2016 Form 1040EZ—Lines 9 through 11
months after death (but he or she must have had minimum
essential coverage every month of 2016 he or she was
Add lines 7 and 8a. Enter the total on line 9.
If you cannot check the box on this line, you must generally
Amount paid with request for extension of time to file. If
either claim a coverage exemption on Form 8965 or report a
you requested an automatic extension of time to file Form
shared responsibility payment on line 11 for each month that
1040EZ using Form 4868, include on line 9 any amount paid
you, your spouse (if filing jointly), or someone you can or do
with that form. Also include any amount you paid by electronic
claim as a dependent didn't have coverage. See the Instructions
funds withdrawal, credit or debit card, or the Electronic Federal
for Form 8965 for information on coverage exemptions and figur-
Tax Payment System (EFTPS) to get an extension. If you paid
ing the shared responsibility payment. However, if you can be
by credit or debit card, do not include on line 9 the convenience
claimed as a dependent, you do not need to check the box,
fee you were charged. To the left of line 9, enter “Form 4868”
claim a coverage exemption, or report a payment. Leave the en-
and show the amount paid.
try space blank. You do not need to attach Form 8965 or see its
If you pay your taxes by credit or debit card, you may
be able to deduct the related credit or debit card con-
If you or someone in your household had minimum essential
venience fees on your 2017 tax return, but you must file
coverage in 2016, the provider of that coverage is required to
Form 1040 to do so.
send you a Form 1095-A, 1095-B, or 1095-C (with Part III com-
pleted) that lists individuals in your family who were enrolled in
the coverage and shows their months of coverage.
Line 10, Tax
Individuals enrolled in health insurance coverage through
the Marketplace generally receive this information on Form
1095-A, Health Insurance Marketplace Statement.
Do you want the IRS to figure your tax for you?
Individuals enrolled in health insurance coverage provided
by their employer generally receive this information on either
Yes. See chapter 30 of Pub. 17 for details, including who is eligible
Form 1095-B, Health Coverage, or on Form 1095-C, Em-
and what to do. If you have paid too much, we will send you a refund. If
you did not pay enough, we will send you a bill.
ployer-Provided Health Insurance Offer and Coverage.
No. Use the Tax Table later in these instructions.
Individuals enrolled in a government-sponsored health pro-
gram or in other types of coverage generally receive this in-
formation on Form 1095-B, Health Coverage.
You should receive the Form 1095-A by early February 2017
Line 11, Health Care: Individual
and, if applicable, Form 1095-B or Form 1095-C by early March
2017. You do not need to wait to receive your Form 1095-B or
Form 1095-C to file your return. You may rely on other informa-
For each month of 2016, you must either:
tion about your coverage to complete line 11. Do not include
Have qualifying health care coverage for yourself, your
Form 1095-A, Form 1095-B, or Form 1095-C with your tax re-
spouse (if filing jointly), and anyone you can or do claim as a
dependent (you are treated as having coverage for any
month in which you have coverage for at least 1 day of the
Your health care coverage provider may have asked for your
social security number. To understand why, go to
Qualify for an exemption from the requirement to have
health care coverage, or
Minimum essential coverage. Most health care coverage that
Make a shared responsibility payment with your tax return
people have is minimum essential coverage.
and enter the amount on this line.
Minimum essential coverage includes:
If you had qualifying health care coverage (called minimum
Most types of health care coverage provided by your em-
essential coverage) for every month of 2016 for yourself, your
spouse (if filing jointly), and anyone you can or do claim as a de-
Many types of government-sponsored health care coverage
pendent, check the box on this line and leave the entry space
including Medicare, most Medicaid coverage, and most
health care coverage provided to veterans and active duty
You can check the box even if:
Health care coverage you buy through the Marketplace, and
A dependent child who was born or adopted during the year
Certain types of health care coverage you buy directly from
was not covered by your insurance during the month of or
an insurance company.
months before birth or adoption (but the child must have had
See the instructions for Form 8965 for more information on
minimum essential coverage every month of 2016 following
what qualifies as minimum essential coverage.
the birth or adoption), or
A spouse or dependent who died during the year was not
covered by your insurance during the month of death and
Instructions for Form 1040EZ