Instructions For Form 1 - Massachusetts Resident Income Tax - 2013 Page 6
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442013 Schedule HC — Line by Line Instructions
If you moved out of Massachusetts during 2013,
If you (and your spouse if married filing jointly) an-
pleting your tax return. Be sure to enclose Sched-
the mandate to obtain and maintain health insur-
swered Yes on both lines 8a and 8b, go to line 9.
ule HC with your return.
ance applies to you up until the last day of the last
If you are filing a joint return and one spouse an -
You must complete the Schedule HC Worksheets
full month you were a resident. For example, if you
swers No to line 8b but the other spouse answers
for Lines 10, 11 and 12 if you were uninsured for
moved out of Massachusetts on July 10, the man -
Yes to line 8b, the spouse who answered No is not
all of 2013 or if you had four or more consecutive
date applies up to June 30. In this example, do not
subject to a penalty and should skip the remain-
months without health insurance (four or more
count the months of July through December be-
der of Schedule HC. The spouse who answered
blank ovals in a row in the Months Covered by
cause the mandate did not apply.
Yes must go to line 9.
Health Insurance That Met Minimum Creditable
Deceased taxpayer. If a taxpayer died during 2013,
Coverage section of line 7).
Line 9. Certificate of Exemption
the mandate to obtain and maintain health insur-
To complete these worksheets, you will need to
The Commonwealth Health Insurance Connector
ance applies to the deceased taxpayer up until the
have your completed 2013 U.S. Form 1040, 1040A
Authority provided certificates of exemption to
last day of the last full month the taxpayer was
or 1040EZ. You also will need to know how much
qualified taxpayers who applied in 2013.
alive. For example, if a taxpayer died on August 4,
it would have cost you to enroll in any health in-
the mandate applies up to July 31. In this example,
If you have a “Certificate of Exemption” issued
surance plan offered by an employer in 2013. An
do not count the months of August through De-
by the Commonwealth Health Insurance Connec-
employer’s Human Resources Department should
cember because the mandate did not apply.
tor Authority for the 2013 tax year, a penalty does
be able to provide this amount to you.
not apply to you. Fill in the Yes oval(s) in line 9 of
Line 8. Religious Exemption
Filing an Appeal
Schedule HC and enter the certificate number in
Line 8a. A religious exemption is available for any -
the space provided. Note: Only enter the numbers
If you are subject to a penalty for not obtaining
one who has a sincere religious belief that is the
of the Certificate of Exemption. Do not enter let-
health insurance in 2013, you have the right to
basis of refusal to obtain and maintain health in-
ters, spaces or dashes. For example, if the certifi-
appeal. The appeal will be heard by the Common-
surance coverage. Fill in the Yes oval(s) if you are
cate number on your Certificate of Exemption is
wealth Health Insurance Connector Authority, an
claiming a religious exemption from the require-
AMLI123456-78, enter in the spaces provided
independent state body.
ment to purchase health insurance based on your
12345678. If married filing jointly and both
In your appeal, you may claim that the penalty
sincerely held religious beliefs.
spouses have a certificate, each spouse must enter
should not apply to you. You may claim that you
If you (and your spouse if married filing jointly)
their certificate number in the space provided. Skip
could not afford insurance in 2013 because you
answer Yes to line 8a, go to line 8b.
the remainder of Schedule HC and continue com-
experienced a hardship. To establish a hardship,
pleting your tax return. Be sure to enclose Sched-
If you (and your spouse if married filing jointly)
you must be able to show that, during 2013:
ule HC with your return.
answer No to line 8a, go to line 9.
(a) You were homeless, more than 30 days in ar-
If you answered No to line 9, go to line 10.
If you are filing a joint return and one spouse an-
rears in rent or mortgage payments, or received
swers No to line 8a but the other spouse answers
If you are filing a joint return and one spouse
an eviction or foreclosure notice;
Yes, the spouse who answered Yes must go to
an swers Yes to line 9 but the other spouse an-
(b) You received a shut-off notice, were shut off,
line 8b and the spouse who answered No must
swers No to line 9, the spouse who answered Yes
or were refused the delivery of essential utilities
go to line 9.
must enter the certificate number and skip the re-
(gas, electric, oil, water, or telephone);
mainder of Schedule HC and the spouse who an-
Line 8b. If you are claiming a religious exemption
(c) You incurred a significant, unexpected increase
swered No must go to line 10.
but you received medical health care during tax
in essential expenses resulting directly from the
year 2013, such as treatment during an emer-
For more information about Certificates of Exemp-
consequences of: (i) domestic violence; (ii) the
gency room visit, you may be subject to a penalty
tion, visit the Commonwealth Health Insurance
death of a spouse, family member, or partner with
if it is determined that you could have afforded
Connector Authority’s website at
primary responsibility for child care, where that
health insurance.
.
spouse, family member, or partner shared house-
Medical health care excludes certain treatments
hold expenses with you; (iii) the sudden responsi-
Lines 10, 11 and 12. Affordability
such as preventative dental care, certain eye exam-
bility for providing full care for yourself, an aging
As Determined By State Guidelines
inations and vaccinations. It also excludes a physi -
parent or other family member, including a major,
Taxpayers who had four or more consecutive
cal examination when required by a third party,
extended illness of a child that required a working
months without health insurance that met Mini-
such as a prospective employer. For additional in-
parent to hire a full-time caretaker for the child; or
mum Creditable Coverage in 2013 may be subject
formation, see Department of Revenue regulation
(iv) a fire, flood, natural disaster, or other unex-
to a penalty if they had access to affordable health
830 CMR 111M.2.1, Health Insurance Individual
pected natural or human-caused event causing
insurance that met MCC requirements.
Mandate; Personal Income Tax Return Require-
substantial household or personal damage for the
ments, available on the department’s website at
individual filing the appeal.
If you answered Yes in line 6 of Schedule HC in-
dicating that your income was at or below 150%
(d) Your financial circumstances were such that
of the Federal Poverty Level, or
If you (and your spouse if married filing jointly)
the expense of purchasing health insurance would
have caused you to experience a serious depriva-
answer Yes on line 8a and No on line 8b, the
If you had three or fewer blank ovals in a row as
penalty does not apply to you. Skip the remainder
tion of food, shelter, clothing or other necessities.
shown in line 7,
of Schedule HC and continue completing your tax
you are not subject to a penalty and should skip
return. Be sure to enclose Schedule HC with your
the remainder of Schedule HC and continue com-
return.
HC-4
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