Instructions For Form 1 - Massachusetts Resident Income Tax - 2013 Page 12
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44Table 3: Affordability
Table 4: Premiums
Individual or Married Filing Separately (no dependents)
Region 1. Berkshire, Franklin and Hampshire Counties
2
a. Federal adjusted gross income
b. Monthly premium
Married couple
Age
*Individual
1
(no dependents)
**Family
3
From
To
00–26
$178
$356
$0,738
$
0
$17,244
$ 0
27–29
$236
$472
$0,812
$17,245
$22,980
$ 40
30–34
$253
$506
$0,880
$22,981
$28,728
$ 78
35–39
$263
$526
$0,841
$28,729
$34,476
$118
$34,477
$40,195
$178
40–44
$294
$588
$0,899
$40,196
$45,554
$239
45–49
$332
$664
$0,976
$45,555
$51,639
$331
50–54
$415
$830
$1,164
$51,640
$56,273
$359
55+
$430
$860
$1,178
If $56,274 or over, divide Schedule HC, line 2
$56,274
by 120 to determine monthly premium.
Region 2. Bristol, Essex, Hampden, Middlesex, Norfolk, Suffolk and
Worcester Counties
Married Filing Jointly with no dependents or Head of Household/
Married couple
2
Married Filing Separately with one dependent
Age
*Individual
1
(no dependents)
**Family
3
a. Federal adjusted gross income
b. Monthly premium
00–26
$189
$378
$0,702
From
To
27–29
$233
$466
$0,722
$
0
$23,268
$ 0
30–34
$239
$478
$0,824
$23,269
$31,020
$ 80
35–39
$254
$508
$0,862
$31,021
$38,784
$156
40–44
$270
$540
$0,912
$38,785
$46,536
$236
45–49
$305
$610
$1,024
$46,537
$56,656
$319
50–54
$364
$728
$1,132
$56,657
$67,448
$403
55+
$378
$756
$1,136
$67,449
$77,604
$524
$77,605
$89,032
$598
Region 3. Barnstable, Dukes, Nantucket and Plymouth Counties
If $89,033 or over, divide Schedule HC, line 2
Married couple
2
$89,033
by 120 to determine monthly premium.
Age
*Individual
1
(no dependents)
**Family
3
00–26
$180
$360
$0,704
Married Filing Jointly with one or more dependents or Head of
Household/Married Filing Separately with two or more dependents
27–29
$227
$454
$0,719
a. Federal adjusted gross income
b. Monthly premium
30–34
$227
$454
$0,933
From
To
35–39
$258
$516
$0,993
$
0
$ 29,304
$ 0
40–44
$294
$588
$1,044
$ 29,305
$ 39,060
$ 80
45–49
$325
$650
$1,097
$ 39,061
$ 48,828
$156
50–54
$381
$762
$1,229
$ 48,829
$ 58,596
$236
55+
$393
$786
$1,260
$ 58,597
$ 75,899
$379
1. Includes married filing separately (no dependents).
$ 75,900
$ 97,584
$550
2. Rates for a married couple are based on the combined monthly pre -
mium cost of individual plans for each spouse, rather than the cost
$ 97,585
$113,443
$756
of a two-person (or self plus spouse) plan.
$113,444
$119,270
$862
3. Head of household or married couple with dependent(s).
If $119,271 or over, divide Schedule HC, line 2
$119,271
by 120 to determine monthly premium.
HC-10
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