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Healthcare Practices: Payroll Tax Guide (2026)
Payroll tax for a healthcare practice is the federal stack every employer runs, withholding, 7.65 percent employer FICA, FUTA, deposits and Form 941, plus the healthcare practice items this page cites: IRS Employer Shared Responsibility Provisions, IRS About Form 941 and IRS Publication 15 (2026). BEG: $45 per employee per month inside the payroll software you already use, live in 3 to 5 days.
Tax rules specific to healthcare practices
An employer that averaged at least 50 full-time employees, counting full-time equivalents, in the prior calendar year is an applicable large employer and must offer affordable minimum essential coverage to full-time employees and their dependents or face an employer shared responsibility payment. A full-time employee is one with at least 30 hours of service a week or 130 hours a month; the base payments are $2,000 and $3,000 per employee per year, indexed, and were $2,970 and $4,460 for 2024.
Employers report federal income tax withheld plus both the employee and employer shares of Social Security and Medicare tax on Form 941 each quarter. Employers that reported more than $50,000 of employment taxes in the lookback period, or accumulated $100,000 or more in liability on any day, are semiweekly depositors and must attach Schedule B.
Sign-on bonuses paid to recruit nurses and other staff are wages subject to Social Security, Medicare and FUTA taxes and income tax withholding. Bonuses paid separately from regular wages are supplemental wages withheld at a flat 22 percent, or 37 percent once an employee's supplemental wages exceed $1 million in the calendar year.
The stack every healthcare practice runs
On one of the registered nurses at the May 2025 national median of $97,550, the employer share of Social Security and Medicare is $7,463 a year, FUTA is $42 after the 5.4 percent state credit on the first $7,000, and income tax withholding follows the employee's W-4. Deposits are monthly or semiweekly depending on the prior lookback period, with a next-business-day deposit whenever $100,000 accumulates. Form 941 is due the last day of the month after each quarter; W-2s and any 1099-NEC at the $2,000 threshold are due January 31.
The rules behind this page, with sources
General information, not legal advice. Every rule below was read on the agency page linked next to it.
- An employer that averaged at least 50 full-time employees, counting full-time equivalents, in the prior calendar year is an applicable large employer and must offer affordable minimum essential coverage to full-time employees and their dependents or face an employer shared responsibility payment. A full-time employee is one with at least 30 hours of service a week or 130 hours a month; the base payments are $2,000 and $3,000 per employee per year, indexed, and were $2,970 and $4,460 for 2024. [IRS Employer Shared Responsibility Provisions]
- Employers report federal income tax withheld plus both the employee and employer shares of Social Security and Medicare tax on Form 941 each quarter. Employers that reported more than $50,000 of employment taxes in the lookback period, or accumulated $100,000 or more in liability on any day, are semiweekly depositors and must attach Schedule B. [IRS About Form 941]
- Sign-on bonuses paid to recruit nurses and other staff are wages subject to Social Security, Medicare and FUTA taxes and income tax withholding. Bonuses paid separately from regular wages are supplemental wages withheld at a flat 22 percent, or 37 percent once an employee's supplemental wages exceed $1 million in the calendar year. [IRS Publication 15 (2026)]
Read the full guide to how to calculate payroll taxes, and the rest of the healthcare practice payroll library.
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Frequently Asked Questions
Healthcare practice payroll tax: IRS Employer Shared Responsibility Provisions
An employer that averaged at least 50 full-time employees, counting full-time equivalents, in the prior calendar year is an applicable large employer and must offer affordable minimum essential coverage to full-time employees and their dependents or face an employer shared responsibility payment. A full-time employee is one with at least 30 hours of service a week or 130 hours a month; the base payments are $2,000 and $3,000 per employee per year, indexed, and were $2,970 and $4,460 for 2024.
Healthcare practice payroll tax: IRS About Form 941
Employers report federal income tax withheld plus both the employee and employer shares of Social Security and Medicare tax on Form 941 each quarter. Employers that reported more than $50,000 of employment taxes in the lookback period, or accumulated $100,000 or more in liability on any day, are semiweekly depositors and must attach Schedule B.
What is the employer tax cost on one of the registered nurses?
At the $97,550 national median (BLS OEWS, May 2025): $7,463 in employer Social Security and Medicare, $42 in FUTA after the state credit, plus state unemployment at the employer's assigned rate.
What does managed payroll cost for a healthcare practice?
$45 per employee per month, all-inclusive, inside the payroll software you already use, with no monthly minimum. Shift differentials, on-call pay and credentialing-based pay tiers are configured at setup, not billed as add-ons.
Related Resources
Anthony leads payroll solutions at Business Executive Group, a national managed payroll firm serving businesses across industries including Healthcare Practices. BEG manages payroll at $45 PEPM, all-inclusive, with deep expertise in compliance, multi-state filing, and industry-specific payroll requirements. Get instant pricing at beghr.com.
Authoritative source: IRS: Understanding Employment Taxes
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