IRS Form 8885 "Health Coverage Tax Credit"

What Is IRS Form 8885?

This is a tax form that was released by the Internal Revenue Service (IRS) - a subdivision of the U.S. Department of the Treasury. Check the official IRS-issued instructions before completing and submitting the form.

Form Details:

  • A 1-page form available for download in PDF;
  • This form cannot be used to file taxes for the current year. Choose a more recent version to file for the current tax year;
  • Editable, printable, and free;

Download a fillable version of IRS Form 8885 through the link below or browse more documents in our library of IRS Forms.

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Download IRS Form 8885 "Health Coverage Tax Credit"

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8885
Health Coverage Tax Credit
OMB No. 1545-0074
2018
Form
Attach to Form 1040, Form 1040NR, Form 1040-SS, or Form 1040-PR.
Department of the Treasury
Attachment
134
Go to www.irs.gov/Form8885 for instructions and the latest information.
Internal Revenue Service
Sequence No.
Name of recipient (if both spouses are recipients, complete a separate form for each spouse)
Recipient’s social security number
Before you begin: See Definitions and Special Rules in the instructions.
!
Do not complete this form if you can be claimed as a dependent on someone else’s 2018 tax return.
CAUTION
Part I
Election To Take the Health Coverage Tax Credit
1
Check the box below for the first month in your tax year that you elect to take the Health Coverage Tax Credit (HCTC). All of
the following statements must be true as of the first day of that month. You must also check the box for each month after your
election month that all of the following statements were true as of the first day of that month.
• You were an eligible trade adjustment assistance (TAA) recipient, alternative TAA (ATAA) recipient, reemployment TAA (RTAA)
recipient, or Pension Benefit Guaranty Corporation (PBGC) payee; or you were a qualifying family member of an individual who
fell under one of the categories listed above when he or she passed away or with whom you finalized
a divorce.
• You and/or your family member(s) were covered by HCTC-qualified health insurance coverage for which you paid the entire
premiums, or your portion of the premiums, directly to your health plan or to “US Treasury-HCTC.”
• You were not enrolled in Medicare Part A, B, or C, or you were enrolled in Medicare but your family member(s) qualified for
the HCTC.
• You were not enrolled in Medicaid or the Children’s Health Insurance Program (CHIP).
• You were not enrolled in the Federal Employees Health Benefits Program (FEHBP) or eligible to receive benefits under the
U.S. military health system (TRICARE).
• You were not imprisoned under federal, state, or local authority.
• Your or your spouse’s employer (or former employer) did not pay 50% or more of the cost of coverage.
January
February
March
April
May
June
July
August
September
October
November
December
Part II
Health Coverage Tax Credit
2
Enter the total amount paid directly to your health plan for HCTC-qualified health insurance
coverage for the months checked on line 1. See instructions. Do not include on line 2 any insurance
premiums paid to “US Treasury-HCTC” or any advance monthly payments made on your behalf as
shown on Form 1099-H or any insurance premiums you paid for which you received a
reimbursement of the HCTC during the year by filing Form 14095 .
.
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2
You must attach the required documents listed in the instructions for any amounts
!
included on line 2. If you do not attach the required documents, your credit will be
disallowed.
CAUTION
3
Enter the total amount of any Archer MSA or health savings accounts distributions used to pay for
HCTC-qualified health insurance coverage for the months checked on line 1 .
.
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3
4
Subtract line 3 from line 2. Enter the result, but not less than zero
.
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4
5
Health Coverage Tax Credit. If you received the benefit of the advance monthly payment
program for any month not checked on line 1 or received a reimbursement of the HCTC during the
year by filing Form 14095 for any month not checked on line 1, see the instructions for line 5 for
more details. Otherwise, multiply the amount on line 4 by 72.5% (0.725). Enter the result here and
on Schedule 5 (Form 1040), line 74 (check box c); Form 1040NR, line 69 (check box c); Form
1040-SS, line 10; or Form 1040-PR, line 10 .
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5
8885
For Paperwork Reduction Act Notice, see your tax return instructions.
Form
(2018)
Cat. No. 34641D
8885
Health Coverage Tax Credit
OMB No. 1545-0074
2018
Form
Attach to Form 1040, Form 1040NR, Form 1040-SS, or Form 1040-PR.
Department of the Treasury
Attachment
134
Go to www.irs.gov/Form8885 for instructions and the latest information.
Internal Revenue Service
Sequence No.
Name of recipient (if both spouses are recipients, complete a separate form for each spouse)
Recipient’s social security number
Before you begin: See Definitions and Special Rules in the instructions.
!
Do not complete this form if you can be claimed as a dependent on someone else’s 2018 tax return.
CAUTION
Part I
Election To Take the Health Coverage Tax Credit
1
Check the box below for the first month in your tax year that you elect to take the Health Coverage Tax Credit (HCTC). All of
the following statements must be true as of the first day of that month. You must also check the box for each month after your
election month that all of the following statements were true as of the first day of that month.
• You were an eligible trade adjustment assistance (TAA) recipient, alternative TAA (ATAA) recipient, reemployment TAA (RTAA)
recipient, or Pension Benefit Guaranty Corporation (PBGC) payee; or you were a qualifying family member of an individual who
fell under one of the categories listed above when he or she passed away or with whom you finalized
a divorce.
• You and/or your family member(s) were covered by HCTC-qualified health insurance coverage for which you paid the entire
premiums, or your portion of the premiums, directly to your health plan or to “US Treasury-HCTC.”
• You were not enrolled in Medicare Part A, B, or C, or you were enrolled in Medicare but your family member(s) qualified for
the HCTC.
• You were not enrolled in Medicaid or the Children’s Health Insurance Program (CHIP).
• You were not enrolled in the Federal Employees Health Benefits Program (FEHBP) or eligible to receive benefits under the
U.S. military health system (TRICARE).
• You were not imprisoned under federal, state, or local authority.
• Your or your spouse’s employer (or former employer) did not pay 50% or more of the cost of coverage.
January
February
March
April
May
June
July
August
September
October
November
December
Part II
Health Coverage Tax Credit
2
Enter the total amount paid directly to your health plan for HCTC-qualified health insurance
coverage for the months checked on line 1. See instructions. Do not include on line 2 any insurance
premiums paid to “US Treasury-HCTC” or any advance monthly payments made on your behalf as
shown on Form 1099-H or any insurance premiums you paid for which you received a
reimbursement of the HCTC during the year by filing Form 14095 .
.
.
.
.
.
.
.
.
.
.
.
2
You must attach the required documents listed in the instructions for any amounts
!
included on line 2. If you do not attach the required documents, your credit will be
disallowed.
CAUTION
3
Enter the total amount of any Archer MSA or health savings accounts distributions used to pay for
HCTC-qualified health insurance coverage for the months checked on line 1 .
.
.
.
.
.
.
.
.
3
4
Subtract line 3 from line 2. Enter the result, but not less than zero
.
.
.
.
.
.
.
.
.
.
.
4
5
Health Coverage Tax Credit. If you received the benefit of the advance monthly payment
program for any month not checked on line 1 or received a reimbursement of the HCTC during the
year by filing Form 14095 for any month not checked on line 1, see the instructions for line 5 for
more details. Otherwise, multiply the amount on line 4 by 72.5% (0.725). Enter the result here and
on Schedule 5 (Form 1040), line 74 (check box c); Form 1040NR, line 69 (check box c); Form
1040-SS, line 10; or Form 1040-PR, line 10 .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
5
8885
For Paperwork Reduction Act Notice, see your tax return instructions.
Form
(2018)
Cat. No. 34641D