroll deductions are classified into two main categories: pre-tax and post-tax. Pre-tax deductions are taken out of your paycheck before taxes are calculated, while post-tax deductions are taken out after taxes have been calculated.

  • Pre-tax deductions reduce your taxable income, which can save you money on taxes. Common pre-tax deductions include:
    • Health insurance premiums
    • Retirement contributions
    • Dependent care expenses
  • Post-tax deductions are not deductible from your taxable income, so they do not save you money on taxes. Common post-tax deductions include:
    • Union dues
    • Charitable contributions
    • Parking fees

It’s important to understand the difference between pre-tax and post-tax deductions so that you can make informed decisions about how to allocate your paycheck.

Pretax Medical and FICA

FICA (Federal Insurance Contributions Act) taxes are a combination of Social Security and Medicare taxes. These taxes are withheld from your paycheck before you receive it.

Pretax medical deductions are not subject to FICA taxes. This means that you do not pay Social Security or Medicare taxes on the portion of your paycheck that is used to pay for health insurance premiums.

Health insurance premiumsYesNo
Retirement contributionsYesNo
Union duesNoYes
Charitable contributionsNoYes
Parking feesNoYes

Federal Insurance Contributions Act (FICA)

The Federal Insurance Contributions Act (FICA) is a United States federal law that requires employers to withhold specific taxes from their employees’ paychecks to fund government programs like Social Security and Medicare.

FICA taxes are divided into two parts:

  • Social Security (OASDI) tax: Funds retirement, disability, and survivor benefits.
  • Medicare (HI) tax: Funds hospital insurance benefits.

For 2023, the tax rates are:

Tax TypeEmployee RateEmployer Matching Rate
Social Security6.2%6.2%

Pretax vs. Post-Tax Medical Contributions

When you contribute to a health savings account (HSA) or flexible spending account (FSA), you can choose to make pretax or post-tax contributions. With pretax contributions, the money is deducted from your paycheck before taxes are taken out. With post-tax contributions, the money is deducted from your paycheck after taxes are taken out.

There are several key differences between pretax and post-tax medical contributions. First, pretax contributions reduce your taxable income, while post-tax contributions do not. Second, pretax contributions are not subject to FICA taxes (Social Security and Medicare taxes), while post-tax contributions are. Third, pretax contributions can be used to pay for a wider range of medical expenses than post-tax contributions.

The following table summarizes the key differences between pretax and post-tax medical contributions:

CharacteristicPretax ContributionsPost-Tax Contributions
Tax treatmentReduce taxable incomeDo not reduce taxable income
FICA taxesNot subject to FICA taxesSubject to FICA taxes
Eligible expensesCan be used to pay for a wider range of medical expensesCan only be used to pay for qualified medical expenses

Choosing between pretax and post-tax medical contributions depends on your individual circumstances. If you have a high taxable income, pretax contributions may be a better choice because they will reduce your taxable income and save you money on taxes. If you have a low taxable income, post-tax contributions may be a better choice because they will not reduce your taxable income and you will not have to pay FICA taxes on the money you contribute.

Treatment of Medical Expenses for FICA Purposes

Medical expenses are generally not subject to Federal Insurance Contributions Act (FICA) taxes, which fund Social Security and Medicare. This means that employers and employees do not pay FICA taxes on these expenses.

Exclusions from FICA Tax

  • Medical reimbursements from a qualified health plan
  • Health insurance premiums paid by the employer
  • Expenses for the diagnosis, cure, mitigation, treatment, or prevention of disease
  • Transportation expenses for medical care
  • Cost of special equipment, such as a wheelchair or hearing aid


There are some exceptions to the general rule. Medical expenses that are paid for with pretax dollars, such as through a flexible spending account (FSA), are subject to FICA taxes.

Type of Medical ExpenseFICA Tax Treatment
Medical expenses paid with after-tax dollarsNot subject to FICA taxes
Medical expenses paid with pretax dollars through an FSASubject to FICA taxes

Employer Considerations

Employers should be aware of the FICA tax treatment of medical expenses when designing employee benefit plans.

Well, there you have it, folks! I hope this little deep dive into the murky world of pretax medical and FICA has shed some light on the matter. I know it’s not the most exciting topic, but hey, knowledge is power, right? So, if you’re ever feeling a bit overwhelmed by your medical bills or wondering how to stretch your hard-earned dollars further, remember what you’ve learned today. And don’t forget to come back and visit us again soon for more money-saving tips and tricks. Take care!