Instructions For Form 8965 - Health Coverage Exemptions

ample 1, except that Kelly doesn’t have minimum essential cov-

Federal Poverty Line for Hawaii

erage in any month of the year and doesn’t qualify for a cover-

IF the size of your

THEN the federal poverty

age exemption (other than code “H”) for any month of the year.

tax household* is. . .

poverty line is. . .

Joan should compute the shared responsibility payment for Kelly

$13,670

for the months May through December 2017 and report it on her

$18,430

tax return. Joan should not file a Form 8965.

$23,190

$27,950

Example 3—Adoption during year, other coverage ex-

$32,710

emptions claimed. The facts are the same as Example 2, ex-

$37,470

cept Kelly qualifies for the exemption for coverage considered

$42,230

unaffordable for October through December 2017. Joan should

$47,010

compute the shared responsibility payment for Kelly for the

*If your tax household is more than 8 people, add $4,780 for each additional

months May through September 2017 and report it on her tax re-

person. For example, if your tax household is 11, you have 3 additional

turn. Joan should also file Form 8965 and claim code “H” for Kel-

people. Multiply $4,780 by 3 and add the result of $14,340 to $47,010.

ly for January through April and code “A” for Kelly for October

through December.

Member of tax household died during the year (code “H”).

To claim this coverage exemption, enter code “G” in Part III,

Your tax household for a month only includes individuals who

column (c), and check the box in column (d).

were alive for the entire month. In general, if a member of your

If the Marketplace granted you a similar coverage ex-

tax household died during the year you don’t need to file Form

emption for individuals who resided in a state that didn’t

TIP

8965 solely to report that fact. For example, if all members of

expand Medicaid, see the instructions for Part I, earlier,

your tax household have minimum essential coverage for every

to report the exemption.

month they are part of your tax household, check the Full-year

coverage box on your tax return. You don’t need to file Form

Member of tax household born or adopted during the year

8965. Also, if you owe a shared responsibility payment for one or

(code “H”). Your tax household for a month only includes indi-

more months and don't qualify for a coverage exemption (other

viduals who were alive for the entire month. In general, if an indi-

than code “H”) for any month, you should not file Form 8965.

vidual was added to your tax household by birth or adoption, you

don’t need to file Form 8965 solely to report that fact. For exam-

However, if a member of your tax household died during 2017

ple, if all members of your tax household have minimum essen-

and you are claiming a coverage exemption (other than code

tial coverage for every month they are part of your tax house-

“H”) for one or more months on Form 8965, you can claim a cov-

hold, check the Full-year coverage box on your tax return. You

erage exemption for the months following (and including) the

don’t need to file Form 8965. Also, if you owe a shared responsi-

month of his or her death. To claim this coverage exemption, en-

bility payment for one or more months and don't qualify for a cov-

ter code “H” in Part III, column (c), and identify the months to

erage exemption (other than code “H”) for any month, you

which the exemption applies as described under

Columns (d) -

should not file Form 8965.

(p)—Calendar

Months, later.

However, if you had or adopted a child during 2017 and you

Example—Death during year, coverage exemptions

are claiming a coverage exemption (other than code “H”) for one

claimed. George is unmarried and has one dependent, Harriet.

or more months on Form 8965, you can claim a coverage ex-

Neither George nor Harriet has minimum essential coverage in

emption for that child for the months before (and including) the

any month. George is a member of a health care sharing ministry

month when the child was born or adopted. To claim this cover-

for all of 2017. Harriet dies on October 12, 2017. George should

age exemption, enter code “H” in Part III, column (c), and identify

compute a shared responsibility payment for Harriet for January

the months to which the exemption applies as described under

through September and report it on his tax return. George should

Columns (d) - (p)—Calendar

Months, later.

also file Form 8965, claiming code “D” for himself for every

month. George should also claim code “H” for Harriet for Octo-

Example 1—Adoption during year, all individuals have

ber through December.

minimum essential coverage. Joan is unmarried and has one

dependent, Kelly. Joan legally adopted Kelly effective April 10,

Columns (d) – (p)—Calendar Months

2017. Joan has minimum essential coverage all year. Kelly has

minimum essential coverage from May through December. Kelly

For each coverage exemption claimed in row 8 through 13,

is a member of Joan’s tax household from May through Decem-

check the appropriate box or boxes for the months for which the

ber. Joan should check the Full-year coverage box on her tax re-

particular exemption applies. If the coverage exemption applies

turn, regardless of whether Kelly had minimum essential cover-

for the full year, check the box in column (d) and don't check the

age in January through April. Joan should not file a Form 8965.

boxes in columns (e) – (p).

Example 2—Adoption during year, no minimum essen-

tial coverage in other months. The facts are the same as Ex-

-14-

Instructions For Form 8965 - Health Coverage Exemptions - 2016 Page 14

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