Instructions For Form 8965 - Health Coverage Exemptions - 2016 Page 15
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20Shared Responsibility
Flat Dollar Amount
Step 2
Payment
1. Multiply $695 by the number of people in your tax
Use the following flowchart to see if you
household who were at least 18 years old.*
need to make a shared responsibility
1
payment, and if so, the amount.
Follow Steps 1 through 5 next.
Complete
Worksheet A
and
Worksheet B
if you are directed to
*For purposes of figuring the shared responsibility payment, an individual is
them as you complete Steps 1 through 5.
considered under age 18 for an entire month if he or she didn't turn 18 before the
Complete the
Shared Responsibility Payment Worksheet
as
first day of the month. An individual turns 18 on the anniversary of the day the
directed by Steps 1 through 5 or Worksheets A and B.
individual was born.
All Filers
Step 1
2. Multiply $347.50 by the number of people in your tax
1. Can someone claim you as a dependent?
household who were under age 18.
No. Continue
Yes.
2
STOP
You don’t owe a shared
responsibility payment.
Don’t check the box on
line 6a of Form 1040 or
3. Add lines 1 and 2.
Form 1040A. If you file
Form 1040EZ, check
3
the box on line 5.
2. Did you, and everyone else in your tax household (see
Tax
household
under Definitions, earlier) have qualifying health
4. Enter the smaller of line 3 or $2,085 here and on line 1 of
coverage for every month of 2017*?
the
Shared Responsibility Payment
Worksheet. Go to Step
3.
No. Continue
Yes.
STOP
4
You don’t owe a shared
responsibility payment.
Check the Full-year
coverage box on Form
Household Income
Step 3
1040, line 61; Form
1040A, line 38; or
Form 1040EZ, line 11.
1. Enter the amount from Form 1040, line 38; Form 1040A,
line 21; or Form 1040EZ, line 4.
*You can check the Full-year coverage box if you had or adopted a child during the year, or a
1
member of your tax household died during the year, as long as that person had qualifying
health care coverage for every month he or she was a member of your tax household.
3. Did you or anyone else in your tax household have
2. Did you receive any tax-exempt interest?
qualifying health coverage or qualify for a coverage
Yes. Enter the amount
No. Continue
exemption for any month in 2017?
from Form 1040,
Yes.
No. Continue
STOP
line 8b; Form 1040A,
line 8b; or the amount
Claim any coverage
entered in the space to
exemption you qualify
the left of Form
for on Form 8965. Skip
1040EZ, line 2.
question 4; go to
Worksheet A.
2
4. Did you, or anyone else in your tax household turn 18
during 2017?
Yes. Go to
No. Go to Step 2.
Worksheet A.
-15-
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