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Page 4 of 6 Fileid: … ions/i8885/2021/a/xml/cycle04/source 10:43 - 1-Dec-2021
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
IF . . . THEN . . .
the amount on Form 8962, line 5, is 400 or more, leave Form 8962, line 28, blank and enter the amount from line 27 on line 29.
the amount on Form 8962, line 24, is zero or blank, leave Form 8962, line 28, blank and enter the amount from line 27 on line 29.
you didn’t receive the benefit of advance monthly payments of the HCTC, leave Form 8962, line 28, blank and enter the amount from line 27 on line 29.
the amount on Form 8962, line 24, is greater than zero, after you complete Form 8962, line 27, complete Form 8885.
and If you aren’t instructed to complete the Excess Advance HCTC Repayment Worksheet
for Form 8885, line 5, add the amount from Form 8885, line 5, if any, to the applicable
you received the benefit of advance monthly payments of the HCTC for repayment limitation provided in the instructions for Form 8962, line 28. Enter the result
at least 1 month of the year for individual(s) who were enrolled in a on Form 8962, line 28, and complete Form 8962, line 29.
qualified health plan offered through a Marketplace for at least 1 other
month of the year, If you are instructed to complete the Excess Advance HCTC Repayment Worksheet for
Form 8885, line 5, complete only lines 1 and 2 of the worksheet and do one of the
following.
(1) If line 1 of the worksheet is greater than or equal to line 2 of the worksheet:
(a) Complete line 3 of the worksheet and enter the amount on Form 8885, line 5,
and Schedule 3 (Form 1040), 1040-SS, or 1040-PR, as instructed;
(b) On Form 8962, line 28, enter the sum of the amount on Form 8885, line 5,
and the applicable repayment limitation provided in the instructions for Form
8962, line 28; and
(c) Complete Form 8962, line 29.
(2) If line 1 of the worksheet is less than line 2 of the worksheet:
(a) Complete Form 8962, lines 28 and 29, using the applicable repayment
limitation provided in the Instructions for Form 8962 without any
adjustments; and
(b) Using this information, complete lines 4 through 7 of the worksheet as
instructed.
See the Excess Advance HCTC Repayment Worksheet for details.
a. You were eligible for qualified Line 2
Specific Instructions health insurance coverage (including any
employer-sponsored health insurance If your qualified health insurance
Line 1 plan of your spouse) (other than the ! coverage covers anyone other
You must elect the HCTC to receive the coverage listed under item 3, 4a, or 4e in CAUTION than you and your qualifying
benefit of the HCTC. Check the box for the the definition of Qualified Health Insurance family members, see Pub. 502, Medical
first eligible coverage month you are Coverage, earlier) where the employer and Dental Expenses, before completing
electing to take the HCTC. All of the would have paid 50% or more of the cost line 2 to determine which amounts are
statements listed on the form, and as of the coverage. considered to be paid for coverage for you
further explained in these instructions, b. You were covered under any and your qualifying family members.
must be true as of the first day of that qualified health insurance coverage Enter the total amount of insurance
month. You must also check the box for (including any employer-sponsored health premiums paid by you for coverage for
each month after the election month for insurance plan of your spouse) (other than you and all qualifying family members
which all of the statements listed on the the coverage listed under item 3, 4a, or 4e under Qualified Health Insurance
form are true as of the first day of that in the definition of Qualified Health Coverage, earlier, for all eligible coverage
month, even if you aren’t claiming the Insurance Coverage, earlier) and the months checked on line 1. But don’t
HCTC for those months. employer paid any part of the cost of the include any insurance premiums paid by
coverage. you to “US Treasury-HCTC.” Also don’t
Employer-sponsored health insurance
coverage. Don’t check the box for any Any amounts contributed to the include any advance monthly payments
your health plan administrator received
month that, as of the first day of the month, ! cost of coverage by you or your from the IRS, as shown on Form 1099-H,
either (1) or (2) applies. CAUTION spouse on a pre-tax basis are
1. You were covered under any considered to have been paid by the box 1, or any insurance premiums you
employer-sponsored health insurance employer. paid for which you received a
reimbursement of the HCTC during the
plan (including any employer-sponsored year by filing Form 14095.
health insurance plan of your spouse) Example. You had health insurance
(except insurance substantially all of the coverage under an employer-sponsored Example 1. You checked January on
coverage of which is of excepted benefits health insurance plan as of October 1. The line 1. You paid $225 ($200 for basic
described in section 9832(c)) and the employer paid 40% of the cost of the coverage and $25 for dental benefits
employer paid 50% or more of the cost of coverage. You paid 60% of the cost of the which are purchased separately) directly
the coverage. coverage through pre-tax contributions. to your health plan for your January
You can’t take the HCTC for the month of coverage. The $25 you paid for dental
2. You were an eligible ATAA or October because the employer is benefits is ineligible for the HCTC. You
RTAA recipient and either of the following considered to have paid 100% of the cost would include the $200 you paid for your
applies. of the coverage. basic insurance on line 2.
-4- Instructions for Form 8885 (2021)
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