Instructions For Form 8885 - Health Coverage Tax Credit

Excess Advance HCTC Repayment Worksheet—Line 5

1. Multiply the amount from Form 8885, line 4, by 72.5% (0.725)

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2. Enter the total advance monthly payments of the HCTC made on your behalf for coverage for any month not checked on Form 8885, line 1 (see

Form 1099-H) and reimbursements of the HCTC you received by filing Form 14095 for any month not checked on Form 8885, line 1. If line 2 is

greater than line 1, skip line 3 and go to line 4

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3. Subtract line 2 from line 1. Enter the result here and on:

Form 8885, line 5; and

Form 1040, line 73 (check box c); Form 1040NR, line 69 (check box c); Form 1040-SS, line 10; or Form 1040-PR, line 10.

Don’t complete the rest of this worksheet

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4. Subtract line 1 from line 2. Enter the result here

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5. Consider all the individual(s) covered under the health insurance coverage for which you received the benefit of the advance monthly payments

of the HCTC during the year. Were any of those individual(s) also enrolled in a qualified health plan offered through a Marketplace for at least

one other month of the year?

Yes. Complete Form 8962 using the special instructions under

Participants in a Health Insurance

Marketplace, earlier. Go to line 6.

No. Skip line 6. Enter the amount from line 4 on line 7.

6. Is the amount on Form 8962, line 5, less than 400 AND the amount on Form 8962, line 24, greater than zero?

Yes.

IF . . .

THEN enter on line 6 . . .

Form 8962, line 28, is blank

the sum of Form 8962, line 26, and the

applicable repayment limitation provided in the

instructions for Form 8962, line 28.

Form 8962, line 28, isn’t blank

Form 8962, line 28, reduced by Form 8962,

line 29.

Note. If you are married filing jointly and both you and your spouse must file Forms 8885, one spouse should

figure their repayment limitation on line 6 of this worksheet. If line 6 is greater than line 7, enter the difference

on line 6 of the second spouse’s worksheet. Otherwise, enter zero on lines 6 and 7 of the second spouse’s

worksheet.

No. Leave line 6 blank. Enter the amount from line 4 on line 7.

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7. If you entered an amount on line 6, enter the smaller of line 4 or line 6 here. Also enter the items below where indicated.

IF you’re filing . . .

THEN include the amount on

AND enter “HCTC” and the amount on line 7 . . .

line 7 in the total entered on . . .

Form 1040

line 44

in the space next to box c on line 44; then check box c.

Form 1040NR

line 42

to the left of the entry for line 42.

Form 1040-SS or 1040-PR

line 6

on the dotted line next to line 6.

Then, on Form 8885, line 5, enter the line 7 amount as a negative number by enclosing it in parentheses

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Required Documents

For PBGC eligibility—A copy of the

premium includes amounts that don’t

official letter or a copy of your 2017 Form

count towards the HCTC, such as dental

If you claim any HCTC on line 5, you must

1099-R, Distributions From Pensions,

or vision coverage or coverage for family

provide verifiable proof for each month

Annuities, Retirement or Profit-Sharing

members who aren’t eligible for the HCTC,

you are claiming the credit on line 2 that

Plans, IRAs, Insurance Contracts, etc.,

your documentation must also specify

your health insurance coverage is

from the PBGC showing you received a

those ineligible amounts.

qualified health insurance coverage for the

benefit paid by the PBGC.

3. Proof of payment for each month

HCTC and that you paid premiums for the

2. A copy of your health insurance

you are claiming the credit on line 2 such

qualified health insurance coverage by

bills or COBRA payment coupons for each

as:**

attaching the documents listed below to

month you are claiming the credit on

your Form 8885. No documents are

a. Canceled checks (copy of front and

line 2.* The bills must have:

required if you file Form 8885 only to elect

back),

the HCTC for months you participated in

a. Your name (or name of the policy

b. Bank statements,

the advance monthly payment program.

holder),

c. Credit card statements, or

b. The name of your health plan,

All health plans. For all health plans

d. Money orders.

you must include all of the following

c. Your monthly premium amount,

documents.

**Your proof of payment must indicate

d. Dates of coverage, and

the amount paid and to whom it was paid.

1. An official letter reflecting that you

e. Your health plan identification

If you don’t have one of these types of

were an eligible individual for the months

number(s).

proof of payment, contact your health plan

claimed on line 2 in 2017:

for a record of your payment(s).

For trade certified individuals

*If your health plan doesn’t provide

demonstrating TAA, ATAA, or RTAA

members with an insurance bill or COBRA

COBRA coverage. You must include

eligibility—A copy of the official letter from

payment coupon, you must provide health

the information under

All health plans

and

the Department of Labor, your state

plan enrollment documents or an official

one of the following documents.

workforce agency, or employment office

letter from your health plan that has the

1. A copy of your completed and

stating you are eligible for trade

required information listed under items 2a

signed COBRA Election Letter. It may also

adjustment benefits.

through 2e earlier. If your monthly

Instructions for Form 8885 (2017)

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Instructions For Form 8885 - Health Coverage Tax Credit - 2017 Page 5

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