Instructions for IRS Form 8962 "Premium Tax Credit (Ptc)"

This document contains official instructions for IRS Form 8962, Premium Tax Credit (Ptc) - a tax form released and collected by the Internal Revenue Service (IRS), a subdivision of the U.S. Department of the Treasury. An up-to-date fillable IRS Form 8962 is available for download through this link.

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

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2019
Department of the Treasury
Internal Revenue Service
Instructions for Form 8962
Premium Tax Credit (PTC)
Section references are to the Internal Revenue Code unless
Report changes in circumstances when you re-enroll in
otherwise noted.
coverage and during the year. If
APTC
is being paid for an
individual in your
tax family
(described later) and you have had
Purpose of Form
certain changes in circumstances (see the examples below), it is
important that you report them to the Marketplace where you
enrolled in coverage. Reporting changes in circumstances
Use Form 8962 to figure the amount of your
premium tax credit
promptly will allow the Marketplace to adjust your APTC to
(PTC)
and reconcile it with
advance payment of the premium tax
reflect the
PTC
you are estimated to be able to take on your tax
credit
(APTC).
return. Adjusting your APTC when you re-enroll in coverage and
You may take PTC (and APTC may be paid) only for health
during the year can help you avoid owing tax when you file your
insurance coverage in a
qualified health plan
(defined later)
tax return. Changes that you should report to the Marketplace
purchased through a Health Insurance Marketplace
include the following.
(Marketplace, also known as an Exchange). As a result, you
Changes in
household
income.
should complete Form 8962 only for health insurance coverage
Moving to a different address.
in a qualified health plan purchased through a Marketplace. This
Gaining or losing eligibility for other health care coverage.
includes a qualified health plan purchased on
HealthCare.gov
or
Gaining, losing, or other changes to employment.
through a State Marketplace.
Birth or adoption.
Marriage or divorce.
If you or a member of your family enrolled in health insurance
Other changes affecting the composition of your
tax
family.
coverage for 2019 through a Marketplace, you should have
For more information on how to report a change in
received Form 1095-A, Health Insurance Marketplace
circumstances to the Marketplace, see
HealthCare.gov
or your
Statement, from the Marketplace. Form 1095-A shows the
State Marketplace website.
months of coverage purchased through the Marketplace and any
APTC paid to your insurance company to help cover your
Health Coverage Tax Credit (HCTC). The HCTC is a tax
monthly premium. If APTC was paid on your behalf, or if APTC
credit that pays a percentage of health insurance premiums for
was not paid on your behalf but you wish to take the PTC, you
certain eligible taxpayers and their qualifying family members.
must file Form 8962 and attach it to your tax return (Form 1040,
The HCTC and the PTC are different tax credits that have
1040-SR, or 1040-NR).
different eligibility rules. If you think you may be eligible for the
HCTC, see Form 8885 and its instructions or visit
IRS.gov/HCTC
At enrollment, the Marketplace may have referred to
before completing Form 8962.
APTC as your “subsidy” or “tax credit” or “advance
!
payment.” The term APTC is used throughout these
Health insurance options. If you need health coverage, visit
CAUTION
instructions to clearly distinguish APTC from PTC.
HealthCare.gov
to learn about health insurance options that are
available for you and your family, how to purchase health
Future Developments
insurance, and how you might qualify to get financial assistance
with the cost of insurance.
For the latest information about developments related to Form
Additional information. For additional information about the
8962 and its instructions, such as legislation enacted after they
tax provisions of the Affordable Care Act (ACA), including the
were published, go to IRS.gov/Form8962.
individual shared responsibility provisions and the PTC, see
IRS.gov/Affordable-Care-Act/Individuals-and-Families
or call the
Reminders
IRS Healthcare Hotline for ACA questions (800-919-0452).
General Instructions
Qualified small employer health reimbursement arrange-
ment (QSEHRA). Under a QSEHRA, an eligible employer can
reimburse eligible employees for medical expenses, including
What is the Premium Tax Credit
premiums for Marketplace health insurance. If you were covered
(PTC)?
under a QSEHRA, your employer should have reported the
annual permitted benefit in box 12 of your Form W-2 with code
FF. If the QSEHRA is affordable for a month, no PTC is allowed
Premium tax credit (PTC). The PTC is a tax credit for certain
for the month. If the QSEHRA is unaffordable for a month, you
people who enroll, or whose family member enrolls, in a
qualified
must reduce the monthly PTC (but not below -0-) by the monthly
health
plan. The credit provides financial assistance to pay the
permitted benefit amount and you must write “QSEHRA” in the
premiums for the qualified health plan offered through a
top margin on page 1 of Form 8962 to explain your entry and
Marketplace by reducing the amount of tax you owe, giving you
avoid delay in the processing of your return. For more
a refund, or increasing your refund amount. You must file Form
information, see Column (e) under
Line 11—Annual Totals
or
8962 to compute and take the PTC on your tax return.
Lines 12 Through 23—Monthly
Calculation, later. Also see
Advance payment of the premium tax credit (APTC). APTC
Qualified Small Employer Health Reimbursement Arrangement
is a payment during the year to your insurance provider that pays
in Pub. 974 for information on determining QSEHRA affordability
for part or all of the premiums for a qualified health plan covering
and Notice 2017-67 for additional guidance on QSEHRA
you or an individual in your tax family. Your APTC eligibility is
coordination with the PTC. Notice 2017-67 is available at
based on the Marketplace’s estimate of the PTC you will be able
IRS.gov/irb/2017-47_IRB#NOT-2017-67.
Oct 29, 2019
Cat. No. 60401R
2019
Department of the Treasury
Internal Revenue Service
Instructions for Form 8962
Premium Tax Credit (PTC)
Section references are to the Internal Revenue Code unless
Report changes in circumstances when you re-enroll in
otherwise noted.
coverage and during the year. If
APTC
is being paid for an
individual in your
tax family
(described later) and you have had
Purpose of Form
certain changes in circumstances (see the examples below), it is
important that you report them to the Marketplace where you
enrolled in coverage. Reporting changes in circumstances
Use Form 8962 to figure the amount of your
premium tax credit
promptly will allow the Marketplace to adjust your APTC to
(PTC)
and reconcile it with
advance payment of the premium tax
reflect the
PTC
you are estimated to be able to take on your tax
credit
(APTC).
return. Adjusting your APTC when you re-enroll in coverage and
You may take PTC (and APTC may be paid) only for health
during the year can help you avoid owing tax when you file your
insurance coverage in a
qualified health plan
(defined later)
tax return. Changes that you should report to the Marketplace
purchased through a Health Insurance Marketplace
include the following.
(Marketplace, also known as an Exchange). As a result, you
Changes in
household
income.
should complete Form 8962 only for health insurance coverage
Moving to a different address.
in a qualified health plan purchased through a Marketplace. This
Gaining or losing eligibility for other health care coverage.
includes a qualified health plan purchased on
HealthCare.gov
or
Gaining, losing, or other changes to employment.
through a State Marketplace.
Birth or adoption.
Marriage or divorce.
If you or a member of your family enrolled in health insurance
Other changes affecting the composition of your
tax
family.
coverage for 2019 through a Marketplace, you should have
For more information on how to report a change in
received Form 1095-A, Health Insurance Marketplace
circumstances to the Marketplace, see
HealthCare.gov
or your
Statement, from the Marketplace. Form 1095-A shows the
State Marketplace website.
months of coverage purchased through the Marketplace and any
APTC paid to your insurance company to help cover your
Health Coverage Tax Credit (HCTC). The HCTC is a tax
monthly premium. If APTC was paid on your behalf, or if APTC
credit that pays a percentage of health insurance premiums for
was not paid on your behalf but you wish to take the PTC, you
certain eligible taxpayers and their qualifying family members.
must file Form 8962 and attach it to your tax return (Form 1040,
The HCTC and the PTC are different tax credits that have
1040-SR, or 1040-NR).
different eligibility rules. If you think you may be eligible for the
HCTC, see Form 8885 and its instructions or visit
IRS.gov/HCTC
At enrollment, the Marketplace may have referred to
before completing Form 8962.
APTC as your “subsidy” or “tax credit” or “advance
!
payment.” The term APTC is used throughout these
Health insurance options. If you need health coverage, visit
CAUTION
instructions to clearly distinguish APTC from PTC.
HealthCare.gov
to learn about health insurance options that are
available for you and your family, how to purchase health
Future Developments
insurance, and how you might qualify to get financial assistance
with the cost of insurance.
For the latest information about developments related to Form
Additional information. For additional information about the
8962 and its instructions, such as legislation enacted after they
tax provisions of the Affordable Care Act (ACA), including the
were published, go to IRS.gov/Form8962.
individual shared responsibility provisions and the PTC, see
IRS.gov/Affordable-Care-Act/Individuals-and-Families
or call the
Reminders
IRS Healthcare Hotline for ACA questions (800-919-0452).
General Instructions
Qualified small employer health reimbursement arrange-
ment (QSEHRA). Under a QSEHRA, an eligible employer can
reimburse eligible employees for medical expenses, including
What is the Premium Tax Credit
premiums for Marketplace health insurance. If you were covered
(PTC)?
under a QSEHRA, your employer should have reported the
annual permitted benefit in box 12 of your Form W-2 with code
FF. If the QSEHRA is affordable for a month, no PTC is allowed
Premium tax credit (PTC). The PTC is a tax credit for certain
for the month. If the QSEHRA is unaffordable for a month, you
people who enroll, or whose family member enrolls, in a
qualified
must reduce the monthly PTC (but not below -0-) by the monthly
health
plan. The credit provides financial assistance to pay the
permitted benefit amount and you must write “QSEHRA” in the
premiums for the qualified health plan offered through a
top margin on page 1 of Form 8962 to explain your entry and
Marketplace by reducing the amount of tax you owe, giving you
avoid delay in the processing of your return. For more
a refund, or increasing your refund amount. You must file Form
information, see Column (e) under
Line 11—Annual Totals
or
8962 to compute and take the PTC on your tax return.
Lines 12 Through 23—Monthly
Calculation, later. Also see
Advance payment of the premium tax credit (APTC). APTC
Qualified Small Employer Health Reimbursement Arrangement
is a payment during the year to your insurance provider that pays
in Pub. 974 for information on determining QSEHRA affordability
for part or all of the premiums for a qualified health plan covering
and Notice 2017-67 for additional guidance on QSEHRA
you or an individual in your tax family. Your APTC eligibility is
coordination with the PTC. Notice 2017-67 is available at
based on the Marketplace’s estimate of the PTC you will be able
IRS.gov/irb/2017-47_IRB#NOT-2017-67.
Oct 29, 2019
Cat. No. 60401R
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
your PTC, you have excess APTC and you must repay the
included that individual in a tax family. See
Individual you
excess, subject to certain limitations. If the APTC is less than
enrolled who is not included in a tax family
under Lines 12
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 2019 APTC using
otherwise required to file. You must use Form 1040, 1040-SR, or
projections of your income and the number of individuals you
1040-NR. For help determining which of these forms to file, see
certified to the Marketplace would be in your tax family (yourself,
the Instructions for Forms 1040 and 1040-SR or the Instructions
spouse, and dependents) when you enrolled in a
qualified health
for Form 1040-NR.
plan. If this information changed during 2019 and you did not
If you are filing Form 8962, you cannot file Form
promptly report it to the Marketplace, the amount of APTC paid
1040-NR-EZ, 1040-SS, or 1040-PR.
!
may be substantially different from the amount of PTC you can
take on your tax return. See
Report changes in circumstances
CAUTION
when you re-enroll in coverage and during the
year, earlier, for
If someone else enrolled an individual in your tax family in
changes that can affect the amount of your PTC.
coverage, and APTC was paid for that individual’s coverage, you
must file Form 8962 to reconcile the APTC. You need to obtain a
Deductions for health insurance premiums. You cannot
copy of the Form 1095-A from the person who enrolled the
deduct the portion of your health insurance premium on your tax
individual.
return that is paid for by the PTC or APTC (after you determine
how much of any excess APTC you must repay). If you are
If you are claimed as a dependent on another person's
deducting medical expenses as an itemized deduction, see Pub.
tax return, the person who claims you will file Form 8962
TIP
502, Medical and Dental Expenses. If you are claiming the
to take the PTC and, if necessary, repay excess APTC
self-employed health insurance deduction, see Pub. 974,
for your coverage. You do not need to file Form 8962.
Premium Tax Credit.
Who Can Take the PTC
Form 1095-A, Health Insurance Marketplace Statement.
You will need Form 1095-A to complete Form 8962. The
You can take the PTC for 2019 if you meet the conditions under
Marketplace uses Form 1095-A to report certain information to
(1) and (2) below.
the IRS about individuals who enrolled in a
qualified health plan
1. For at least 1 month of the year, all of the following were
through the Marketplace. The Marketplace sends copies to
true.
individuals to allow them to accurately file a tax return taking the
a. An individual in your
tax family
was enrolled in a
qualified
PTC and reconciling APTC. For coverage in 2019, the
health plan
offered through the Marketplace on the first day of
Marketplace is required to provide or send Form 1095-A to the
the month.
individual(s) identified in the Marketplace enrollment application
by January 31, 2020. If you are expecting to receive Form
b. That individual was not eligible for minimum essential
1095-A for a qualified health plan and you do not receive it by
coverage (MEC) for the month, other than coverage in the
early February, contact the Marketplace.
individual market. An individual is generally considered eligible
for MEC for the month only if he or she was eligible for every day
Under certain circumstances, for example, where two
of the month (see
Minimum essential
coverage, later).
spouses enroll in a qualified health plan and divorce during the
year, the Marketplace will provide Form 1095-A to one taxpayer,
c. The portion of the
enrollment premiums
(described later)
but another taxpayer will also need the information from that
for the month for which you are responsible was paid by the due
form to complete Form 8962. The recipient of Form 1095-A
date of your tax return (not including extensions). However, if
should provide a copy to other taxpayers as needed.
you became eligible for APTC because of a successful eligibility
VOID BOX. If you received a Form 1095-A with the void box
appeal and you retroactively enrolled in the plan, then the
checked at the top of the form, that means you previously
portion of the enrollment premium for which you are responsible
received a Form 1095-A for the policy shown in Part I that was
must be paid on or before the 120th day following the date of the
sent in error. You should not have received a Form 1095-A for
appeals decision.
the policy shown in Part I of the Form 1095-A. Do not use the
2. You are an
applicable taxpayer
for 2019. To be an
information on the Form 1095-A with the void box checked or the
applicable taxpayer, you must meet all of the following
previously received Form 1095-A to complete Form 8962.
requirements.
CORRECTED BOX. If you receive a Form 1095-A with the
a. Your
household income
for 2019 is at least 100% but no
corrected box checked at the top of the form, use the information
more than 400% of the federal poverty line for your family size
on the Form 1095-A with the corrected box checked to figure the
(see the instructions for
Line
4, later). However, having
PTC and reconcile any APTC on Form 8962. Do not use the
household income below 100% of the federal poverty line will not
information on the original Form 1095-A you received for the
disqualify you from taking the PTC if you meet certain
policy shown in Part I of the corrected Form 1095-A.
requirements described under
Household income below 100%
Additional information. For additional information on the PTC,
of the federal poverty
line, later.
see Pub. 974, Premium Tax Credit. You can also visit
IRS.gov
b. No one can claim you as a dependent on a tax return for
and enter “premium tax credit” in the search box.
2019.
Also see
How To Avoid Common Mistakes in Completing
c. If you were married at the end of 2019, generally you
Form 8962
at the end of these instructions.
must file a joint return. However, filing a separate return from
Who Must File
your spouse will not disqualify you from being an applicable
taxpayer if you meet certain requirements described under
You must file Form 8962 with your income tax return (Form
Married
taxpayers, later.
1040, 1040-SR, or 1040-NR) if any of the following apply to you.
You are taking the PTC.
-2-
Instructions for Form 8962 (2019)
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 2019 and the enrollment was effective on the date
of the individual's birth, adoption, or placement for adoption or in
foster care, or on the effective date of a court order placing the
Tax family. For purposes of the PTC, your tax family consists of
individual with your family, the individual is treated as enrolled as
the following individuals.
of the first day of that month. Therefore, the individual may be a
You, if you file a tax return for the year and you can’t be
member of your tax family and coverage family for the entire
claimed as a dependent on someone else’s 2019 tax return.
month for purposes of computing your monthly credit amount.
Your spouse if filing jointly and he or she can’t be claimed as a
Enrollment premiums. The enrollment premiums are the
dependent on someone else’s 2019 tax return.
total amount of the premiums for the month, reduced by any
Your dependents whom you claim on your 2019 tax return. If
premium amounts for that month that were refunded, for one or
you are filing Form 1040-NR, you should include your
more
qualified health plans
in which any individual in your
tax
dependents in your tax family only if you are a U.S. national;
family
enrolled. Form 1095-A, Part III, column A, reports the
resident of Canada, Mexico, or South Korea; or a resident of
enrollment premiums.
India who was a student or business apprentice.
You are generally not allowed a monthly credit amount for the
Your family size equals the number of qualifying individuals in
month if any part of the enrollment premiums for which you are
your tax family (including yourself). See the instructions for
responsible that month has not been paid by the due date of
Line 1
for more information on figuring your tax family size.
your tax return (not including extensions). However, if you
became eligible for APTC because of a successful eligibility
Note. Listing your dependents by name and SSN or individual
taxpayer identification number (ITIN) on your tax return is the
appeal and you retroactively enrolled in the plan, the portion of
the enrollment premium for which you are responsible must be
same as claiming them as a dependent. If you have more than
paid on or before the 120th day following the date of the appeals
four dependents, see the Instructions for Forms 1040 and
decision. Premiums another person pays on your behalf are
1040-SR or the Instructions for Form 1040-NR.
treated as paid by you.
Household income. For purposes of the PTC, household
If your share of the enrollment premiums is not paid, the
income is the modified adjusted gross income (modified AGI) of
issuer may terminate coverage. The termination is generally
you and your spouse (if filing a joint return) (see
Line
2a, later)
effective no sooner than the second month of nonpayment. For
plus the modified AGI of each individual whom you claim as a
any months you were covered but did not pay your share of the
dependent and who is required to file an income tax return
premiums, you are not allowed a monthly credit amount.
because his or her income meets the income tax return filing
Applicable SLCSP premium. The applicable SLCSP
threshold (see
Line
2b, later). Household income does not
premium is the second lowest cost silver plan premium offered
include the modified AGI of those individuals whom you claim as
through the Marketplace where you reside that applies to your
dependents and who are filing a 2019 return only to claim a
coverage family
(described earlier). The SLCSP premium is not
refund of withheld income tax or estimated tax.
the same as your
enrollment
premium, unless you enroll in the
Modified AGI. For purposes of the PTC, modified AGI is the
applicable SLCSP. Form 1095-A, Part III, column B, generally
AGI on your tax return plus certain income that is not subject to
reports the applicable SLCSP premium. If no APTC was paid for
tax (foreign earned income, tax-exempt interest, and the portion
your coverage, Form 1095-A, Part III, column B, may be wrong
of social security benefits that is not taxable). Use
Worksheet
or blank or may report your applicable SLCSP premium as -0-.
1-1
and
Worksheet 1-2
to determine your modified AGI.
Also, if you had a change in circumstances during 2019 that you
Taxpayer’s tax return including income of a dependent
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
have to request a corrected Form 1095-A from the Marketplace.
the child’s social security benefits that is not taxable.
See
Missing or incorrect SLCSP premium on Form
1095-A, later.
Coverage family. Your coverage family includes all individuals
Monthly contribution amount. Your monthly contribution
in your
tax family
who are enrolled in a
qualified health plan
and
amount is used to calculate your monthly credit amount. It is the
are not eligible for
MEC
(other than coverage in the individual
amount of your household income you would be responsible for
market). The individuals included in your coverage family may
paying as your share of premiums each month if you enrolled in
change from month to month. If an individual in your tax family is
the
applicable
SLCSP. It is not based on the amount of
not enrolled in a qualified health plan, or is enrolled in a qualified
premiums you paid out of pocket during the year. You will
health plan but is eligible for MEC (other than coverage in the
compute your monthly contribution amount in Part I of Form
individual market), he or she is not part of your coverage family.
8962.
Your PTC is available to help you pay only for the coverage of
Qualified health plan. For purposes of the PTC, a qualified
the individuals included in your coverage family.
health plan is a health insurance plan or policy purchased
Monthly credit amount. The monthly credit amount is the
through a Marketplace at the bronze, silver, gold, or platinum
amount of your tax credit for a month. Your PTC for the year is
level. Throughout these instructions, a qualified health plan is
the sum of all of your monthly credit amounts. Your credit
also referred to as a policy. Catastrophic health plans and
amount for each month is the lesser of:
stand-alone dental plans purchased through the Marketplace,
The
enrollment premiums
(described next) for the month for
and all plans purchased through the Small Business Health
one or more
qualified health plans
in which you or any individual
Options Program (SHOP), are not qualified health plans for
in your
tax family
enrolled, or
purposes of the PTC. Therefore, they do not qualify a taxpayer
The amount of the monthly
applicable second lowest cost
to take the PTC.
silver plan (SLCSP) premium
(described below) less your
monthly contribution amount
(described below).
-3-
Instructions for Form 8962 (2019)
accurate information to the Marketplace about the availability of
Minimum essential coverage (MEC). An individual in your tax
employer coverage, and the Marketplace determined that he
family who is eligible for MEC (except coverage in the individual
was eligible for APTC for coverage in a qualified health plan. The
market) for a month is not in your coverage family for that month.
Marketplace determination does not apply, however, for the
Therefore, you cannot take the PTC for that individual’s
months September through December of 2019 because Don did
coverage for the months that individual is eligible for MEC. In
not provide information to the Marketplace about his new
addition to qualified health plans and other coverage in the
employer’s offer of coverage. Whether Don is considered
individual market, MEC includes:
eligible for employer-sponsored coverage and ineligible for the
Most coverage through government-sponsored programs
PTC for the months September through December of 2019 is
(including Medicaid coverage, Medicare parts A or C, the
determined under the eligibility rules described under
Children’s Health Insurance Program (CHIP), certain benefits for
Employer-Sponsored Plans in Pub. 974.
veterans and their families, TRICARE, and health coverage for
Waiting periods and post-employment coverage. If you
Peace Corps volunteers);
cannot get benefits under an employer-sponsored plan until after
Most types of employer-sponsored coverage; and
a waiting period has expired, you are not treated as eligible for
Other health coverage the Department of Health and Human
that coverage during the waiting period. Also, if you leave your
Services designates as MEC.
employment and are offered post-employment coverage such as
Eligibility for MEC. In most cases, you are considered eligible
COBRA or retiree coverage, you are not considered eligible for
for MEC if the coverage is available to you, whether or not you
that post-employment coverage unless you actually enroll in the
enroll in it. However, special rules apply to certain types of MEC
coverage. See Coverage after employment ends under
as explained below.
Employer-Sponsored Plans in Pub. 974 for more information.
Employer-sponsored coverage. Even if you and other
Medicaid and CHIP. You are generally considered eligible
members of your tax family had the opportunity to enroll in a plan
for coverage under a government-sponsored program for a
that is MEC offered by your employer for 2019, you are
month if you met the eligibility criteria for that month, even if you
considered eligible for MEC under the plan for a month only if
did not enroll. However, if a Marketplace made a determination
the offer of coverage met a minimum standard of affordability
that you or a family member were ineligible for Medicaid or CHIP
and provided a minimum level of benefits, referred to as
and were eligible for APTC when the individual enrolls in a
“minimum value.” The coverage offered by your employer is
qualified health plan, the individual is treated as not eligible for
generally considered affordable for you and the members of
Medicaid or CHIP for purposes of the PTC for the duration of the
your tax family allowed to enroll in the coverage if your share of
period of coverage under the qualified health plan (generally, the
the annual cost for self-only coverage, which is sometimes
rest of the plan year), even if your actual 2019 income suggests
referred to as the employee required contribution, is not more
that the individual may have been eligible for Medicaid or CHIP.
than 9.86% of your household income. However,
However, in order to rely on a Marketplace's determination
employer-sponsored coverage is not considered affordable if,
that you or a family member were ineligible for Medicaid, CHIP,
when you or a family member enrolled in a qualified health plan,
or a similar program, you must provide accurate information to
you gave accurate information about the availability of employer
the Marketplace when you enroll in a qualified health plan. You
coverage to the Marketplace, and the Marketplace determined
or the family member may be treated as eligible for Medicaid,
that you were eligible for APTC for the individual’s coverage in
CHIP, or the similar program, and not eligible for PTC, if the
the qualified health plan. In addition, if you or your family
Marketplace determination is later found to be based on
member enrolls in employer-sponsored coverage for a month,
incorrect information that was given with an intentional or
you or your family member is considered eligible for
reckless disregard for the facts. See Pub. 974 for more
employer-sponsored coverage for that month, even if the
information.
coverage does not satisfy the affordability and minimum value
For more information about eligibility for Medicaid, CHIP, and
standards. Finally, if your employer offered coverage for you but
other forms of government-sponsored MEC, see Pub. 974.
not your family, you may be able to take the PTC for your family
members. For more information on affordability and minimum
Example. Married taxpayers Tom and Nicole applied for
value, see Pub. 974.
insurance affordability programs at the Marketplace for
Your employer may have sent you a Form 1095-C,
themselves and their two children whom they claim as
Employer-Provided Health Insurance Offer and Coverage, with
dependents, Kim and Chris. The Marketplace determined that
information about the coverage offered to you, if any. See Form
Kim and Chris were eligible for coverage under CHIP. Instead of
1095-C, line 14, and the Instructions for Recipient included with
enrolling Kim and Chris in CHIP, the entire tax family enrolled in
that form, for information about whether you and other members
a qualified health plan (with APTC paid only for Tom and
of your tax family were offered coverage. See Pub. 974 for more
Nicole’s coverage). Because Kim and Chris were eligible for
information on how to determine whether the coverage you were
CHIP, which is MEC, Tom and Nicole are not eligible for the PTC
offered was affordable and provided minimum value, including
for coverage of Kim and Chris, but may be eligible for the PTC
on how to use Form 1095-C.
for their own coverage.
Coverage in the individual market outside the
Example. Don was eligible to enroll in his employer’s
Marketplace. While coverage purchased in the individual
coverage for 2019 but instead applied for coverage in a qualified
market outside the Marketplace is MEC, eligibility for this type of
health plan through the Marketplace for coverage in 2019. Don
coverage does not prevent you from being eligible for the PTC
provided accurate information about his employer’s coverage to
for Marketplace coverage. Coverage purchased in the individual
the Marketplace, and the Marketplace determined that the offer
market outside the Marketplace does not qualify for the PTC.
of coverage was not affordable and that Don was eligible for
APTC. Don enrolled in the qualified health plan for 2019. Don
For more details on eligibility for MEC, including additional
got a new job with employer coverage that Don could have
special eligibility rules, see Minimum Essential Coverage in Pub.
enrolled in as of September 1, 2019, but chose not to. Don did
974. You can also check
IRS.gov/Affordable-Care-Act/
not return to the Marketplace to determine if he was eligible for
Individuals-and-Familes/Individual-Shared-Responsibilty-
APTC for the months September through December 2019, and
Provision
for future updates about types of coverage that are
remained enrolled in the qualified health plan. Don is not
recognized as MEC.
considered eligible for employer-sponsored coverage for the
Applicable taxpayer. You must be an applicable taxpayer to
months January through August of 2019 because he gave
take the PTC. Generally, you are an applicable taxpayer if your
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Instructions for Form 8962 (2019)
household income
for 2019 (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 2019. In addition, if you were married at
described below.
the end of 2019, 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
victim's ability to reason independently. All the facts and
For individuals with household income below 100% of the
circumstances are considered in determining whether an
federal poverty line, see
Household income below 100% of the
individual is abused, including the effects of alcohol or drug
federal poverty line
under line 6, later.
abuse by the victim’s spouse. Depending on the facts and
Individuals who are incarcerated. Individuals who are
circumstances, abuse of an individual’s child or other family
incarcerated (other than pending disposition of charges, for
member living in the household may constitute abuse of the
example awaiting trial) are not eligible for coverage in a
qualified
individual.
health plan
through a Marketplace. However, these individuals
Spousal abandonment. A taxpayer is a victim of spousal
may be applicable taxpayers and take the PTC for the coverage
abandonment for a tax year if, taking into account all facts and
of individuals in their
tax families
who are eligible for coverage in
circumstances, the taxpayer is unable to locate his or her
a qualified health plan.
spouse after reasonable diligence.
Individuals who are not lawfully present. Individuals who
Three-year limit for Exception 2. You cannot claim the PTC
are not lawfully present in the United States are not eligible for
using this exception for more than 3 consecutive years. For
coverage in a
qualified health plan
through a Marketplace. They
example, if you used this exception to claim the PTC on your tax
cannot take the PTC for their own coverage and are not eligible
returns for 2016, 2017, and 2018, you cannot use this exception
for the repayment limitations in
Table 5
for APTC paid for their
to claim the PTC on your 2019 return.
own coverage. However, these individuals may be applicable
Married filing separately. If you file as married filing
taxpayers and take the PTC for the coverage of individuals in
separately and are not a victim of domestic abuse or spousal
their
tax
families, such as their children, who are lawfully present
abandonment (see
Exception 2—Victim of domestic abuse or
and eligible for coverage in a qualified health plan. For more
spousal abandonment
under Married taxpayers above), then
information about who is treated as lawfully present for this
you are not an
applicable taxpayer
and you cannot take the
purpose, visit HealthCare.gov. See Individuals Not Lawfully
PTC. You must generally repay all of the APTC paid for a
Present in the United States Enrolled in a Qualified Health Plan
qualified health plan
that covered only individuals in your
tax
in Pub. 974 for more information on reconciling APTC when an
family. If the policy also covered at least one individual in your
unlawfully present person is enrolled individually or with lawfully
spouse’s tax family, you must generally repay half of the APTC
present family members.
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
name that appears first on your return.
be able to take the PTC on your separate return. See Pub. 501,
Dependents, Standard Deduction, and Filing Information.
Social security number. The social security number on this
form should match the social security number on your tax return.
If you are considered married for federal income tax
If you are married and filing a joint return, enter the first social
purposes, you may be eligible to take the PTC without filing a
security number that appears on your tax return.
joint return if one of the two exceptions below applies to you. If
Exception 1
applies, you can file a return using head of
If you entered an ITIN on your tax return, enter this number on
household or single filing status and take the PTC. If
Exception 2
Form 8962.
applies, you are treated as married but can take the PTC with
Victims of domestic abuse or spousal abandonment.
the filing status of married filing separately.
Check the box on the line above Part I of Form 8962 if you are
Exception 1—Certain married persons living apart. You
filing as married filing separately, are a victim of domestic abuse
may file your return as if you are unmarried and take the PTC if
or spousal abandonment, and qualify for
Exception 2—Victim of
one of the following applies to you.
domestic abuse or spousal abandonment
under Married
You file a separate return from your spouse on Form 1040 or
taxpayers, earlier. By checking this box, you are certifying that
1040-SR because you meet the requirements for Married
you qualify for an exception to the requirement to file a joint
persons who live apart under Head of Household in the
return with your spouse. Do not attach documentation of the
instructions for Forms 1040 and 1040-SR.
abuse or abandonment to your tax return. Keep any
You file as single on your Form 1040-NR because you meet
documentation you may have with your tax return records. For
the requirements for Married persons who live apart under Were
examples of what documentation to keep, see Pub. 974.
You Single or Married? in the instructions for Form 1040-NR.
Married filing separately. If APTC was paid for your coverage
Exception 2—Victim of domestic abuse or spousal
but you cannot take the PTC because you are married filing a
abandonment. If you are a victim of domestic abuse or spousal
separate return and you do not qualify for an exception to the
abandonment, you can file a return as married filing separately
joint filing requirement, complete lines 1 through 5 to figure your
and take the PTC for 2019 if all of the following apply to you.
separate household income as a percentage of the federal
You are living apart from your spouse at the time you file your
poverty line. Skip lines 6 through 8b and complete lines 9 and 10
2019 tax return.
(and Part IV, if applicable). When completing line 11 or lines 12
You are unable to file a joint return because you are a victim
through 23, complete only column (f). Then complete the rest of
of
domestic abuse
(described next) or
spousal abandonment
the form to determine how much you must repay.
(described below).
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Instructions for Form 8962 (2019)