The document discusses the 3.8% Medicare surtax introduced by the Affordable Care Act that applies to individuals with modified adjusted gross income over $200,000 and married couples over $250,000. It applies to net investment income including capital gains, dividends, and rents. Gains from selling a primary residence are excluded. The surtax could apply to capital gains over $500,000 for married couples from selling a home if other income exceeds the threshold. Ways to minimize its impact include increasing municipal bond or annuity holdings, installment sales, gifting assets, and Roth IRA conversions.