The two situations in which your SLCSP may not be accurately reflected on your Form 1095-A are the following. Form 1095-A, Part III, column A, reports the enrollment premiums. For example, if you were enrolled in a policy with your former spouse from January through June, enter 06 in column (d). The law extends eligibility to taxpayers with household income above 400 percent of the federal poverty line by lowering the upper premium contribution limit to 8.5 percent of household income. Other situations where a policy is shared between two tax families. Federal poverty levels are used to determine your eligibility for certain programs and benefits, including savings on Marketplace health insurance, and Medicaid and CHIP coverage. Note. Was anyone in your tax family enrolled in a qualified health plan before your first full month of marriage? You can take the PTC for 2022 if you meet the conditions under (1), (2), and (3) below. 974 under, Allocation of Policy Amounts Among Three or More Taxpayers, You may need to allocate policy amounts under a qualified health plan using different rules for different months if you had a change in circumstance. See Marriage in 2022, later, if you got married during 2022. 4; 1) What is a Qualified Health Plan? If your allocation situation requires you to allocate the APTC on Form 1095-A, lines 21 through 32, column C, enter your allocation percentage for that policy in column (g). An individual in your tax family who is eligible for MEC (except coverage in the individual market) for a month is not in your coverage family for that month. If you are required to use lines 12 through 23 of Form 8962, enter the amounts from lines 1 through 12 of this worksheet in the lines for the corresponding months and columns on Form 8962. Health reimbursement arrangements (HRAs). See Coverage after employment ends under Employer-Sponsored Plans in Pub. Taxpayers married at year end but filing separate returns. 974. The children become eligible for and enroll in government-sponsored health coverage and disenroll from the qualified health plan, effective August 1. Generally, there are two situations where your SLCSP premium may not be accurately reflected on your Form 1095-A. The amount on line 1 above is more than 400% of the federal poverty line. Complete line 35, columns (a) through (d), as indicated in Pub. Carol and Mark continued to reside at the residence. You answered Yes to all five questions in Table 4. $16,400 a household of two people with a householder 65 years or older with no children. Joe enrolls himself, Chris, and Jane in a qualified health plan for 2022. No one can claim you as a dependent for the year. raised benefits by 23 percent for federal . Your PTC for the year is the sum of all of your monthly credit amounts. The poverty thresholds are the original version of the federal poverty measure. As a result, you should complete Form 8962 only for health insurance coverage in a qualified health plan purchased through a Marketplace. For example, if your family size is 11, you have 3 additional people. The percentage of the population living in poverty decreased from 14.9% in 2018 to 13.3% in 2019. For additional information and resources, see Pub. If you file a paper return and do not round amounts to whole dollars, be sure to enter the decimal point to separate dollars and cents. When devised in the 1960s, the OPM came to roughly 50 percent of median household income, adjusted for family size. Enter the result of $67,020 on Form 8962, line 4. Multiply $4,540 by 3 and add the result of $13,620 to $44,660. The excess APTC you must repay may be limited to the amounts in Table 5. The poverty line is usually calculated by estimating the total cost of one year's worth of necessities for the average adult. See the instructions for Line 9, later. Gaining or losing eligibility for other health care coverage. Therefore, you cannot take the PTC for that individuals coverage for the months that individual is eligible for MEC. 12. Part IIPremium Tax Credit Claim and Reconciliation of Advance Payment of Premium Tax Credit. Coverage in the individual market outside the Marketplace. The Marketplace determined your eligibility for and the amount of your 2022 APTC using projections of your income and the number of individuals you certified to the Marketplace would be in your tax family (yourself, your spouse, and your dependents) when you enrolled in a qualified health plan. You are an applicable taxpayer for 2022. benefit equally from the combined income of the household. They cannot take the PTC for their own coverage and are not eligible for the repayment limitations in Table 5 for APTC paid for their own coverage. Keith and Stephanie are married at the beginning of 2022 and have three children, Ben, Grace, and Max. While coverage purchased in the individual market outside the Marketplace is MEC, eligibility for this type of coverage does not prevent you from being eligible for the PTC for Marketplace coverage. If you have an amount on line 29, be sure to enter that amount on Schedule 2 (Form 1040), line 2. Enter 0.50 in columns (e) and (g) of the appropriate line in Part IV to allocate the enrollment premium and APTC. Note. The Census Bureau has changed the methodology for computing median income over time. Use Worksheet 1-1 and Worksheet 1-2 to determine your modified AGI. Part IIIRepayment of Excess Advance Payment of the Premium Tax Credit. Source: 2006 Current Population Survey (March Supplement), U.S. Department of Commerce, Bureau of the Census. Henry enrolled himself, his spouse Cara, and their two dependent children, Heidi and Matt, in a policy for 2022 purchased through a Marketplace. If neither exception applies, see Married filing separately (not in Exception 2Victim of domestic abuse or spousal abandonment), later. Net income, which is the household's income minus deductions, must be at or below the poverty line (100%). If individuals in your coverage family enrolled in separate policies in the same state, you will receive a Form 1095-A for each policy. Starting in 2020, employers can offer individual coverage HRAs to help employees and their families with their medical expenses. 6 If you're a family of four living in the continental US and applying for 2022 health insurance coverage, your FPL (from the 2021 FPL table) is $26,500. 974 for instructions on what amounts to enter in columns (a) and (b). Your enrollment premium is reported in Part III, column A, lines 21 through 32, of Form 1095-A. Kevin and Nancy are married at the end of 2022 and have no dependents. Your tax family generally includes you, your spouse if you are filing a joint return, and your dependents. Nancy enters this amount on the applicable lines in column (b), lines 12 through 23. Jane lives with Alice for more than half of 2022 and Alice claims Jane as a dependent. In all other situations, leave column (f) blank because you do not allocate the applicable SLCSP premium reported in those situations. 974, Premium Tax Credit. If you elected the alternative calculation for year of marriage, and line 24 is greater than line 25, enter -0- on line 26 and skip lines 27 through 29. (Some states may report -0- or leave column B blank on the Form 1095-A when no APTC is paid.) Were you and your spouse each unmarried on January 1, 2022? If 100% of the policy amounts are allocated to you, check Yes on line 9 and complete Part IV by entering 100 in the appropriate box(es) for your allocation percentage. If either of these two situations applies to you, or if you have reason to believe the Marketplace reported the wrong applicable SLCSP premium, you must determine the correct applicable SLCSP premium for every month. However, in order to rely on a Marketplace's determination that you or a family member was ineligible for Medicaid, CHIP, or a similar program, you must provide accurate information to the Marketplace when you enroll in a qualified health plan. Follow the instructions in, If you need to allocate policy amounts and are also using the alternative calculation for year of marriage, follow the instructions in, Also follow these instructions if you meet the rules in, Exception 2Victim of domestic abuse or spousal abandonment, earlier, and a policy covered at least one individual in your tax family. Do not use the information on the original Form 1095-A you received for the policy shown in Part I of the corrected Form 1095-A. Enter on line 7 the decimal number from Table 2 that applies to the amount you entered on line 5. Today, it comes to less than 30 percent, meaning that those who are officially poor today can buy far fewer of the essentials of modern life than they could fifty years ago. A household is considered low income if its income is below 50% of median household incomes. Because John is filing his tax return as married filing separately and no exception to the married filing jointly requirement applies, he is not an applicable taxpayer and must repay the $4,250 in APTC allocated to him, subject to the repayment limitations on line 28. If you are offered an individual coverage HRA, see, Under a QSEHRA, an eligible employer can reimburse eligible employees for medical expenses, including premiums for Marketplace health insurance. The Marketplace sends copies to individuals to allow them to accurately file a tax return taking the PTC and reconciling APTC. See Pub. An incorrect entry on this line will impact the amount of your PTC. If you did not elect the alternative calculation for year of marriage or you are using filing status married filing separately and Exception 2Victim of domestic abuse or spousal abandonment, earlier, does not apply to you, skip columns (a) through (e), and complete only Column (f), later. Determine the number of individuals in your tax family using your tax return. What percentage of the premium cost is her expected contribution toward the premium? They are updated each year by the Census Bureau . For each policy to which (1) and (2) above apply, follow the instructions in Table 3 to determine which allocation rule applies for that qualified health plan. Electronic Federal Tax Payment System (EFTPS), Instructions for Form 8962 - Introductory Material. Yes. "Opportunity for All" is a whole-of-government strategy that involves actions and investments that span across the federal government. According to Table 3, Joe and Alice use the rules under Allocation Situation 4. If neither exception applies, see, If this allocation situation applies, the enrollment premiums are allocated in proportion to the SLCSP premium that applies to each taxpayers coverage family. Alternative calculation for year of marriage. If you completed Part IVAllocation of Policy Amounts for any Form 1095-A, add the monthly premium amounts allocated to you, if any, using the allocation percentage you entered on Form 8962, lines 30 through 33, column (e), to the monthly premiums for other policies that you did not allocate. Deductions for health insurance premiums. If you shared multiple policies during the year or must do more than one allocation for a single policy, complete lines 31 through 33 for each separate allocation, as needed. If the QSEHRA is affordable for a month, no PTC is allowed for the month. Between 130 and 185 percent of the Federal poverty line can receive a reduced-price lunch. For instance, in 2021 the poverty guideline in the 48 contiguous states is an annual income of $26,500 for a family of four. Even if you and other members of your tax family had the opportunity to enroll in a plan that is MEC offered by your employer for 2022, you are considered eligible for MEC under the plan for a month only if the offer of coverage met a minimum standard of affordability and provided a minimum level of benefits, referred to as minimum value. The coverage offered by your employer is generally considered affordable for you and the members of your tax family allowed to enroll in the coverage if your share of the annual cost for self-only coverage, which is sometimes referred to as the employee required contribution, is not more than 9.61% of your household income. Premiums another person pays on your behalf are treated as paid by you. See Pub. Enter your allocation percentage as a decimal rounded to two places (for example, for 40%, enter 0.40). Waiting periods and post-employment coverage. For example, for 0.9984, enter the result as 99; for 1.8565, enter the result as 185; and for 3.997, enter the result as 399. Carols family size is two because John is not in her tax family. If line 25 is greater than line 24, subtract line 24 from line 25 and enter the result. For instructions on making more than four separate allocations, see Line 34, later. If you complete Part IV, check the No box on line 10. Jim enters Garys SSN on line 30, column (b), and enters 0.33 in column (e). For additional information about the tax provisions of the Affordable Care Act (ACA), see IRS.gov/Affordable-Care-Act/Individuals-and-Families or call the IRS Healthcare Hotline for ACA questions (800-919-0452). See Report changes in circumstances when you re-enroll in coverage and during the year, earlier, for changes that can affect the amount of your PTC. (Specifically, in the instructions for Part IV, see Policy amounts allocated 100% in either Allocation Situation 1. APTC was paid on behalf of each. Coverage purchased in the individual market outside the Marketplace does not qualify for the PTC. If a -0- appears on any of lines 21 through 32, column A, of Form 1095-A, you may not have paid your enrollment premiums for the month by the due date of your return (not including extensions). You and the other taxpayer must complete only column (e) on the appropriate line in Part IV to allocate the enrollment premiums to each family. Enter the amount from column B of only one Form 1095-Ado not add the amounts from each form. If both (1) and (2) above apply, check the Yes box. 974. Alice must compute her contribution amount using the federal poverty line percentage for the household income and family size reported on her Form 8962. Use Tax Form 8962: Premium Tax Credit (PTC) as a stand alone tax form calculator to quickly calculate specific amounts for your 2023 tax return. The thresholds vary by state. Therefore, you and the other tax family must allocate the enrollment premiums, the APTC, and the applicable SLCSP premium so that each family is able to compute their PTC and reconcile their PTC with the APTC paid for their coverage. Enter the last month you are allocating policy amounts. The cost of housing, such as the rent for an apartment, usually makes up the largest proportion of this estimate, so economists track . If you have more than one Form 1095-A, enter the amount as follows. $27,479 for a family of four with two children under age 18. Because John is not in Carols tax family, he is not in her coverage family, which consists of Carol and her dependent, Mark, for purposes of determining her applicable SLCSP premium. If you completed Part VAlternative Calculation for Year of Marriage, see Pub. In January, Keith enrolls Ben, Grace, and Max in a qualified health plan beginning in January. More than 45 million people, or 14.5 percent of all Americans, lived below the poverty line last year, the Census Bureau reported on Tuesday. However, if no APTC was paid for any individuals in your tax family, stop; do not complete Form 8962. Either you or your spouse should have a start month that is the same as the first month you claim the PTC on lines 12 through 23. Lines 30 Through 33, Columns (a) Through (g), Part VAlternative Calculation for Year of Marriage, How To Avoid Common Mistakes in Completing Form 8962, Instructions for Form 8962 - Additional Material, IRS.gov/Affordable-Care-Act/Individuals-and-Families, advance payment of the premium tax credit (APTC), applicable second lowest cost silver plan (SLCSP) premium, IRS.gov/Affordable-Care-Act/Individuals-and-Familes/Individual-Shared-Responsibilty-Provision, Household income below 100% of the federal poverty line, Estimated household income at least 100% of the federal poverty line, Treasury Inspector General for Tax Administration, Enter your adjusted gross income (AGI)* from Form 1040, 1040-SR, or 1040-NR, line 11, Enter any tax-exempt interest from Form 1040, 1040-SR, or 1040-NR, line 2a, Enter any amounts from Form 2555, lines 45 and 50, Add lines 1 through 4. If no APTC was paid for the policy, the Marketplace may not know which enrollees are in which tax family, and therefore may furnish only one Form 1095-A showing the total premium. Option 2: Get Federal Poverty Levels Without Entering Your Income. Health Insurance Marketplace is a registered trademark of the Department of Health and Human Services. If you indicated to the Marketplace at enrollment that you would claim an individual in your tax family for the year of coverage but the individual is not included in any tax family for the year of coverage, you must report any APTC paid for that individual's coverage. Throughout these instructions, a qualified health plan is also referred to as a policy. Gary and Jim are applicable taxpayers and each can take the PTC. Enter the result of $72,890 on Form 8962, line 4. Do not go to Pub. According to Table 3, they follow the rules under Allocation Situation 2. Based on Your Income. Cara claims Matt as a dependent on her tax return. If the amount on line 5 is 400 or more, your applicable figure is 0.0850. Gary computes his credit using his household income and family size of three, and the applicable SLCSP premium for a coverage family of three of $12,000. Mike and Susan enroll together in a qualified health plan through the Marketplace. Your PTC is available to help you pay only for the coverage of the individuals included in your coverage family. This number is used to calculate your contribution amount. Enter on line 2b the combined modified AGI for your dependents who are required to file an income tax return because their income meets the income tax return filing threshold. Generally, you are an applicable taxpayer if your, For individuals with household income below 100% of the federal poverty line, see, Individuals Not Lawfully Present in the United States Enrolled in a Qualified Health Plan, If you are considered married for federal income tax purposes, you may be eligible to take the PTC without filing a joint return if one of the two exceptions below applies to you. However, you may be able to take the PTC if you meet either of the following conditions. The facts are the same as in Example 2 above, but starting on August 1, Mike is eligible for MEC (other than individual market coverage) and does not notify the Marketplace. Your coverage family includes all individuals in your tax family who are enrolled in a qualified health plan and are not eligible for MEC (other than coverage in the individual market). For example, if you were enrolled in a policy with your former spouse from January through June, enter 01 in column (c). Mistakes in completing Form 8962 can cause you to pay too much tax, delay the processing of your return or refund, or cause you to receive correspondence from the IRS. APTC was paid for an individual you told the Marketplace would be in your tax family and neither you nor anyone else included that individual in a tax family. Melissa must add this amount to her APTC of $3,200 for her single coverage. The termination is generally effective no sooner than the second month of nonpayment. Therefore, they do not qualify a taxpayer to take the PTC. Amounts from this policy are allocated for all months Carol and John were enrolled. Column (f) is left blank. The Marketplace uses Form 1095-A to report certain information to the IRS about individuals who enrolled in a qualified health plan through the Marketplace. If the amount on line 5 is less than 100%, you can take the PTC if you meet the requirements under Estimated household income at least 100% of the federal poverty line next or Alien lawfully present in the United States, later. Today, 73 percent of extremely low-income renters defined as households whose incomes are at or below the poverty line or 30 percent of their area's median income pay more than half of . Federal poverty levels for previous years, How income is counted for health coverage savings, How to find out if you qualify for Medicaid & CHIP coverage. For example, an. You checked the Yes box on line 14 of Worksheet 3. Table 1: Percent of Income Paid for Marketplace Benchmark Silver Premium, by Income: Income (% of poverty): Affordable Care Act (before legislative change) COVID-19 Relief (current law 2021-2022) If the QSEHRA is unaffordable for a month, you must reduce the monthly PTC (but not below -0-) by the monthly permitted benefit amount and you must enter QSEHRA in the top margin on page 1 of Form 8962 to explain your entry and avoid delay in the processing of your return. * Enter the result here and on line 5 of Form 8962. The 2022 federal poverty level (FPL) income numbers below are used to calculate eligibility for Medicaid and the Children's Health Insurance Program (CHIP). Enter the amount from line 29 on your Schedule 2 (Form 1040), line 2. When Joe completes Part IV of Form 8962, he enters Alices SSN on line 30, column (b), and enters 0.80 in columns (e), (f), and (g). Use the amounts shown on Form 1095-A, line 33 (columns A, B, and C), for completing line 11. 3865, Tax Information for Survivors of Domestic Abuse, available at, If you file as married filing separately and are not a victim of domestic abuse or spousal abandonment (see, Check the box on line A, above Part I of Form 8962, if you are filing as married filing separately, are a victim of domestic abuse or spousal abandonment, and qualify for, *If you are filing Form 8814 and the amount on Form 8814, line 4, is more than $1,150, you must enter certain amounts from that form on Worksheet 1-2. Taxpayers divorced or legally separated in 2022. How federal poverty levels are used to determine eligibility for reduced-cost health coverage. Enter -0- on the appropriate line on Form 8962, column (b). Under the rules in this section, you and the other taxpayer may agree on any allocation of the policy amounts between the two of you. You otherwise qualify as an applicable taxpayer (except for the federal poverty line percentage). Finally, if your employer offered coverage for you but not your family, you may be able to take the PTC for your family members. Carol qualifies to file her return as head of household. Kevin and Nancy are enrolled in a qualified health plan for 2022 with an annual premium of $10,000 and APTC of $6,500. If you or a family member could have been covered by an individual coverage HRA for 2022, but you opted out of receiving reimbursements under the individual coverage HRA, you may be allowed a PTC for your, and your family member's, Marketplace health insurance if the individual coverage HRA is considered unaffordable. Your Form 1095-A may include amounts in dollars and cents. Nancy must reconcile $3,250 ($6,500 x 0.50) of the APTC for her coverage. If your household income is less than 100% of the federal poverty line, and you do not meet the requirements under Estimated household income at least 100% of the federal poverty line or Alien lawfully present in the United States, earlier, you are not an applicable taxpayer and you are not eligible to take the PTC. In addition, if you were married at the end of 2022, you must file a joint return to be an applicable taxpayer unless you meet one of the exceptions described under Married taxpayers, later. Print or type your name exactly as you entered it on your tax return. If no APTC was paid for your coverage, Form 1095-A, Part III, column B, may be wrong or blank or may report your applicable SLCSP premium as -0-. Note. The Marketplace should have entered the same SLCSP premium, which applies to all members of your coverage family for coverage that month, on each Form 1095-A. Divide line 8a by 12.0 and enter the result on line 8b, rounded to the nearest whole dollar amount. She reports all of the APTC on line 11 or lines 12 through 23, whichever applies. 974 for information on determining the correct premium for the applicable SLCSP or, if you enrolled through the federally facilitated Marketplace, go to HealthCare.gov/Tax-Tool/. It is the amount of your household income you would be responsible for paying as your share of premiums each month if you enrolled in the, Your employer may have sent you a Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, with information about the coverage offered to you, if any. If you enter an amount greater than -0-, the IRS will reduce your entry to -0-. Often programs limit participant's income to 100% of the FPL, or some percentage of the FPL, such as $138% or 200%. If someone else enrolled an individual in your tax family in coverage, and APTC was paid for that individuals coverage, you must file Form 8962 to reconcile the APTC. In 2018, the national middle-income range was about $48,500 to $145,500 annually for a household of three. If you were covered under a QSEHRA, your employer should have reported the annual permitted benefit in box 12 of your Form W-2 with code FF. Your SLCSP premium is the same for every month of 2022. Generally, you are an applicable taxpayer if your household income for 2022 (described earlier) is at least 100% of the federal poverty line for your family size (provided in Tables 1-1, 1-2, and 1-3) and no one can claim you as a dependent for 2022. 2020 Poverty Lines for the 48 Contiguous States and the District of Columbia For families/households with more than 8 persons, add $4,480 for each additional person (100% Poverty Line) Persons in family/household 100% Poverty Line 138% Poverty Line 400% Poverty Line 1 $12,760 $17,608 $51,040 2 $17,240 $23,791 $68,960 They check the Yes box on Form 8962, line 10, and complete line 11 because for each of columns A and B there is an amount for all 12 months and the amounts did not change. Enter the amount from column B of, If, during 2022, your coverage family changed or you moved and you did not notify the Marketplace, or if no APTC was paid, the applicable SLCSP premium reported on your Form(s) 1095-A may be missing or incorrect. You are not allowed a monthly credit amount for any month that the enrollment premiums for the month were not paid by the due date of your return (not including extensions). Taxpayers divorced or legally separated in 2022. *Only include your dependents who are required to file an income tax return because their income meets the income tax return filing threshold. You must generally repay all of the APTC paid for a qualified health plan that covered only individuals in your tax family. Once you complete line 11, skip to line 24. In 2023, the maximum FBR is $914 for a single individual and $1,371 for a married couple. Alternative Calculation for Year of Marriage, If Part IVAllocation of Policy Amounts applies to you, do, Your SLCSP premium is the same for every month of 2022. See the instructions for, For purposes of the PTC, household income is the modified adjusted gross income (modified AGI) of you and your spouse (if filing a joint return) (see, For purposes of the PTC, modified AGI is the AGI on your tax return plus certain income that is not subject to tax (foreign earned income, tax-exempt interest, and the portion of social security benefits that is not taxable).