In addition to the strategies already discussed, these clients can make larger contributions to qualified plans to lower taxable wages and, in turn, MAGI and the surtax. Business owners can reduce MAGI by managing profits with year-end equipment purchases and careful customer billing, Drossman says.

To manage MAGI in future years, planners suggest Roth conversions. Their non-taxable distributions don't get included in MAGI, whereas distributions from traditional retirement accounts do. A Roth conversion today can stop required distributions-and surtax-later, LaBrecque tells wealthy clients. Convert in 2012, he adds, so that the conversion itself predates the surtax while benefiting from the low Bush-era ordinary rates, which are currently set to expire at year end.

For Fiduciaries
Trusts and estates are subject to the Medicare surtax and for these entities, tripping the threshold is easy because it's low.  The surtax is computed on the smaller of (1) the trust's undistributed net investment income or (2) the amount of AGI that falls in the highest tax bracket for trusts and estates, which in 2013 is expected to be income exceeding about $12,000. "For trusts and estates the threshold is indexed," says Drossman.

Practically speaking, a non-grantor trust that does not make any distributions will be subject to the surtax on its investment income above the lowly threshold, according to Drossman.  "Distributions reduce the trust's AGI and shift the income to the beneficiary, who may or may not be taxable on it depending on his personal situation.  This is one more thing for a trustee to consider when making a distribution," Drossman says.

Regarding recent deaths, executors should bear in mind that the surtax only applies to years beginning on or after January 1, 2013, says Keebler.  An election to end the estate's fiscal year on, say, November 30, 2012, would effectively place the first 11 months of 2013 in a pre-surtax year and avoid the levy for that period.

Health-Care Reform And The Business Owner
Clients with businesses may face many significant new requirements, and equally serious penalties for non-compliance, although some of the most onerous provisions apply only to larger employers.

"Business owners should immediately focus on the costs that health-care reform will bring to their organizations," advises Steven J. Roper, president of Roper Insurance & Financial Services, a consulting firm in Englewood, Colo.  Because the costs will not be trivial for many employers, they need to understand what's coming down the pike as they prepare budgets and business plans.

Also deserving immediate attention is a new document required of plan sponsors, the Summary of Benefits and Coverage (SBC).  Beginning September 23, employers must distribute the SBC to new hires at initial enrollment, as well as annually during open enrollment to all employees, if they work an average of 30 hours per week or more. This includes employees who do not participate in the health plan.

The SBC gives workers a side-by-side comparison of the benefits provided by different plans, along with a glossary of key terms, explains Roper, who serves on the board of the Colorado Health Benefit Exchange, created by the reform legislation to provide coverage to high-risk individuals.

Also coming to plan sponsors this fall is the assessment formerly known as the Comparative Clinical Effectiveness Research Fee, although princely it is not.  Now called the Patient-Centered Outcomes Research Institute (PCORI) Fee, it is $1 times the average number of covered lives (i.e., spouses and dependents as well as employees) for plan years ending before October 1, 2013. After that this nuisance fee doubles. It ceases after 2019. Several methods are available for calculating the average number of participants.