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You may be subject to both taxes, but not on the same type of income. The 0.9% Additional Medicare Tax applies to individuals’ wages, compensation and self-employment income over certain thresholds, but it does not apply to income items included in Net Investment Income

Individuals will owe the tax if they have Net Investment Income and also have modified adjusted gross income over the following thresholds:
Married Filing jointly & Qualifying widow(er) $250,000
Single or Head of Household $200,000
Married filing separately $125,000

In general, investment income includes, but is not limited to: interest, dividends, capital gains, rental and royalty income, non-qualified annuities, income from businesses involved in trading of financial instruments or commodities, and businesses that are passive activities to the taxpayer.
To calculate your Net Investment Income, your investment income is reduced by certain expenses properly allocable to the income

The rate is 0.9 percent.

Employer contributions to the HSA of a qualified individual (determined monthly) are exempt from federal income tax withholding, social security tax, Medicare tax, and FUTA tax.
For 2013, the employer can contribute up to $3,250 for self-only coverage or $6,450 for family coverage to a qualified individual's HSA.
HSA holders 55 and older get to save an extra $1,000 which means $4,250 for an individual and $7,450 for a family) - and these contributions are 100% tax deductible from gross income.
Minimum annual deductibles are $1,250 for self-only coverage or $2,500 for family coverage. Annual out-of-pocket expenses (deductibles, co-payments and other amounts, but not premiums) cannot exceed $6,250 for self-only coverage and $12,500 for family coverage.

Mail your U.S. tax return and all attachments to:
Department of the Treasury Internal Revenue Service Center Austin, TX 73301-0215

Mail your Puerto Rican tax return and all attachments to If you request a refund
Departamento de Hacienda P.O. Box 50072 San Juan, PR 00902-6272
Mail all other Puerto Rican tax returns and attachments to Departamento de Hacienda P.O. Box 9022501 San Juan, PR 00902-2501

Generally, you are a bona fide resident of Puerto Rico if during the year you meet the presence test, do not have a tax home outside of Puerto Rico and do not have a closer connection to the U.S. or to a foreign country than to Puerto Rico.

If you are a U.S. citizen or resident alien you will satisfy the presence test for the entire year if you meet one of the following conditions.
You were present in Puerto Rico for at least 183 days during the tax year.
You were present in Puerto Rico for at least 549 days during the 3 year period that includes the current year and the 2 immediately preceding tax years. During each year of the 3 year period you must be present in Puerto Rico for at least 60 days
You were present in the United States for no more than 90 days during the year. You had earned income in the U.S. of no more than $3,000 and were present for more days in Puerto Rico than in the U.S. during the year.
You had no significant connection to the United States during the tax year.

If you are a U.S. citizen or Resident Alien and also a bona fide resident of Puerto Rico during the entire tax year, you generally must file:,br> A Puerto Rican tax return reporting income from worldwide sources. If you report U.S. source income on your Puerto Rican tax return, you can claim a credit against your Puerto Rican tax, up to the amount allowable for income taxes paid to the United States.
A U.S. tax return reporting income from worldwide sources, but Excluding Puerto Rican source income. If you are excluding Puerto Rican income on your U.S. tax return, you will not be allowed any deductions or credits that are directly or indirectly allocable to exempt income.
If all your income is from Puerto Rican sources, you are not required to file a U.S. tax return.

If you are a bona fide resident of Puerto Rico during the entire tax year and a nonresident alien of the U.S., you generally must file:,br> A Puerto Rican tax return reporting income from worldwide sources. If you report U.S. source income on your Puerto Rican tax return, you can claim a credit against your Puerto Rican tax, up to the amount allowable for income taxes paid to the United States.
A U.S. tax return (Form 1040) reporting income from worldwide sources, but Excluding Puerto Rican source income other than amounts for services performed as an employee of the U.S. or any of its agencies.
For tax purposes other than reporting income, you will be treated as a nonresident alien individual with its associated limitations.