As clínicas médicas podem optar por diferentes regimes de tributação dentro do Simples Nacional, dependendo do Fator R e do anexo aplicado. No Anexo III, a alíquota inicial é de 6%, podendo atingir até 33%, enquanto no Anexo V, ela começa em 15,5% e pode chegar a 30,5%. Frequentemente, essas opções não são as mais vantajosas para clínicas médicas.
No regime de Lucro Presumido, a tributação é baseada em uma estimativa do lucro da empresa. Para clínicas que prestam serviços médicos, a base de cálculo é geralmente de 32% do faturamento, com uma tributação de 8% sobre esse valor, de acordo com o código de serviço utilizado. Para profissões regulamentadas como a medicina, a carga tributária costuma ser cerca de 16,33% do faturamento total.
Por outro lado, no regime de Lucro Real, a tributação é mais detalhada. O Imposto de Renda das Pessoas Jurídicas (IRPJ) varia entre 15% e 25%, enquanto a Contribuição Social sobre o Lucro Líquido (CSLL) é de 9%. Este regime é geralmente preferido por clínicas com um faturamento significativo, superior a R$78 milhões anuais, o que corresponde a cerca de R$6,5 milhões mensais. Hospitais são comumente encontrados sob este regime tributário.
No caso de médicos que utilizam o carnê-leão, este costuma ser o regime menos vantajoso. O imposto é calculado com base na soma dos rendimentos e despesas mensais, aplicando-se a tabela progressiva do Imposto de Renda da Pessoa Física (IRPF) vigente.
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