Instructions For Form 8962 - Premium Tax Credit (Ptc)

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 2017 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 2017 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

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 generally are 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 2017, 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 2017 income suggests

referred to as the employee required contribution, is not more

that the individual may have been eligible for Medicaid or CHIP.

than 9.69% 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

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

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.

Example. Don was eligible to enroll in his employer’s

Coverage in the individual market outside the

coverage for 2017 but instead applied for coverage in a qualified

Marketplace. While coverage purchased in the individual

health plan through the Marketplace for coverage in 2017. Don

market outside the Marketplace is MEC, eligibility for this type of

provided accurate information about his employer’s coverage to

coverage does not prevent you from being eligible for the PTC

the Marketplace and the Marketplace determined that the offer

for Marketplace coverage. Coverage purchased in the individual

of coverage was not affordable and that Don was eligible for

market outside the Marketplace does not qualify for the PTC.

APTC. Don enrolled in the qualified health plan for 2017. 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 (MEC)

enrolled in as of September 1, 2017, but chose not to. Don did

in Pub. 974. You also can check

IRS.gov/uac/Individual-Shared-

not return to the Marketplace to determine if he was eligible for

Responsibility-Provision

for future updates about types of

APTC for the months September through December 2017, and

coverage that are recognized as MEC.

remained enrolled in the qualified health plan. Don is not

Applicable taxpayer. You must be an applicable taxpayer to

considered eligible for employer-sponsored coverage for the

take the PTC. Generally, you are an applicable taxpayer if your

months January through August of 2017 because he gave

household income

for 2017 (described earlier) is at least 100%

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Instructions for Form 8962 (2017)

Instructions For Form 8962 - Premium Tax Credit (Ptc) - 2017 Page 4

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