Instructions For Form 8962 - Premium Tax Credit (Ptc)

Examples of changes in circumstances that may affect your

apply to you, skip columns (a) through (e), and complete only

applicable SLCSP premium include the following.

Column

(f), later.

You enrolled an individual newly added to your tax family

Column (a). Enter the annual enrollment premiums from Form

during 2017 (for example, a newborn).

1095-A, line 33, column A. If you have more than one Form

An individual in your tax family was enrolled in your qualified

1095-A, add the amounts together and enter the total on Form

health plan for some but not all of 2017.

8962, line 11, column (a). This amount is the total of your

An individual in your coverage family became eligible for or

enrollment premiums for the year, including the portion paid by

lost eligibility for employer coverage or other MEC during 2017.

APTC.

You are claiming the personal exemption for an individual, but

If you or a member of your tax family was enrolled in a

you did not indicate to the Marketplace at enrollment that you

would do so.

stand-alone dental plan that provided pediatric benefits,

TIP

You indicated to the Marketplace at enrollment that you would

the portion of the dental plan premiums for the pediatric

claim the personal exemption for an individual, but you are not

benefits will be included in the amount in column A on the Form

1095-A that reports the coverage in your primary health plan. If

doing so.

An individual enrolled in the coverage died during 2017.

your plan covered benefits that are not essential health benefits,

You moved during 2017.

such as adult dental or vision benefits, the amount in this column

will be reduced by the premiums for the non-essential benefits.

If any of the above apply and you did not notify the

Marketplace or if you have reason to believe the Marketplace

Column (b). Enter the annual applicable SLCSP premium from

reported the wrong applicable SLCSP premium, determine the

Form 1095-A, line 33, column B. If you have more than one Form

correct applicable SLCSP premium for the months affected. See

1095-A, enter the amount as follows.

Pub. 974 for information on determining the correct applicable

If individuals in your coverage family enrolled in more than

SLCSP premium or, if you enrolled through the federally

one policy in the same state you will receive a Form 1095-A for

facilitated Marketplace, go to HealthCare.gov/Tax-Tool/. If your

each policy. The Marketplace should have entered the same

correct applicable SLCSP premium is not the same for all 12

SLCSP premium, which applies to all members of your coverage

months, check the “No” box and continue to lines 12–23.

family, on each Form 1095-A. Enter the amount from column B

Example 1. Lee receives a Form 1095-A, which reports in

of only one Form 1095-A—do not add the amounts from each

column A $1,000 on lines 21 through 32 for January through

form. However, if you got married in December of 2017 and you

December and in column B $900 on lines 21 through 31 for

and your spouse, or individuals in your and your spouse's tax

January through November. However, column B reports $650

family, were enrolled in separate qualified health plans, add the

for December on line 32 because an individual included in Lee's

amounts from Form 1095-A, column B, for each plan (or plans)

coverage family was eligible for MEC (other than coverage in the

and enter the total. If you got married in a month other than

individual market) for the entire month of December and Lee

December, your applicable SLCSP premium may not be the

reported the change to the Marketplace. Lee checks the “No”

same for every month. If it is not the same for every month, you

box on line 10 and completes lines 12 through 23.

cannot use line 11.

Example 2. Mike and Susan enroll together in a qualified

For individuals enrolled in qualified health plans in different

health plan through the Marketplace. They do not have a change

states, add together the amounts from column B of the Forms

in circumstance during the year. They receive a Form 1095-A,

1095-A from each state and enter the total on Form 8962,

which reports $800 for the enrollment premiums in column A on

line 11, column (b).

lines 21 through 32 and $850 for the applicable SLCSP premium

Need to determine applicable SLCSP premium. If during

in column B on lines 21 through 32, for January through

2017, your coverage family changed or you moved and you did

December. They check the “Yes” box on Form 8962, line 10

not notify the Marketplace, or if no APTC was paid, the

and complete line 11 because for each of columns A and B there

applicable SLCSP premium reported on your Form(s) 1095-A

is an amount for all 12 months and the amounts did not change.

may be missing or incorrect. See

Missing or incorrect SLCSP

Example 3. The facts are the same as in

Example 2

above,

premium on Form 1095-A

under Line 10, earlier, to determine

but starting on August 1, Mike is eligible for Medicare, and does

your correct applicable SLCSP premium to enter in column (b).

not notify the Marketplace. Because Mike is eligible for other

Column (c). Enter the amount from line 8a of Form 8962.

MEC, their coverage family changed starting in August. As a

result, the applicable SLCSP premium reported on Form 1095-A

Column (d). Subtract the amount in column (c) from the

for August–December is incorrect and Mike and Susan must

amount in column (b). If the result is zero or less, enter -0-.

determine the correct applicable SLCSP premium for these

Column (e). Enter the lesser of the amount in column (a) or the

months by following the instructions in Pub. 974. Because the

amount in column (d).

SLCSP premium is not the same for every month of the year,

Note. Do not follow this instruction if you were provided a

Mike and Susan cannot use line 11 and must complete lines 12

qualified small employer health reimbursement arrangement

through 23 on Form 8962. Mike and Susan check the “No” box

(QSEHRA). See Qualified Small Employer Health

on Form 8962, line 10 and complete lines 12 through 23. They

Reimbursement Arrangement in Pub. 974 for instructions on

determine that the applicable SLCSP premium for the coverage

how to figure the amounts to enter in column (e). If the QSEHRA

family of one (Susan) for August through December is $400

was unaffordable for a month and you had to reduce the monthly

each month. Mike and Susan enter $850 in Form 8962, lines 12

PTC (but not below -0-) by the monthly permitted benefit

through 18, column (b), and $400 in lines 19 through 23, column

amount, write “QSEHRA” in the top margin on page 1 of Form

(b).

8962 to explain your entry and avoid delay in the processing of

Line 11—Annual Totals

your return.

Note. If you checked the “Yes” box on line 10 and you are

Column (f). Enter the APTC amount from Form 1095-A, line 33,

completing line 11, do not complete lines 12 through 23. Once

column C. If you have more than one Form 1095-A, add the

you complete line 11, skip to line 24.

amounts together and enter the total on Form 8962, line 11,

column (f).

If you checked the “Yes” box on line 6 or you are using filing

Not an applicable taxpayer. If you are not an applicable

status married filing separately and

Exception 2—Victim of

taxpayer because your household income is over 400% of the

domestic abuse or spousal

abandonment, earlier, does not

-13-

Instructions for Form 8962 (2017)

Instructions For Form 8962 - Premium Tax Credit (Ptc) - 2017 Page 13

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