Instructions For Form 8965 - Health Coverage Exemptions - 2016 Page 19
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20Worksheet B
!
Don’t complete this worksheet unless you were directed here in Step 4 under
Shared Responsibility
Payment.
CAUTION
(a)
(b)
(c)
Enter the
For each month, you must determine if the amount on line 5 of Worksheet A is less than
Enter the
Enter the larger
amount from
the amount on line 7 of Step 4 under Shared Responsibility Payment. *
amount from
of column (a) or
line 5 of
Step 4, line 7
column (b)
Worksheet A
1.
January
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.
February
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.
March
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.
April
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.
May
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.
June
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.
July
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.
August
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9.
September
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. October
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. November
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. December
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Add the amounts in column (c)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14. Divide line 13 by 12.0. Enter the result on lines 2 and 3 of the Shared Responsibility Payment Worksheet. Go to
Step 5
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*If the amount on line 1 of Worksheet A is -0- for any month, leave all columns of this worksheet blank for that month.
Filing Thresholds for Most People
IF your filing status is...
AND at the end of 2017 you were*...
THEN you must file a tax return if
your gross income** was at least...
Single
Under 65
$10,400
65 or older
$11,950
Head of household
Under 65
$13,400
65 or older
$14,950
Married filing jointly***
Under 65 (both spouses)
$20,800
65 or older (one spouse)
$22,050
65 or older (both spouses)
$23,300
Married filing separately
Any age
$4,050
Qualifying widow(er)
Under 65
$16,750
65 or older
$18,000
*If you were born on January 1, 1953, you are considered to be age 65 at the end of 2017. (If your spouse died in 2017 or if you are preparing a return for
someone who died in 2017, see Pub. 501.)
**Gross income means all income you received in the form of money, goods, property, and services that isn't exempt from tax, including any
income from sources outside the United States. It also includes gain from the sale of your main home, even if you can exclude part or all of it.
Include only the taxable part of social security benefits (Form 1040, line 20b; Form 1040A, line 14b). Also include gains, but not losses,
reported on Form 8949 or Schedule D. Gross income from a business means, for example, the amount on Schedule C, line 7, or Schedule F,
line 9. But, in figuring gross income, don't reduce your income by any losses, including any loss on Schedule C, line 7, or Schedule F, line 9.
***If you didn’t live with your spouse at the end of 2017 (or on the date your spouse died) and your gross income was at least $4,050, you must file a return
regardless of your age.
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