Instructions For Filing: Personal & School District Income Tax - Department Of Taxation State Of Ohio - 2014 Page 28

2014 Ohio Forms IT 1040EZ / IT 1040 / Instructions

Example 1: Sue has a health care insurance

your spouse were eligible to participate in a

plan. Sue cannot use her $50 monthly pay-

Medicare and/or a subsidized health insur-

plan through her employer. The health care

ment on line 2a of the worksheet, but she

insurance premium for this coverage is $265

ance plan.

can include this amount on Line 2.

every two weeks, of which $100 is deducted

Note: You must reduce the unsubsidized

Example 2: Sue is retired and qualiﬁ es for

from Sue’s post-tax pay and $165 is paid by

medical care insurance premium amount

Medicare for the entire year. She pays $50

her employer. The taxpayer can include on

you enter on line 2a of the worksheet by the

each month for unsubsidized supplemental

line 2 of the worksheet the $100 insurance

amount of the self-employed health insur-

health insurance and $20 each month for

premiums that she paid.

ance deduction that you claimed on line 29

Medicare B premiums. Sue can include her

of federal form 1040.

$50 monthly premium payments on line

Line 2a – Unsubsidized Medical Care

Insurance Premiums

2a of the worksheet as she is eligible for a

Example 1: Sue has a health care insur-

If you were eligible to participate in a sub-

subsidized plan through Medicare; Also, she

ance plan through her employer. She has

sidized health care plan, enter on line 2a of

can include the $20 Medicare B premium

$50 deducted from her paycheck (post-tax)

the worksheet the costs for unsubsidized

payments amounts on line 2.

each month to pay for her portion of her

medical care insurance premiums you paid

health care insurance premium costs. Her

Note: If you are eligible for Medicare cover-

for dental, vision and health insurance for

employer contributes $450 each month

age, you can use line 2a of the worksheet

you, your spouse and dependents. If you or

toward the health care insurance premium

to report any unsubsidized medical care

your spouse were eligible to participate in

costs that total $500 each month. This is a

insurance premiums paid while you were

a subsidized plan for part of the year, enter

subsidized plan, so Sue is not participating

eligible for Medicare coverage.

on this line the unsubsidized premiums for

in an unsubsidized health care insurance

the portion of the year during which you or

Unreimbursed Health Care Expenses Worksheet for Line 46a

Do not include on this worksheet any amounts excluded from federal adjusted

gross income under a cafeteria plan (see Internal Revenue Code 125) or under any ﬂ exible spending account.

1. Were you eligible to participate in any subsidized health insurance plan / Medicare for (check one of the following):

A. The entire year;

B. None of the year; OR

C. Part of the year (see Note 1, below)

2. Enter the medical care expenses you paid and any subsidized medical insurance premiums you

paid for dental, vision and health insurance. Ohio Revised Code (R.C.) 5747.01(A)(11)(b)

.................... 2.

2a. Enter the amount you paid for unsubsidized medical care insurance premiums for dental, vision and

health insurance. R.C. 5747.01(A)(11)(b)

If you checked A on line 1, enter your unsubsidized premiums on this line.



If you checked B on line 1, enter -0-.



If you checked C on line 1, enter your unsubsidized premiums for the part of the year in which you



were eligible to participate in a subsidized health insurance plan or Medicare.

................................. 2a.

..................................................................................................................................... 3.

3. Add lines 2 and 2a

..... 4.

4. Enter your federal adjusted gross income (from line 1 of Ohio form IT 1040). If less than -0-, enter -0-

5. Multiply line 4 times the statutory factor of 7.5%

....................................................................................... 5.

6. Line 3 minus line 5. If less than -0-, enter -0-

............................................................................................ 6.

7. Enter the amount for unsubsidized premiums you paid for long-term care insurance (see Note 2,

below). R.C. 5747.01(A)(11)(a)

................................................................................................................ 7.

8. Enter the amount you paid for unsubsidized medical care insurance premiums, including those for

dental, vision and health insurance. R.C. 5747.01(A)(11)(a)

If you checked A on line 1, enter -0-.



If you checked B on line 1, enter your unsubsidized premiums on this line



If you checked C on line 1, enter this amount for the part of the year that you were not eligible to





participate in a subsidized health insurance plan or Medicare.

............................................................ 8.

9. Enter the amount paid by your employer and included in your federal adjusted gross income solely

because it relates to an "accident and health plan" for qualifying relatives and any amounts included in

your federal adjusted gross income that were paid through an employer-subsidized accident and health

plan to reimburse you for medical care expenses for qualifying relatives (see instructions for line 9). R.C.

5747.01(A)(11)(c)

....................................................................................................................................... 9.

10. Add lines 6, 7, 8 and 9. Enter the total on line 46a of Schedule A

........................................................... 10.

Note 1: If you or your spouse were eligible to participate in a subsidized plan for part of the year, check C on line 1 above and enter on line 2a these unsubsidized premiums

for the portion of the year during which you or your spouse were eligible to participate in a Medicare and/or a subsidized health insurance plan. Enter on line 8 any portion

of the unsubsidized premiums paid for dental, vision and health insurance for the portion of the year during which you or your spouse were not eligible to participate in a

Medicare and/or a subsidized health insurance plan (see instructions, Example 3).

Note 2: Do not enter any amounts on line 7 that are included on line 2, 2a, 8 or 9.

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