Instructions for IRS Form 8962 - Premium Tax Credit (Ptc) 2018

December 3, 2018 "Instructions For Irs Form 8962 - Premium Tax Credit (ptc)" contain the latest filing requirements for the IRS-issued Form 8962. Download your copy of the instructions by clicking the link below.

IRS Form 8962 is a tax form issued by the United States Internal Revenue Service.

ADVERTISEMENT
2018
Department of the Treasury
Internal Revenue Service
Instructions for Form 8962
Premium Tax Credit (PTC)
Section references are to the Internal Revenue Code unless
including premiums for Marketplace health insurance. If you
otherwise noted.
were covered under a QSEHRA, your employer should have
reported the annual permitted benefit in box 12 of your Form
Purpose of Form
W-2 with code FF. If the QSEHRA is affordable for a month, no
PTC is allowed for the month. If the QSEHRA is unaffordable for
a month, you must reduce the monthly PTC (but not below -0-)
Use Form 8962 to figure the amount of your
premium tax credit
by the monthly permitted benefit amount and you must write
(PTC)
and reconcile it with
advance payment of the premium tax
“QSEHRA” in the top margin on page 1 of Form 8962 to explain
credit
(APTC).
your entry and avoid delay in the processing of your return. For
You may take PTC (and APTC may be paid) only for health
more information, see Column (e) under
Line 11—Annual Totals
insurance coverage in a
qualified health plan
(defined later)
or
Lines 12 Through 23—Monthly
Calculation, later. Also see
purchased through a Health Insurance Marketplace
Qualified Small Employer Health Reimbursement Arrangement
(Marketplace, also known as an Exchange). As a result, you
in Pub. 974 for information on determining QSEHRA affordability
should complete Form 8962 only for health insurance coverage
and Notice 2017-67 for additional guidance on QSEHRA
in a qualified health plan purchased through a Marketplace. This
coordination with the PTC. Notice 2017-67 is available at
includes a qualified health plan purchased on
HealthCare.gov
or
IRS.gov/irb/2017-47_IRB#NOT-2017-67.
through a State Marketplace.
Report changes in circumstances when you re-enroll in
If you or a member of your family enrolled in health insurance
coverage and during the year. If
APTC
is being paid for an
coverage for 2018 through a Marketplace, you should have
individual in your
tax family
(described later) and you have had
received Form 1095-A, Health Insurance Marketplace
certain changes in circumstances (see the examples below), it is
Statement, from the Marketplace. Form 1095-A shows the
important that you report them to the Marketplace where you
months of coverage purchased through the Marketplace and any
enrolled in coverage. Reporting changes in circumstances
APTC paid to your insurance company to help cover your
promptly will allow the Marketplace to adjust your APTC to
monthly premium. If APTC was paid on your behalf or, if APTC
reflect the
PTC
you are estimated to be able to take on your tax
was not paid on your behalf but you wish to take the PTC, you
return. Adjusting your APTC when you re-enroll in coverage and
must file Form 8962 and attach it to your tax return (Form 1040
during the year can help you avoid owing tax when you file your
or Form 1040NR).
tax return. Changes that you should report to the Marketplace
include the following.
At enrollment, the Marketplace may have referred to
Changes in
household
income.
APTC as your “subsidy” or “tax credit” or “advance
!
Moving to a different address.
payment.” The term APTC is used throughout these
CAUTION
Gaining or losing eligibility for other health care coverage.
instructions to clearly distinguish APTC from PTC.
Gaining, losing, or other changes to employment.
Birth or adoption.
What's New
Marriage or divorce.
Other changes affecting the composition of your
tax
family.
2018 Form 1040 redesigned. The 2018 Form 1040 has been
For more information on how to report a change in
redesigned and is supplemented with new Schedules 1 through
circumstances to the Marketplace, see
HealthCare.gov
or your
6. These additional schedules will be used as needed to
State Marketplace website.
complete more complex tax returns. References to Form 1040
Health Coverage Tax Credit (HCTC). The HCTC is a tax
and its related schedules have been revised accordingly on
credit that pays a percentage of health insurance premiums for
Form 8962 and in these instructions.
certain eligible taxpayers and their qualifying family members.
Form 1040A and Form 1040-EZ no longer available. Form
The HCTC and the PTC are different tax credits that have
1040A and Form 1040-EZ aren’t available to file your 2018
different eligibility rules. If you think you may be eligible for the
taxes. Previous filers of these forms will file Form 1040.
HCTC, see Form 8885 and its instructions or visit
IRS.gov/HCTC
References to these forms have been revised accordingly on
before completing Form 8962.
Form 8962 and in these instructions.
Health insurance options. If you need health coverage, visit
Future Developments
HealthCare.gov
to learn about health insurance options that are
available for you and your family, how to purchase health
insurance, and how you might qualify to get financial assistance
For the latest information about developments related to Form
with the cost of insurance.
8962 and its instructions, such as legislation enacted after they
were published, go to IRS.gov/Form8962.
Additional information. For additional information about the
tax provisions of the Affordable Care Act (ACA), including the
Reminders
individual shared responsibility provisions, the PTC, and the
employer shared responsibility provisions, see
IRS.gov/
Qualified small employer health reimbursement arrange-
Affordable-Care-Act/Individuals-and-Families
or call the IRS
ment (QSEHRA). Rules enacted under the 21st Century Cures
Healthcare Hotline for ACA questions (800-919-0452).
Act of 2016 allow eligible employers to provide a QSEHRA to
their eligible employees. Under a QSEHRA, an eligible employer
can reimburse eligible employees for medical expenses,
Dec 03, 2018
Cat. No. 60401R
2018
Department of the Treasury
Internal Revenue Service
Instructions for Form 8962
Premium Tax Credit (PTC)
Section references are to the Internal Revenue Code unless
including premiums for Marketplace health insurance. If you
otherwise noted.
were covered under a QSEHRA, your employer should have
reported the annual permitted benefit in box 12 of your Form
Purpose of Form
W-2 with code FF. If the QSEHRA is affordable for a month, no
PTC is allowed for the month. If the QSEHRA is unaffordable for
a month, you must reduce the monthly PTC (but not below -0-)
Use Form 8962 to figure the amount of your
premium tax credit
by the monthly permitted benefit amount and you must write
(PTC)
and reconcile it with
advance payment of the premium tax
“QSEHRA” in the top margin on page 1 of Form 8962 to explain
credit
(APTC).
your entry and avoid delay in the processing of your return. For
You may take PTC (and APTC may be paid) only for health
more information, see Column (e) under
Line 11—Annual Totals
insurance coverage in a
qualified health plan
(defined later)
or
Lines 12 Through 23—Monthly
Calculation, later. Also see
purchased through a Health Insurance Marketplace
Qualified Small Employer Health Reimbursement Arrangement
(Marketplace, also known as an Exchange). As a result, you
in Pub. 974 for information on determining QSEHRA affordability
should complete Form 8962 only for health insurance coverage
and Notice 2017-67 for additional guidance on QSEHRA
in a qualified health plan purchased through a Marketplace. This
coordination with the PTC. Notice 2017-67 is available at
includes a qualified health plan purchased on
HealthCare.gov
or
IRS.gov/irb/2017-47_IRB#NOT-2017-67.
through a State Marketplace.
Report changes in circumstances when you re-enroll in
If you or a member of your family enrolled in health insurance
coverage and during the year. If
APTC
is being paid for an
coverage for 2018 through a Marketplace, you should have
individual in your
tax family
(described later) and you have had
received Form 1095-A, Health Insurance Marketplace
certain changes in circumstances (see the examples below), it is
Statement, from the Marketplace. Form 1095-A shows the
important that you report them to the Marketplace where you
months of coverage purchased through the Marketplace and any
enrolled in coverage. Reporting changes in circumstances
APTC paid to your insurance company to help cover your
promptly will allow the Marketplace to adjust your APTC to
monthly premium. If APTC was paid on your behalf or, if APTC
reflect the
PTC
you are estimated to be able to take on your tax
was not paid on your behalf but you wish to take the PTC, you
return. Adjusting your APTC when you re-enroll in coverage and
must file Form 8962 and attach it to your tax return (Form 1040
during the year can help you avoid owing tax when you file your
or Form 1040NR).
tax return. Changes that you should report to the Marketplace
include the following.
At enrollment, the Marketplace may have referred to
Changes in
household
income.
APTC as your “subsidy” or “tax credit” or “advance
!
Moving to a different address.
payment.” The term APTC is used throughout these
CAUTION
Gaining or losing eligibility for other health care coverage.
instructions to clearly distinguish APTC from PTC.
Gaining, losing, or other changes to employment.
Birth or adoption.
What's New
Marriage or divorce.
Other changes affecting the composition of your
tax
family.
2018 Form 1040 redesigned. The 2018 Form 1040 has been
For more information on how to report a change in
redesigned and is supplemented with new Schedules 1 through
circumstances to the Marketplace, see
HealthCare.gov
or your
6. These additional schedules will be used as needed to
State Marketplace website.
complete more complex tax returns. References to Form 1040
Health Coverage Tax Credit (HCTC). The HCTC is a tax
and its related schedules have been revised accordingly on
credit that pays a percentage of health insurance premiums for
Form 8962 and in these instructions.
certain eligible taxpayers and their qualifying family members.
Form 1040A and Form 1040-EZ no longer available. Form
The HCTC and the PTC are different tax credits that have
1040A and Form 1040-EZ aren’t available to file your 2018
different eligibility rules. If you think you may be eligible for the
taxes. Previous filers of these forms will file Form 1040.
HCTC, see Form 8885 and its instructions or visit
IRS.gov/HCTC
References to these forms have been revised accordingly on
before completing Form 8962.
Form 8962 and in these instructions.
Health insurance options. If you need health coverage, visit
Future Developments
HealthCare.gov
to learn about health insurance options that are
available for you and your family, how to purchase health
insurance, and how you might qualify to get financial assistance
For the latest information about developments related to Form
with the cost of insurance.
8962 and its instructions, such as legislation enacted after they
were published, go to IRS.gov/Form8962.
Additional information. For additional information about the
tax provisions of the Affordable Care Act (ACA), including the
Reminders
individual shared responsibility provisions, the PTC, and the
employer shared responsibility provisions, see
IRS.gov/
Qualified small employer health reimbursement arrange-
Affordable-Care-Act/Individuals-and-Families
or call the IRS
ment (QSEHRA). Rules enacted under the 21st Century Cures
Healthcare Hotline for ACA questions (800-919-0452).
Act of 2016 allow eligible employers to provide a QSEHRA to
their eligible employees. Under a QSEHRA, an eligible employer
can reimburse eligible employees for medical expenses,
Dec 03, 2018
Cat. No. 60401R
information on the Form 1095-A with the void box checked or the
General Instructions
previously received Form 1095-A to complete Form 8962.
CORRECTED BOX. If you receive a Form 1095-A with the
What is the Premium Tax Credit
corrected box checked at the top of the form, use the information
on the Form 1095-A with the corrected box checked to figure the
(PTC)?
PTC and reconcile any APTC on Form 8962. Do not use the
information on the original Form 1095-A you received for the
Premium tax credit (PTC). The PTC is a tax credit for certain
policy shown in Part I of the corrected Form 1095-A.
people who enroll, or whose family member enrolls, in a
qualified
health
plan. The credit provides financial assistance to pay the
Additional information. For additional information on the PTC,
premiums for the qualified health plan offered through a
see Pub. 974, Premium Tax Credit. You also can visit
IRS.gov
Marketplace by reducing the amount of tax you owe, giving you
and enter “premium tax credit” in the search box.
a refund, or increasing your refund amount. You must file Form
Also see
How To Avoid Common Mistakes in Completing
8962 to compute and take the PTC on your tax return.
Form 8962
at the end of these instructions.
Advance payment of the premium tax credit (APTC). APTC
Who Must File
is a payment during the year to your insurance provider that pays
for part or all of the premiums for a qualified health plan covering
You must file Form 8962 with your income tax return (Form 1040
or Form 1040NR) if any of the following apply to you.
you or an individual in your tax family. Your APTC eligibility is
You are taking the PTC.
based on the Marketplace’s estimate of the PTC you will be able
to take on your tax return. If APTC was paid for you or an
APTC was paid for you or another individual in your
tax
family.
individual in your
tax
family, you must file Form 8962 to reconcile
APTC was paid for an individual you told the Marketplace
(compare) this APTC with your PTC. If the APTC is more than
would be in your
tax family
and neither you nor anyone else
included that individual in a tax family. See
Individual you
your PTC, you have excess APTC and you must repay the
enrolled who is not included in a tax family
under Lines 12
excess, subject to certain limitations. If the APTC is less than
the PTC, you can get a credit for the difference, which reduces
Through 23—Monthly Calculation, later.
your tax payment or increases your refund.
If any of the circumstances above apply to you, you must file
Changes in circumstances. The Marketplace determined
an income tax return and attach Form 8962 even if you are not
your eligibility for and the amount of your 2018 APTC using
otherwise required to file. You must use Form 1040 or Form
projections of your income and the number of individuals you
1040NR. For help determining which of these forms to file, see
certified to the Marketplace would be in your tax family (yourself,
Tax Topic 352 at IRS.gov/TaxTopics.
spouse, and dependents) when you enrolled in a
qualified health
If you are filing Form 8962, you cannot file Form
plan. If this information changed during 2018 and you did not
1040NR-EZ, Form 1040-SS, or Form 1040-PR.
!
promptly report it to the Marketplace, the amount of APTC paid
may be substantially different from the amount of PTC you can
CAUTION
take on your tax return. See
Report changes in circumstances
If someone else enrolled an individual in your tax family in
when you re-enroll in coverage and during the
year, earlier, for
coverage, and APTC was paid for that individual’s coverage, you
changes that can affect the amount of your PTC.
must file Form 8962 to reconcile the APTC. You need to obtain a
copy of the Form 1095-A from the person who enrolled the
Deductions for health insurance premiums. You cannot
individual.
deduct the portion of your health insurance premium on your tax
return that is paid for by the PTC or APTC (after you determine
If you are claimed as a dependent on another person's
how much of any excess APTC you must repay). If you are
tax return, the person who claims you will file Form 8962
TIP
deducting medical expenses as an itemized deduction, see Pub.
to take the PTC and, if necessary, repay excess APTC
502, Medical and Dental Expenses. If you are claiming the
for your coverage. You do not need to file Form 8962.
self-employed health insurance deduction, see Pub. 974,
Who Can Take the PTC
Premium Tax Credit.
Form 1095-A, Health Insurance Marketplace Statement.
You can take the PTC for 2018 if you meet the conditions under
You will need Form 1095-A to complete Form 8962. The
(1) and (2) below.
Marketplace uses Form 1095-A to report certain information to
1. For at least 1 month of the year, all of the following were
the IRS about individuals who enrolled in a
qualified health plan
true.
through the Marketplace. The Marketplace sends copies to
a. An individual in your
tax family
was enrolled in a
qualified
individuals to allow them to accurately file a tax return taking the
health plan
offered through the Marketplace on the first day of
PTC and reconciling APTC. For coverage in 2018, the
the month.
Marketplace is required to provide or send Form 1095-A to the
individual(s) identified in the Marketplace enrollment application
b. That individual was not eligible for minimum essential
by January 31, 2019. If you are expecting to receive Form
coverage (MEC) for the month, other than coverage in the
1095-A for a qualified health plan and you do not receive it by
individual market. An individual is generally considered eligible
early February, contact the Marketplace.
for MEC for the month only if he or she was eligible for every day
of the month (see
Minimum essential
coverage, later).
Under certain circumstances, for example, where two
spouses enroll in a qualified health plan and divorce during the
c. The portion of the
enrollment premiums
(described later)
year, the Marketplace will provide Form 1095-A to one taxpayer,
for the month for which you are responsible was paid by the due
but another taxpayer also will need the information from that
date of your tax return (not including extensions). However, if
form to complete Form 8962. The recipient of Form 1095-A
you became eligible for APTC because of a successful eligibility
should provide a copy to other taxpayers as needed.
appeal and you retroactively enrolled in the plan, then the
VOID BOX. If you received a Form 1095-A with the void box
portion of the enrollment premium for which you are responsible
checked at the top of the form, that means you previously
must be paid on or before the 120th day following the date of the
received a Form 1095-A for the policy shown in Part I that was
appeals decision.
sent in error. You should not have received a Form 1095-A for
the policy shown in Part I of the Form 1095-A. Do not use the
-2-
Instructions for Form 8962 (2018)
2. You are an
applicable taxpayer
for 2018. To be an
are not eligible for
MEC
(other than coverage in the individual
applicable taxpayer, you must meet all of the following
market). The individuals included in your coverage family may
requirements.
change from month to month. If an individual in your tax family is
not enrolled in a qualified health plan, or is enrolled in a qualified
a. Your
household income
for 2018 is at least 100% but no
health plan but is eligible for MEC (other than coverage in the
more than 400% of the federal poverty line for your family size
individual market), he or she is not part of your coverage family.
(see the instructions for
Line
4, later). However, having
Your PTC is available to help you pay only for the coverage of
household income below 100% of the federal poverty line will not
the individuals included in your coverage family.
disqualify you from taking the PTC if you meet certain
requirements described under
Household income below 100%
Monthly credit amount. The monthly credit amount is the
of the federal poverty
line, later.
amount of your tax credit for a month. Your PTC for the year is
the sum of all of your monthly credit amounts. Your credit
b. No one can claim you as a dependent on a tax return for
amount for each month is the lesser of:
2018.
The
enrollment premiums
(described next) for the month for
c. If you were married at the end of 2018, generally you
one or more
qualified health plans
in which you or any individual
must file a joint return. However, filing a separate return from
in your
tax family
enrolled; or
your spouse will not disqualify you from being an applicable
The amount of the monthly
applicable second lowest cost
taxpayer if you meet certain requirements described under
silver plan (SLCSP) premium
(described below) less your
Married
taxpayers, later.
monthly contribution amount
(described below).
You are not entitled to the PTC for health coverage for an
To qualify for a monthly credit amount, at least one individual
individual for any period during which the individual is not
in your tax family must be enrolled in a qualified health plan on
lawfully present in the United States.
the 1st day of that month. Generally, if coverage in a qualified
health plan began after the 1st day of the month, you are not
For additional requirements and more details, see
Applicable
allowed a monthly credit amount for the coverage for that month.
taxpayer, later.
However, if an individual in your tax family enrolled in a qualified
Terms You May Need to Know
health plan in 2018 and the enrollment was effective on the date
of the individual's birth, adoption, or placement for adoption or in
Tax family. For purposes of the PTC, your tax family consists of
foster care, or on the effective date of a court order placing the
the following individuals.
individual with your family, the individual is treated as enrolled as
You, if you file a tax return for the year and you can’t be
of the first day of that month. Therefore, the individual may be a
claimed as a dependent on someone else’s 2018 tax return.
member of your tax family and coverage family for the entire
Your spouse if filing jointly and he or she can’t be claimed as a
month for purposes of computing your monthly credit amount.
dependent on someone else’s 2018 tax return.
Enrollment premiums. The enrollment premiums are the
Your dependents whom you claim on your 2018 tax return. If
total amount of the premiums for the month, reduced by any
you are filing Form 1040NR, you should include your
premium amounts for that month that were refunded, for one or
dependents in your tax family only if you are a U.S. national,
more
qualified health plans
in which any individual in your
tax
resident of Canada, Mexico, or South Korea, or a resident of
family
enrolled. Form 1095-A, Part III, column A, reports the
India who was a student or business apprentice.
enrollment premiums.
Your family size equals the number of qualifying individuals in
You generally are not allowed a monthly credit amount for the
your tax family (including yourself). See the instructions for
month if any part of the enrollment premiums for which you are
Line 1
for more information on figuring your tax family size.
responsible that month has not been paid by the due date of
your tax return (not including extensions). However, if you
Note. Listing your dependents by name and SSN or individual
became eligible for APTC because of a successful eligibility
taxpayer identification number (ITIN) on your tax return is the
appeal and you retroactively enrolled in the plan, the portion of
same as claiming them as a dependent. If you have more than
the enrollment premium for which you are responsible must be
four dependents, see the instructions for Form 1040 or Form
paid on or before the 120th day following the date of the appeals
1040NR.
decision. Premiums another person pays on your behalf are
treated as paid by you.
Household income. For purposes of the PTC, household
income is the modified adjusted gross income (modified AGI) of
If your share of the enrollment premiums is not paid, the
you and your spouse (if filing a joint return) (see
Line
2a, later)
issuer may terminate coverage. The termination is generally
plus the modified AGI of each individual whom you claim as a
effective no sooner than the second month of nonpayment. For
dependent and who is required to file an income tax return
any months you were covered but did not pay your share of the
because his or her income meets the income tax return filing
premiums, you are not allowed a monthly credit amount.
threshold (see
Line
2b, later). Household income does not
Applicable SLCSP premium. The applicable SLCSP
include the modified AGI of those individuals whom you claim as
premium is the second lowest cost silver plan premium offered
dependents and who are filing a 2018 return only to claim a
through the Marketplace where you reside that applies to your
refund of withheld income tax or estimated tax.
coverage family
(described earlier). The SLCSP premium is not
Modified AGI. For purposes of the PTC, modified AGI is the
the same as your
enrollment
premium, unless you enroll in the
AGI on your tax return plus certain income that is not subject to
applicable SLCSP. Form 1095-A, Part III, column B, generally
tax (foreign earned income, tax-exempt interest, and the portion
reports the applicable SLCSP premium. If no APTC was paid for
of social security benefits that is not taxable). Use
Worksheet
your coverage, Form 1095-A, Part III, column B, may be wrong
1-1
and
Worksheet 1-2
to determine your modified AGI.
or blank or may report your applicable SLCSP premium as -0-.
Taxpayer’s tax return including income of a dependent
Also, if you had a change in circumstances during 2018 that you
did not report to the Marketplace, the SLCSP premium reported
child. A taxpayer who includes the gross income of a
in Part III, column B, may be wrong. In either case you must
dependent child on the taxpayer’s tax return must include on
determine your correct applicable SLCSP premium. You do not
Worksheet 1-2 the child’s tax-exempt interest and the portion of
the child’s social security benefits that is not taxable.
have to request a corrected Form 1095-A from the Marketplace.
See
Missing or incorrect SLCSP premium on Form
1095-A, later.
Coverage family. Your coverage family includes all individuals
in your
tax family
who are enrolled in a
qualified health plan
and
-3-
Instructions for Form 8962 (2018)
Monthly contribution amount. Your monthly contribution
Your employer may have sent you a Form 1095-C,
amount is used to calculate your monthly credit amount. It is the
Employer-Provided Health Insurance Offer and Coverage, with
amount of your household income you would be responsible for
information about the coverage offered to you, if any. See Form
paying as your share of premiums each month if you enrolled in
1095-C, line 14, and the Instructions for Recipient included with
the
applicable
SLCSP. It is not based on the amount of
that form, for information about whether you and other members
premiums you paid out of pocket during the year. You will
of your tax family were offered coverage. See Pub. 974 for more
compute your monthly contribution amount in Part I of Form
information on how to determine whether the coverage you were
8962.
offered was affordable and provided minimum value, including
on how to use Form 1095-C.
Qualified health plan. For purposes of the PTC, a qualified
Example. Don was eligible to enroll in his employer’s
health plan is a health insurance plan or policy purchased
coverage for 2018 but instead applied for coverage in a qualified
through a Marketplace at the bronze, silver, gold, or platinum
health plan through the Marketplace for coverage in 2018. Don
level. Throughout these instructions, a qualified health plan also
provided accurate information about his employer’s coverage to
is referred to as a policy. Catastrophic health plans and
the Marketplace and the Marketplace determined that the offer
stand-alone dental plans purchased through the Marketplace,
of coverage was not affordable and that Don was eligible for
and all plans purchased through the Small Business Health
APTC. Don enrolled in the qualified health plan for 2018. Don
Options Program (SHOP), are not qualified health plans for
got a new job with employer coverage that Don could have
purposes of the PTC. Therefore, they do not qualify a taxpayer
enrolled in as of September 1, 2018, but chose not to. Don did
to take the PTC.
not return to the Marketplace to determine if he was eligible for
Minimum essential coverage (MEC). A separate tax
APTC for the months September through December 2018, and
provision requires most individuals to have qualifying health
remained enrolled in the qualified health plan. Don is not
coverage, qualify for a coverage exemption, or make a payment
considered eligible for employer-sponsored coverage for the
with their tax return. Health coverage that satisfies this
months January through August of 2018 because he gave
requirement is called MEC. An individual in your tax family who
accurate information to the Marketplace about the availability of
is eligible for MEC (except coverage in the individual market) for
employer coverage and the Marketplace determined that he was
a month is not in your coverage family for that month. Therefore,
eligible for APTC for coverage in a qualified health plan. The
you cannot take the PTC for that individual’s coverage for the
Marketplace determination does not apply, however, for the
months that individual is eligible for MEC. In addition to qualified
months September through December of 2018 because Don did
health plans and other coverage in the individual market, MEC
not provide information to the Marketplace about his new
includes:
employer’s offer of coverage. Whether Don is considered
Most coverage through government-sponsored programs
eligible for employer-sponsored coverage and ineligible for the
(including Medicaid coverage, Medicare parts A or C, the
PTC for the months September through December of 2018 is
Children’s Health Insurance Program (CHIP), certain benefits for
determined under the eligibility rules described under
veterans and their families, TRICARE, and health coverage for
Employer-Sponsored Plans in Pub. 974.
Peace Corps volunteers);
Waiting periods and post-employment coverage. If you
Most types of employer-sponsored coverage; and
cannot get benefits under an employer-sponsored plan until after
Other health coverage the Department of Health and Human
a waiting period has expired, you are not treated as eligible for
Services designates as MEC.
that coverage during the waiting period. Also, if you leave your
Eligibility for MEC. In most cases you are considered eligible
employment and are offered post-employment coverage such as
for MEC if the coverage is available to you, whether or not you
COBRA or retiree coverage, you are not considered eligible for
enroll in it. However, special rules apply to certain types of MEC
that post-employment coverage unless you actually enroll in the
as explained below.
coverage. See Coverage after employment ends under
Employer-Sponsored Plans in Pub. 974 for more information.
Employer-sponsored coverage. Even if you and other
members of your tax family had the opportunity to enroll in a plan
Medicaid and CHIP. You generally are considered eligible
that is MEC offered by your employer for 2018, you are
for coverage under a government-sponsored program for a
considered eligible for MEC under the plan for a month only if
month if you met the eligibility criteria for that month, even if you
the offer of coverage met a minimum standard of affordability
did not enroll. However, if a Marketplace made a determination
and provided a minimum level of benefits, referred to as
that you or a family member were ineligible for Medicaid or CHIP
“minimum value.” The coverage offered by your employer is
and were eligible for APTC when the individual enrolls in a
generally considered affordable for you and the members of
qualified health plan, the individual is treated as not eligible for
your tax family allowed to enroll in the coverage if your share of
Medicaid or CHIP for purposes of the PTC for the duration of the
the annual cost for self-only coverage, which is sometimes
period of coverage under the qualified health plan (generally, the
referred to as the employee required contribution, is not more
rest of the plan year), even if your actual 2018 income suggests
than 9.56% of your household income. However,
that the individual may have been eligible for Medicaid or CHIP.
employer-sponsored coverage is not considered affordable if,
However, in order to rely on a Marketplace's determination
when you or a family member enrolled in a qualified health plan,
that you or a family member were ineligible for Medicaid, CHIP,
you gave accurate information about the availability of employer
or a similar program, you must provide accurate information to
coverage to the Marketplace, and the Marketplace determined
the Marketplace when you enroll in a qualified health plan. You
that you were eligible for APTC for the individual’s coverage in
or the family member may be treated as eligible for Medicaid,
the qualified health plan. In addition, if you or your family
CHIP, or the similar program, and not eligible for PTC, if the
member enrolls in employer-sponsored coverage for a month,
Marketplace determination is later found to be based on
you or your family member is considered eligible for
incorrect information that was given with an intentional or
employer-sponsored coverage for that month, even if the
reckless disregard for the facts. See Pub. 974 for more
coverage does not satisfy the affordability and minimum value
information.
standards. Finally, if your employer offered coverage for you but
For more information about eligibility for Medicaid, CHIP, and
not your family, you may be able to take the PTC for your family
other forms of government-sponsored MEC, see Pub. 974.
members. For more information on affordability and minimum
value, see Pub. 974.
Example. Married taxpayers Tom and Nicole applied for
insurance affordability programs at the Marketplace for
-4-
Instructions for Form 8962 (2018)
themselves and their two children whom they claim as
joint return if one of the two exceptions below applies to you. If
dependents, Kim and Chris. The Marketplace determined that
Exception 1
applies, you can file a return using head of
Kim and Chris were eligible for coverage under CHIP. Instead of
household or single filing status and take the PTC. If
Exception 2
enrolling Kim and Chris in CHIP, the entire tax family enrolled in
applies, you are treated as married but can take the PTC with
a qualified health plan (with APTC paid only for Tom and
the filing status of married filing separately.
Nicole’s coverage). Because Kim and Chris were eligible for
Exception 1—Certain married persons living apart. You
CHIP, which is MEC, Tom and Nicole are not eligible for the PTC
may file your return as if you are unmarried and take the PTC if
for coverage of Kim and Chris, but may be eligible for the PTC
one of the following applies to you.
for their own coverage.
You file a separate return from your spouse on Form 1040
Coverage in the individual market outside the
because you meet the requirements for Married persons who
Marketplace. While coverage purchased in the individual
live apart under Head of Household in the instructions for Form
market outside the Marketplace is MEC, eligibility for this type of
1040.
coverage does not prevent you from being eligible for the PTC
You file as single on your Form 1040NR because you meet
for Marketplace coverage. Coverage purchased in the individual
the requirements for Married persons who live apart under Were
market outside the Marketplace does not qualify for the PTC.
You Single or Married? in the instructions for Form 1040NR.
Exception 2—Victim of domestic abuse or spousal
For more details on eligibility for MEC, including additional
abandonment. If you are a victim of domestic abuse or spousal
special eligibility rules, see Minimum Essential Coverage in Pub.
abandonment, you can file a return as married filing separately
974. You also can check
IRS.gov/Affordable-Care-Act/
and take the PTC for 2018 if all of the following apply to you.
Individuals-and-Familes/Individual-Shared-Responsibilty-
You are living apart from your spouse at the time you file your
Provision
for future updates about types of coverage that are
2018 tax return.
recognized as MEC.
You are unable to file a joint return because you are a victim
Applicable taxpayer. You must be an applicable taxpayer to
of
domestic abuse
(described next) or
spousal abandonment
take the PTC. Generally, you are an applicable taxpayer if your
(described below).
household income
for 2018 (described earlier) is at least 100%
You check the box on your Form 8962 to certify that you are a
but not more than 400% of the federal poverty line for your family
victim of domestic abuse or spousal abandonment.
size (provided in Tables 1-1, 1-2, and 1-3) and no one can claim
You do not meet the three-year limit for Exception 2,
you as a dependent for 2018. In addition, if you were married at
described below.
the end of 2018, you must file a joint return to be an applicable
Domestic abuse. Domestic abuse includes physical,
taxpayer unless you meet one of the exceptions described under
psychological, sexual, or emotional abuse, including efforts to
Married
taxpayers, later.
control, isolate, humiliate, and intimidate, or to undermine the
For individuals with household income below 100% of the
victim's ability to reason independently. All the facts and
federal poverty line, see
Household income below 100% of the
circumstances are considered in determining whether an
federal poverty line
under line 6, later.
individual is abused, including the effects of alcohol or drug
Individuals who are incarcerated. Individuals who are
abuse by the victim’s spouse. Depending on the facts and
incarcerated (other than pending disposition of charges, for
circumstances, abuse of an individual’s child or other family
example awaiting trial) are not eligible for coverage in a
qualified
member living in the household may constitute abuse of the
health plan
through a Marketplace. However, these individuals
individual.
may be applicable taxpayers and take the PTC for the coverage
Spousal abandonment. A taxpayer is a victim of spousal
of individuals in their
tax families
who are eligible for coverage in
abandonment for a tax year if, taking into account all facts and
a qualified health plan.
circumstances, the taxpayer is unable to locate his or her
Individuals who are not lawfully present. Individuals who
spouse after reasonable diligence.
are not lawfully present in the United States are not eligible for
Three-year limit for Exception 2. You cannot claim the PTC
coverage in a
qualified health plan
through a Marketplace. They
using this exception for more than 3 consecutive years. For
cannot take the PTC for their own coverage and are not eligible
example, if you used this exception to claim the PTC on your tax
for the repayment limitations in
Table 5
for APTC paid for their
returns for 2015, 2016, and 2017, you cannot use this exception
own coverage. However, these individuals may be applicable
to claim the PTC on your 2018 return.
taxpayers and take the PTC for the coverage of individuals in
Married filing separately. If you file as married filing
their
tax
families, such as their children, who are lawfully present
separately and are not a victim of domestic abuse or spousal
and eligible for coverage in a qualified health plan. For more
abandonment (see
Exception 2—Victim of domestic abuse or
information about who is treated as lawfully present for this
spousal abandonment
under Married taxpayers above), then
purpose, visit HealthCare.gov. See Individuals Not Lawfully
you are not an
applicable taxpayer
and you cannot take the
Present in the United States Enrolled in a Qualified Health Plan
PTC. You generally must repay all of the APTC paid for a
in Pub. 974 for more information on reconciling APTC when an
qualified health plan
that covered only individuals in your
tax
unlawfully present person is enrolled individually or with lawfully
family. If the policy also covered at least one individual in your
present family members.
spouse’s tax family, you generally must repay half of the APTC
paid for the policy. See the instructions for
Line
9, later.
Married taxpayers. If you are considered married for federal
However, the amount of APTC you have to repay may be limited.
income tax purposes, you must file a joint return with your
See the instructions for
Line
28, later.
spouse to take the PTC unless one of the two exceptions below
applies to you.
Specific Instructions
You are not considered married for federal income tax
purposes if you are divorced or legally separated according to
Name. Print or type your name exactly as you entered it on your
your state law under a decree of divorce or separate
tax return. If you are married and filing a joint return, enter the
maintenance. In that case, you cannot file a joint return but may
be able to take the PTC on your separate return. See Pub. 501,
name that appears first on your return.
Dependents, Standard Deduction, and Filing Information.
Social security number. The social security number on this
If you are considered married for federal income tax
form should match the social security number on your tax return.
purposes, you may be eligible to take the PTC without filing a
-5-
Instructions for Form 8962 (2018)

Download Instructions for IRS Form 8962 - Premium Tax Credit (Ptc) 2018

848 times
Rate
4.4(4.4 / 5) 39 votes
ADVERTISEMENT