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            Department of the Treasury                        Contents
            Internal Revenue Service
                                                              Future Developments . . . . . . . . . . . . . . . . . . . . . . .          1
                                                              What’s New    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1
Publication 974
Cat. No. 66452Q                                               Reminders    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
                                                              Introduction  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2
                                                              What Is the Premium Tax Credit (PTC)?                   . . . . . . . . .  3
Premium Tax 
                                                              Who Must File Form 8962 . . . . . . . . . . . . . . . . . . . .            3
Credit (PTC)                                                  Who Can Take the PTC          . . . . . . . . . . . . . . . . . . . . . .  4
                                                              Terms You May Need To Know                  . . . . . . . . . . . . . . .  4
For use in preparing
                                                              Minimum Essential Coverage (MEC)                    . . . . . . . . . . .  8
2022 Returns                                                  Individuals Not Lawfully Present in the United 
                                                              States Enrolled in a Qualified Health Plan                        . . .    19
                                                              Determining the Premium for the Applicable 
                                                              Second Lowest Cost Silver Plan (SLCSP)                            . . .    27
                                                              Allocating Policy Amounts for Individuals With 
                                                              No One in Their Tax Family                  . . . . . . . . . . . . . .    27
                                                              Allocation of Policy Amounts Among Three or 
                                                              More Taxpayers . . . . . . . . . . . . . . . . . . . . . . .               28
                                                              Alternative Calculation for Year of Marriage                    . . . .    38
                                                              Self-Employed Health Insurance Deduction 
                                                              and PTC       . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    47
                                                              How To Get Tax Help         . . . . . . . . . . . . . . . . . . . . . .    63
                                                              Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  68

                                                              Future Developments
                                                              For the latest information about developments related to 
                                                              Pub.  974,  such  as  legislation  enacted  after  it  was 
                                                              published, go to IRS.gov/Pub974.

                                                              What’s New
                                                              Health Coverage Tax Credit (HCTC).                    HCTC expired on 
                                                              December 31, 2021. Beginning tax year 2022, Form 8885 
                                                              and its instructions have been discontinued by the IRS.

                                                              Reminders
                                                              Applicable  federal  poverty  line  percentages.                    For  tax 
                                                              year 2022, the PTC is available to taxpayers with house-
                                                              hold  incomes  that  exceed  400%  of  the  federal  poverty 
                                                              line.
Get forms and other information faster and easier at:         Health  reimbursement  arrangements  (HRAs).                          Begin-
• IRS.gov (English)         • IRS.gov/Korean (한국어)            ning  in  2020,  employers  can  offer  individual  coverage 
• IRS.gov/Spanish (Español) • IRS.gov/Russian (Pусский)       health reimbursement arrangements (individual coverage 
• IRS.gov/Chinese (中文)      • IRS.gov/Vietnamese (Tiếng Việt) 
                                                              HRAs)  to  help  employees  and  their  families  with  their 

Mar 17, 2023

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medical expenses. If you are offered an individual cover- Health insurance options. If you need health coverage,
age HRA, see Individual Coverage HRAs, later, for more go to HealthCare.gov to learn about health insurance op-
information on whether you can claim a PTC for you or a tions that are available for you and your family, how to pur-
member of your family for Marketplace coverage. chase health insurance, and how you might qualify to get
Qualified small employer health reimbursement ar- financial assistance with the cost of insurance.
rangement (QSEHRA). Under a QSEHRA, an eligible Additional information. For additional information about
employer can reimburse eligible employees for medical the tax provisions of the Affordable Care Act (ACA), in-
expenses, including premiums for Marketplace health in- cluding the individual shared responsibility provisions and
surance. If you were provided a QSEHRA, your employer the PTC, see IRS.gov/Affordable-Care-Act/Individuals-
should have reported the annual permitted benefit in and-Families or call the IRS Healthcare Hotline for ACA
box 12 of your Form W-2 with code FF. If the QSEHRA is questions (800-919-0452).
considered affordable coverage for a month, no premium Photographs of missing children. The Internal Reve-
tax credit (PTC) is allowed for the month. If the QSEHRA nue Service is a proud partner with the National Center for
is not considered affordable coverage for a month, you Missing & Exploited Children® (NCMEC). Photographs of
may still be eligible for the PTC but you must reduce the missing children selected by the Center may appear in
monthly PTC (but not below -0-) by the monthly permitted this publication on pages that would otherwise be blank.
benefit amount. For more information, see Qualified Small You can help bring these children home by looking at the
Employer Health Reimbursement Arrangement, later. photographs and calling 1-800-THE-LOST
Requirement to reconcile advance payments of the (1-800-843-5678) if you recognize a child.
premium tax credit. If you, your spouse with whom you
are filing a joint return, or a dependent was enrolled in
coverage through the Marketplace for 2022 and advance
payments of the premium tax credit (APTC) were made Introduction
for this coverage, you must file a 2022 return and attach This publication covers the following general topics, relat-
Form 8962 to claim a net PTC. You (or whoever enrolled ing to the PTC, which are also covered in the Form 8962
you) should have received Form 1095-A, Health Insur- instructions.
ance Marketplace Statement, from the Marketplace with
information about your coverage and any APTC. You • What is the PTC?
must attach Form 8962 even if someone else enrolled • Who must file Form 8962.
you, your spouse, or your dependent. If you are a depend-
ent who is claimed on someone else's 2022 return, you do • Who can take the PTC. (See Figure A—Can You Take
not have to attach Form 8962. the PTC, later.)
This publication also provides additional instructions for
Report changes in circumstances when you re-enroll
taxpayers in the following special situations.
in coverage and during the year. If APTC is being paid
for an individual in your tax family (defined later) and you • Taxpayers who take the PTC and who are filing a sep-
have had certain changes in circumstances (see the ex- arate return from their spouses because of domestic
amples below), it is important that you report them to the abuse or spousal abandonment.
Marketplace where you enrolled in coverage. Reporting
• Taxpayers who take the PTC and who are also provi-
changes in circumstances promptly will allow the Market-
ded a QSEHRA.
place to adjust your APTC to reflect the PTC you are esti-
mated to be able to take on your tax return. Adjusting your • Taxpayers who need to calculate the PTC and APTC
APTC when you re-enroll in coverage and during the year for a policy that covered an individual not lawfully
can help you avoid owing tax when you file your tax return. present in the United States.
Changes that you should report to the Marketplace in- • Taxpayers who need to determine the applicable sec-
clude the following. ond lowest cost silver plan (SLCSP) premium.
• Changes in household income. • Taxpayers who need to allocate policy amounts for in-
• Moving to a different address. dividuals not included in any tax family.
• Gaining or losing eligibility for other health care cover- • Taxpayers who need to allocate policy amounts be-
age. cause one qualified health plan covers individuals
from three or more tax families in the same month.
• Gaining, losing, or other changes to employment.
• Taxpayers who married during the tax year and want
• Birth or adoption.
to use an alternative PTC calculation that may lower
• Marriage or divorce. their taxes.
• Other changes affecting the composition of your tax • Self-employed taxpayers who wish to take the PTC
family. and the self-employed health insurance deduction.
For more information on how to report a change in This publication also provides additional information to
circumstances to the Marketplace, visit HealthCare.gov or help you determine if your health care coverage is mini-
your State Marketplace website. mum essential coverage (MEC).

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Comments and suggestions. We welcome your com-
ments about this publication and suggestions for future
editions. What Is the Premium Tax
You can send us comments through IRS.gov/
Credit (PTC)?
FormComments. Or, you can write to the Internal Reve-
nue Service, Tax Forms and Publications, 1111 Constitu-
Premium tax credit (PTC). The PTC is a tax credit for
tion Ave. NW, IR-6526, Washington, DC 20224.
certain people who enroll, or whose family member en-
Although we can’t respond individually to each com-
rolls, in a qualified health plan offered through a Market-
ment received, we do appreciate your feedback and will
place. The credit provides financial assistance to pay the
consider your comments and suggestions as we revise
premiums for the qualified health plan by reducing the
our tax forms, instructions, and publications. Don’t send
amount of tax you owe, giving you a refund, or increasing
tax questions, tax returns, or payments to the above ad-
your refund amount. You must file Form 8962 to compute
dress.
and take the PTC on your tax return.
Getting answers to your tax questions. If you have
a tax question not answered by this publication or the How Advance payments of the premium tax credit (APTC).
To Get Tax Help section at the end of this publication, go The APTC is a payment made during the year to your in-
to the IRS Interactive Tax Assistant page at IRS.gov/ surance provider that pays for part or all of the premiums
Help/ITA where you can find topics by using the search for a qualified health plan covering you or an individual in
feature or viewing the categories listed. your tax family. Your APTC eligibility is based on the Mar-
ketplace’s estimate of the PTC you will be able to take on
Getting tax forms, instructions, and publications. your tax return. If APTC was paid for you or an individual
Go to IRS.gov/Forms to download current and prior-year in your tax family, you must file Form 8962 to reconcile
forms, instructions, and publications. (compare) this APTC with your PTC. If the APTC is more
Ordering tax forms, instructions, and publications. than your PTC, you have excess APTC and you must re-
Go to IRS.gov/OrderForms to order current forms, instruc- pay the excess, subject to certain limitations. If the APTC
tions, and publications; call 800-829-3676 to order is less than the PTC, you can get a credit for the differ-
prior-year forms and instructions. The IRS will process ence, which reduces your tax payment or increases your
your order for forms and publications as soon as possible. refund.
Don’t resubmit requests you’ve already sent us. You can
Changes in circumstances. The Marketplace deter-
get forms and publications faster online.
mined your eligibility for, and the amount of, your 2022
Questions about Form 1095-A, Health Insurance APTC using projections of your income and the number of
Marketplace Statement. If you or a member of your tax individuals you certified to the Marketplace would be in
family was enrolled in a qualified health plan through a your tax family (yourself, spouse, and dependents) when
Marketplace in 2022, you should have received a Form you enrolled in a qualified health plan. If this information
1095-A by early February 2023. Contact your Marketplace changed during 2022 and you did not promptly report it to
if you do not receive a Form 1095-A or if you have ques- the Marketplace, the amount of APTC paid may be sub-
tions about the accuracy of your Form 1095-A. stantially different from the amount of PTC you can take
on your tax return. See Report changes in circumstances
Useful Items when you re-enroll in coverage and during the year, ear-
You may want to see: lier, for changes that can affect the amount of your PTC.

Publication
535 535 Business Expenses (Self-employed individuals Who Must File Form 8962
may need to see chapter 6.)
You must file Form 8962 with your income tax return
Form (and Instructions) (Form 1040, 1040-SR, or 1040-NR) if any of the following
apply to you.
1095-A 1095-A Health Insurance Marketplace Statement
• You are taking the PTC.
1095-B 1095-B Health Coverage
• APTC was paid for you or another individual in your
1095-C 1095-C Employer-Provided Health Insurance Offer
tax family.
and Coverage
• APTC was paid for an individual you told the Market-
8962 8962 Premium Tax Credit (PTC)
place would be in your tax family and neither you nor
See How To Get Tax Help, at the end of this publication, anyone else included that individual in a tax family.
for information about getting publications and forms. See Individual you enrolled who is not included in a
tax family under Lines 12 Through 23—Monthly Cal-
culation in the Form 8962 instructions.

If any of the circumstances above apply to you, you
must file an income tax return and attach Form 8962 even

Publication 974 (2022) Page 3

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if  you  are  not  otherwise  required  to  file.  You  must  use         federal poverty line under Line 5 in the Form 8962 
Form 1040, 1040-SR, or 1040-NR. For help in determin-                     instructions.
ing  which  of  these  forms  to  file,  see  the  Instructions  for 
                                                                       b. If you were married at the end of 2022, you must 
Form 1040 or the Instructions for Form 1040-NR.
                                                                          generally file a joint return. However, filing a sepa-
                                                                          rate return from your spouse will not disqualify you 
       If you are filing Form 8962, you cannot file Form 
                                                                          from being an applicable taxpayer if you meet cer-
!      1040-SS or 1040-PR.                                                tain requirements described under Married tax-
CAUTION
                                                                          payers, later.
If someone else enrolled an individual in your tax family 
                                                                     You are not entitled to the PTC for health coverage for 
in coverage, and APTC was paid for that individual’s cov-
                                                                     an individual for any period during which the individual is 
erage,  you  must  file  Form  8962  to  reconcile  the  APTC. 
                                                                     not lawfully present in the United States.
You need to obtain a copy of the Form 1095-A from the 
person who enrolled the individual.                                  For additional requirements and more details, see   Ap-
       If  you  are  claimed  as  a  dependent,  the  person         plicable taxpayer, later.
TIP    who  claims  you  will  file  Form  8962  to  take  the 
       PTC  and,  if  necessary,  repay  excess  APTC  for 
your coverage. You do not need to file Form 8962.                    Terms You May Need To Know

                                                                     The terms defined below are generally the same as those 
                                                                     in the Form 8962 instructions. However, additional infor-
Who Can Take the PTC                                                 mation is provided below on what documentation to keep 
                                                                     if you are a victim of domestic abuse or spousal abandon-
You can take the PTC for 2022 if you meet the conditions             ment, and on MEC, later.
under (1), (2), and (3) below.
                                                                     Tax  family. For  purposes  of  the  PTC,  your  tax  family 
1. For at least 1 month of the year, all of the following            consists of the following individuals.
were true.
                                                                     • You, if you file a tax return for the year and you can't 
a. An individual in your tax family was enrolled in a                  be claimed as a dependent on someone else's 2022 
       qualified health plan offered through the Market-               tax return.
       place on the first day of the month.
                                                                     • Your spouse if filing jointly and they can't be claimed 
b. That individual was not eligible for MEC for the                    as a dependent on someone else's 2022 tax return.
       month, other than individual market coverage. An 
       individual is generally considered eligible for MEC           • Your dependents whom you claim on your 2022 tax 
       for the month only if they were eligible for every              return. If you are filing Form 1040-NR, you should in-
       day of the month (see Minimum Essential Cover-                  clude your dependents in your tax family only if you 
       age, later).                                                    are a U.S. national; resident of Canada, Mexico, or 
                                                                       South Korea; or a resident of India who was a student 
c. The portion of the enrollment premiums (descri-                     or business apprentice.
       bed later) for the month for which you are respon-
                                                                     Your  family  size  equals  the  number  of  qualifying  indi-
       sible was paid by the due date of your tax return 
                                                                     viduals in your tax family (including yourself).
       (not including extensions). However, if you be-
       came eligible for APTC because of a successful                Note. Listing your dependents by name and social se-
       eligibility appeal and you retroactively enrolled in          curity  number  (SSN)  or  individual  taxpayer  identification 
       the plan, then the portion of the enrollment pre-             number (ITIN) on your tax return is the same as claiming 
       mium for which you are responsible must be paid               them as a dependent. If you have more than four depend-
       on or before the 120th day following the date of              ents, see the Instructions for Form 1040 or the Instructions 
       the appeals decision.                                         for Form 1040-NR.
2. No one can claim you as a dependent for the year.
                                                                     Household  income. For  purposes  of  the  PTC,  house-
3. You are an applicable taxpayer for 2022. To be an ap-             hold income is the modified adjusted gross income (modi-
plicable taxpayer, you must meet all of the following                fied  AGI)  of  you  and  your  spouse  (if  filing  a  joint  return) 
requirements.                                                        (see Line 2a in the Form 8962 instructions) plus the modi-
                                                                     fied AGI of each individual whom you claim as a depend-
a. Your household income for 2022 is at least 100% 
                                                                     ent  and  who  is  required  to  file  an  income  tax  return  be-
       of the federal poverty line for your family size (see 
                                                                     cause  their  income  meets  the  income  tax  return  filing 
       Line 4 in the Form 8962 instructions). However, 
                                                                     threshold  (see Line  2b  in  the  Form  8962  instructions). 
       having household income below 100% of the fed-
                                                                     Household income does not include the modified AGI of 
       eral poverty line will not disqualify you from taking 
                                                                     those individuals whom you claim as dependents and who 
       the PTC if you meet certain requirements descri-
                                                                     are filing a 2022 return only to claim a refund of withheld 
       bed under Household income below 100% of the 
                                                                     income tax or estimated tax.

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Figure A. Can You Take the PTC?
This flowchart can help you determine whether you can take the PTC. But do not rely on this flowchart alone. Be sure 
you read Who Can Take the PTC, discussed earlier, or in the Form 8962 instructions.

                                                           Start here
                       Were any of the individuals included in your tax family enrolled in a qualied              No
                       health plan through the Marketplace for at least 1 month during 2022?
                                                                 Yes

                No     Were any of these individuals eligible for MEC (other than individual           Yes
                       market coverage) for the months they were enrolled in the qualied health
                       plan? (See Minimum Essential Coverage, later.)

Can someone else claim you asa dependent            No                  Were all of these individuals eligible for MEC for
on another tax return for 2022?                                         all of the months they were enrolled in the
                                                                        qualied health plan?
          No                         Yes                                                                             Yes

Were the premiums paid by the due date of
your tax return (not including extensions)?         No                                                      You cannot take the PTC.
(A different due date applies in the case of a
successful eligibility appeal. See Enrollment
premiums.)
                                              Yes
                                   No
                                      Were you married at the end of 2022?
                                                               Yes
                                   Yes
                                      Are you and your spouse ling a joint return?
                                                               No

                                              Do you meet the requirements for Married persons who live apart 
                                   Yes        under Head of Household in the Instructions for Form 1040, or 
                                              Married Filing Separately under Filing Status in the Form 1040-NR 
                                              instructions?
                                                               No
                                                                                                                   No
                                              Are youa victim of domestic abuse or spousal abandonment?
                                                               Yes

            Yes        Was your household income at least 100% of the federal poverty 
                       line for your family size? (See the Form 8962 instructions.)
                                                               No
            At the time of enrollment, did the Marketplace estimate that your household income would be at least 
            100% of the federal poverty line for your family size for 2022?
                                                               Yes                           No                              Yes
         Yes
             Was APTC paid for 1 or more months during 2022?               No   Was everyone in your tax family a U.S. citizen?
                                                                                             No
You may be able to take the PTC.                                           Was at least one individual enrolled ina qualied    No
                                                                           health plan lawfully present in the United States?
                                                                                             Yes
                                                           Yes          Was at least one enrolled individual ineligible         No
                                                                        for Medicaid due to immigration status?

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Modified AGI. For purposes of the PTC, modified AGI by the due date of your tax return (not including exten-
is the AGI on your tax return plus certain income that is not sions). However, if you became eligible for APTC because
subject to tax (foreign earned income, tax-exempt inter- of a successful eligibility appeal and you retroactively en-
est, and the portion of social security benefits that is not rolled in the plan, the portion of the enrollment premium
taxable). Use Worksheet 1-1 and Worksheet 1-2 in the for which you are responsible must be paid on or before
Form 8962 instructions to determine your modified AGI. the 120th day following the date of the appeals decision.
Premiums another person pays on your behalf are treated
Taxpayer's tax return including income of a de-
as paid by you.
pendent child. A taxpayer who includes the gross in-
If your share of the enrollment premiums is not paid, the
come of a dependent child on the taxpayer’s tax return
issuer may terminate coverage. The termination is gener-
must include on Worksheet 1-2 the child’s tax-exempt in-
ally effective no sooner than the second month of nonpay-
terest and the portion of the child’s social security benefits
ment. For any months you were covered but did not pay
that is not taxable.
your share of the premiums, you are not allowed a
Coverage family. Your coverage family includes all indi- monthly credit amount.
viduals in your tax family who are enrolled in a qualified Applicable SLCSP premium. The applicable SLCSP
health plan and are not eligible for MEC (other than indi- premium is the second lowest cost silver plan premium of-
vidual market coverage). The individuals included in your fered through the Marketplace where you reside that ap-
coverage family may change from month to month. If an plies to your coverage family (described earlier). The
individual in your tax family is not enrolled in a qualified SLCSP premium is not the same as your enrollment pre-
health plan, or is enrolled in a qualified health plan but is mium unless you enroll in the applicable SLCSP. Form
eligible for MEC (other than individual market coverage), 1095-A, Part III, column B, generally reports the applica-
they are not part of your coverage family. Your PTC is ble SLCSP premium. If no APTC was paid for your cover-
available to help you pay only for the coverage of the indi- age, Form 1095-A, Part III, column B, may be wrong or
viduals included in your coverage family. blank or may report your applicable SLCSP premium
as -0-. Also, if you had a change in circumstances during
Monthly credit amount. The monthly credit amount is
2022 that you did not report to the Marketplace, the
the amount of your tax credit for a month. Your PTC for
SLCSP premium reported on Form 1095-A in Part III, col-
the year is the sum of all of your monthly credit amounts.
umn B, may be wrong. In either case, you must determine
Your credit amount for each month is the lesser of:
your correct applicable SLCSP premium. You do not have
• The enrollment premiums (described next) for the to request a corrected Form 1095-A from the Marketplace.
month for one or more qualified health plans in which See Missing or incorrect SLCSP premium on Form
you or any individual in your tax family enrolled, or 1095-A under Line 10 in the Form 8962 instructions.
• The amount of the monthly applicable SLCSP pre- Monthly contribution amount. Your monthly contri-
mium (described later) less your monthly contribution bution amount is used to calculate your monthly credit
amount (described later). amount. It is the amount of your household income you
To qualify for a monthly credit amount, at least one indi- would be responsible for paying as your share of premi-
vidual in your tax family must be enrolled in a qualified ums each month if you enrolled in the applicable SLCSP.
health plan on the first day of that month. Generally, if cov- It is not based on the amount of premiums you paid out of
erage in a qualified health plan began after the first day of pocket during the year. You will compute your monthly
the month, you are not allowed a monthly credit amount contribution amount in Part I of Form 8962.
for the coverage for that month. However, if an individual
Qualified health plan. For purposes of the PTC, a quali-
in your tax family enrolled in a qualified health plan in 2022
fied health plan is a health insurance plan or policy pur-
and the enrollment was effective on the date of the individ-
chased through a Marketplace at the bronze, silver, gold,
ual's birth, adoption, or placement for adoption or in foster
or platinum level. Throughout this publication, a qualified
care, or on the effective date of a court order placing the
health plan is also referred to as a “policy.” Catastrophic
individual with your family, the individual is treated as en-
health plans and stand-alone dental plans purchased
rolled as of the first day of that month. Therefore, the indi-
through the Marketplace, and all plans purchased through
vidual may be a member of your tax family and coverage
the Small Business Health Options Program (SHOP), are
family for the entire month for purposes of computing your
not qualified health plans for purposes of the PTC. There-
monthly credit amount.
fore, they do not qualify a taxpayer to take the PTC.
Enrollment premiums. The enrollment premiums are
the total amount of the premiums for the month, reduced Applicable taxpayer. You must be an applicable tax-
by any premium amounts for that month that were refun- payer to take the PTC. Generally, you are an applicable
ded, for one or more qualified health plans in which any in- taxpayer if your household income for 2022 (described
dividual in your tax family enrolled. Form 1095-A, Part III, earlier) is at least 100% of the federal poverty line for your
column A, reports the enrollment premiums. family size (provided in Tables 1-1, 1-2, and 1-3 in the
You are generally not allowed a monthly credit amount Form 8962 instructions) and no one can claim you as a
for the month if any part of the enrollment premiums for dependent for 2022. In addition, if you were married at the
which you are responsible that month has not been paid end of 2021, you must file a joint return to be an

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applicable  taxpayer  unless  you  meet  one  of  the  excep-        married but can take the PTC with the filing status of mar-
tions described under Married taxpayers, later.                      ried filing separately.
For individuals with household income below 100% of 
                                                                      Exception 1—Certain married persons living apart. 
the  federal  poverty  line,  see Household  income  below 
                                                                     You may file your return as if you are unmarried and take 
100% of the federal poverty line under  Line 5 in the Form 
                                                                     the PTC if one of the following applies to you.
8962 instructions. However, the exception described un-
der Estimated household income at least 100% of the fed-             • You file a separate return from your spouse on Form 
eral  poverty  line  in  the  Form  8962  instructions  does  not      1040 or 1040-SR because you meet the requirements 
apply if, with intentional or reckless disregard for the facts,        for Married persons who live apart under Head of 
you  provide  incorrect  information  to  the  Marketplace  for        Household in the Instructions for Form 1040.
the year of coverage. You provide information with inten-              You file as single on your Form 1040-NR because you 
                                                                     •
tional disregard for the facts if you know that the informa-           meet the requirements for Exception under Filing Sta-
tion provided is inaccurate. You provide information with a            tus in the Instructions for Form 1040-NR.
reckless disregard for the facts if you make little or no ef-
fort to determine whether the information provided is ac-             Exception 2—Victim of domestic abuse or spousal 
curate and your lack of effort to provide accurate informa-          abandonment.  If you are a victim of domestic abuse or 
tion  is  substantially  different  from  what  a  reasonable        spousal abandonment, you can file a return as married fil-
person would do under the circumstances.                             ing separately and take the PTC for 2022 if all of the fol-
                                                                     lowing apply to you.
Individuals who are incarcerated.       Individuals who are 
incarcerated  (other  than  pending  disposition  of  charges,       • You are living apart from your spouse at the time you 
for example, awaiting trial) are not eligible for coverage in          file your 2022 tax return.
a  qualified  health  plan  through  a  Marketplace.  However,       • You are unable to file a joint return because you are a 
these  individuals  may  be  applicable  taxpayers  and  take          victim of domestic abuse (described next) or spousal 
the PTC for the coverage of individuals in their tax families          abandonment (described below).
who are eligible for coverage in a qualified health plan.
                                                                     • You check the box on your Form 8962 to certify that 
Individuals who are not lawfully present.       Individuals            you are a victim of domestic abuse or spousal aban-
who are not lawfully present in the United States are not              donment.
eligible  for  coverage  in  a  qualified  health  plan  through  a  • You have not used this exception to take the PTC in 
Marketplace. They cannot take the PTC for their own cov-               each of 2019, 2020, and 2021.
erage and are not eligible for the repayment limitations in 
Table 5 (in the Form 8962 instructions) for APTC paid for             Domestic abuse.       Domestic abuse includes physical, 
their  own  coverage.  However,  these  individuals  may  be         psychological,  sexual,  or  emotional  abuse,  including  ef-
applicable taxpayers and take the PTC for the coverage of            forts to control, isolate, humiliate, and intimidate, or to un-
individuals in their tax families, such as their children, who       dermine  the  victim's  ability  to  reason  independently.  All 
are lawfully present and eligible for coverage in a qualified        the facts and circumstances are considered in determin-
health plan. For more information about who is treated as            ing whether an individual is abused, including the effects 
lawfully  present  for  this  purpose,  visit HealthCare.gov.        of alcohol or drug abuse by the victim’s spouse. Depend-
See Individuals Not Lawfully Present in the United States            ing on the facts and circumstances, abuse of an individu-
Enrolled  in  a  Qualified  Health  Plan,  later,  for  more  infor- al’s child or other family member living in the household 
mation  on  reconciling  APTC  when  an  unlawfully  present         may  constitute  abuse  of  the  individual.  If  you  have  con-
person is enrolled individually or with lawfully present fam-        cerns  about  your  safety,  please  consider  contacting  the 
ily members.                                                         confidential  24-hour  National  Domestic  Violence  Hotline 
                                                                     at 1-800-799-SAFE (7233), or 1-800-787-3224 (TTY), or 
Married  taxpayers. If  you  are  considered  married  for           1-855-812-1001 (video phone, only for deaf callers). For 
federal income tax purposes, you must file a joint return            additional information and resources, see Pub. 3865, Tax 
with your spouse to take the PTC unless one of the two               Information for Survivors of Domestic Abuse, available at 
exceptions below applies to you.                                     IRS.gov/Pub3865 and Part V of Form 8857, Request for 
You are not considered married for federal income tax                Innocent Spouse Relief, available at IRS.gov/Form8857.
purposes if you are divorced or legally separated accord-             Spousal  abandonment.      A  taxpayer  is  a  victim  of 
ing to your state law under a decree of divorce or separate          spousal abandonment for a tax year if, taking into account 
maintenance.  In  that  case,  you  cannot  file  a  joint  return   all facts and circumstances, the taxpayer is unable to lo-
but may be able to take the PTC on your separate return.             cate their spouse after reasonable diligence.
See Pub. 501, Dependents, Standard Deduction, and Fil-
ing Information.                                                      Records of domestic abuse and spousal abandon-
If  you  are  considered  married  for  federal  income  tax         ment. If you checked the box in the upper right corner of 
purposes, you may be eligible to take the PTC without fil-           Form 8962 indicating that you are eligible for the PTC de-
ing  a  joint  return  if  one  of  the  two  exceptions  below  ap- spite having a filing status of married filing separately, you 
plies to you. If Exception 1 applies, you can file a return          should keep records relating to your situation, like with all 
using  head  of  household  or  single  filing  status  and  take    aspects of your tax return. What you have available may 
the  PTC.  If  Exception  2  applies,  you  are  treated  as         depend on your circumstances. However, the following list 

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provides some examples of records that may be useful. For more information on what is MEC, see IRS.gov/
(Do not attach these records to your tax return.) Affordable-Care-Act/Individuals-and-Families/Individual-
Shared-Responsibility-Provision.
• Protective and/or restraining order.
• Police report. Note. Your MEC may be reported to you on Form
1095-A, Form 1095-B, or Form 1095-C.
• Doctor’s report or letter.
• A statement from someone who was aware of, or who MEC eligibility when Marketplace does not discon-
witnessed, the abuse or the results of the abuse. The tinue APTC. If an individual in your tax family is enrolled
statement should be notarized if possible. in a qualified health plan for which APTC was made and
the individual is or will soon become eligible for other
• A statement from someone who knows of the aban- MEC, you must notify the Marketplace about the other
donment. The statement should be notarized if possi- MEC and that the APTC for the individual’s coverage
ble. should be discontinued. If the Marketplace does not dis-
Married filing separately. If you file as married filing continue APTC for the first calendar month beginning after
separately and are not a victim of domestic abuse or the month you notify the Marketplace, the individual is
spousal abandonment (see Exception 2—Victim of do- treated as eligible for the other MEC no earlier than the
mestic abuse or spousal abandonment under Married tax- first day of the second calendar month beginning after the
payers, earlier), then you are not an applicable taxpayer first month the individual may enroll in the other MEC. A
and you cannot take the PTC. You must generally repay different rule applies to Medicaid and CHIP eligibility, dis-
all of the APTC paid for a qualified health plan that cov- cussed later under Government-Sponsored Programs.
ered only individuals in your tax family. If the policy also
covered at least one individual in your spouse’s tax family, Expatriate Health Plans
you must generally repay half of the APTC paid for the
policy. See Line 9 in the Form 8962 instructions. However, In general, an expatriate health plan is certain health in-
the amount of APTC you have to repay may be limited. surance coverage that is offered to foreign nationals who
See Line 28 in the Form 8962 instructions. are temporarily assigned for work in the United States,
U.S. residents who are temporarily working outside of the
United States, and certain nonemployees (such as stu-
dents and missionaries) who are traveling internationally.
Minimum Essential Coverage To qualify, the health insurance coverage must generally
offer a minimum level of benefits in the region in which the
(MEC) covered individual is temporarily located and be offered
by a qualifying expatriate health insurance issuer. An ex-
Under the health care law, certain health coverage is
patriate health plan is considered employer-sponsored
called MEC. You generally cannot take the PTC for an in-
coverage for a primary insured who receives it through
dividual in your tax family for any month that the individual
their employer (and for that employee’s covered depend-
is eligible for MEC, except for individual market coverage
ents). It is considered individual market coverage for any
(defined below). MEC includes the following.
other primary insured.
• Individual market coverage (including qualified health
plans).
Individual Market Coverage
• Most coverage through government-sponsored pro-
grams (including Medicaid coverage, Medicare Part A A health plan offered in the individual market is health in-
or C, the Children's Health Insurance Program (CHIP), surance coverage provided to an individual by a health in-
certain benefits for veterans and their families, TRI- surance issuer licensed by a state, including a qualified
CARE, and health coverage for Peace Corps volun- health plan offered through the Marketplace. Even though
teers). these plans are MEC, eligibility for individual market cov-
erage does not prevent an individual from qualifying for
• Most types of employer-sponsored coverage. the PTC for coverage in a qualified health plan purchased
• Grandfathered health plans. through the Marketplace.
• Other health coverage designated by the Department Individual market coverage also includes coverage un-
of Health and Human Services (HHS) as MEC. der certain expatriate health plans offered to students and
MEC does not include coverage consisting solely religious missionaries traveling internationally. See Expa-
TIP of excepted benefits. Excepted benefits include triate Health Plans, earlier.
vision and dental coverage not part of a compre-
hensive health insurance plan, workers’ compensation Government-Sponsored Programs
coverage, and coverage limited to a specified disease or
illness. The following government-sponsored programs are MEC.
1. Medicare Part A coverage.
2. Medicare Advantage plans.

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3. Medicaid, except for the following programs. In general, you cannot get the PTC for your coverage in
a qualified health plan if you are eligible for govern-
a. Optional coverage of family planning services.
ment-sponsored MEC. You are generally considered eligi-
b. Optional coverage of tuberculosis-related serv- ble for a government-sponsored program if you meet the
ices. criteria for coverage under the program. But see Excep-
tions, later. However, you will not lose the PTC for your
c. Coverage of pregnancy-related services in states
coverage until the first day of the first full month you can
that do not provide full Medicaid benefits on the
receive benefits under the government program. If you
basis of pregnancy.
can be covered under a government-sponsored program,
d. Coverage limited to the treatment of emergency you must complete the requirements necessary to receive
medical conditions. benefits (for example, submitting an application or provid-
ing required information) by the last day of the third full
e. Coverage of medically needy individuals (except calendar month following the event that establishes eligi-
for coverage for medically needy individuals that bility (for example, becoming eligible for Medicare when
HHS has designated as MEC—see Other Cover- you turn 65). If you do not complete the necessary re-
age Designated by the Department of Health and quirements in this time, you will lose the PTC for your cov-
Human Services, later). erage in a qualified health plan beginning with the first day
f. Coverage under a section 1115 demonstration of the fourth calendar month following the event that
waiver program (except for coverage under a sec- makes you eligible for the government coverage.
tion 1115 demonstration program that HHS has
designated as MEC—see Other Coverage Desig- Example 1. Ellen was enrolled in a qualified health
nated by the Department of Health and Human plan with APTC. She turned 65 on June 3 and became eli-
Services, later). gible for Medicare. Ellen must apply to Medicare to re-
ceive benefits. She applied to Medicare in September and
Call your state Medicaid office if you have any was eligible to receive Medicare benefits beginning on
questions about the coverage you have. December 1. Ellen completed the requirements necessary
4. The Children's Health Insurance Program (CHIP), ex- to receive Medicare benefits by September 30 (the last
cept certain CHIP coverage for pregnancy services. day of the third full calendar month after the event that es-
(Certain coverage often called a CHIP buy-in program tablished her eligibility, turning 65). She was eligible for
is not considered a government-sponsored program Medicare coverage on December 1, the first day of the
and is discussed later under Other Coverage Desig- first full month that she could receive benefits. Thus, Ellen
nated by the Department of Health and Human Serv- can get the PTC for her coverage in the qualified health
ices.) plan for January through November. Beginning in Decem-
ber, Ellen cannot get the PTC for her coverage in the
5. Coverage under the TRICARE program, except for qualified health plan because she is eligible for Medicare.
the following programs.
Example 2. The facts are the same as in Example 1,
a. Coverage on a space-available basis in a military except that Ellen did not apply for the Medicare coverage
treatment facility for individuals who are not eligi- by September 30. Ellen is considered eligible for govern-
ble for TRICARE coverage for private sector care. ment-sponsored coverage beginning on October 1. She
b. Coverage for a line-of-duty-related injury, illness, can get the PTC for her coverage for January through
or disease for individuals who have left active September. She cannot get the PTC for her coverage in a
duty. qualified health plan as of October 1, the first day of the
fourth month after she turned 65.
6. The following coverage administered by the Depart-
ment of Veterans Affairs. Exceptions. While you are generally considered eligible
for government-sponsored MEC (and are ineligible for the
a. Coverage consisting of the medical benefits pack-
PTC) if you are able to enroll in that coverage, you are
age for eligible veterans.
considered eligible for government-sponsored coverage
b. Civilian Health and Medical Program of the De- under the following programs only if you are enrolled in
partment of Veterans Affairs (CHAMPVA). the program.
c. Comprehensive health care for children suffering 1. A veteran’s health care program listed in (6), earlier.
from spina bifida who are the children of Vietnam
2. The following TRICARE programs.
veterans and veterans of covered service in Ko-
rea. a. The Continued Health Care Benefit Program.
7. Health coverage provided to Peace Corps volunteers. b. Retired Reserve.
8. Refugee Medical Assistance. c. Young Adult.
9. Coverage through a Basic Health Program (BHP) d. Reserve Select.
standard health plan.

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3. Medicaid coverage for comprehensive pregnancy-re- income will be 140% of the federal poverty line for her
lated services and CHIP coverage based on preg- family size for purposes of determining APTC. During the
nancy, if the individual is enrolled in a qualified health year, Catelyn lost her job and her household income for
plan at the time the individual becomes eligible for 2022 is 130% of the federal poverty line (within the Medic-
Medicaid or CHIP. aid income threshold). For purposes of the PTC, Catelyn
is treated as ineligible for Medicaid for 2022. Catelyn may
4. Coverage under Medicare Part A for which the indi-
be eligible for the PTC for the entire year.
vidual must pay a premium.
In addition, an individual is considered eligible for MEC Medicaid or CHIP eligibility when Marketplace does
under a Medicaid or Medicare program for which eligibility not discontinue APTC. If a determination is made that
requires a determination of disability, blindness, or illness an individual who is enrolled in a qualified health plan for
only when the responsible agency makes a favorable eli- which APTC is made is eligible for Medicaid or CHIP but
gibility determination. the Marketplace does not discontinue APTC for the first
calendar month beginning after the eligibility determina-
Retroactive coverage. If APTC is being paid for cover- tion, the individual is treated as eligible for Medicaid or
age in a qualified health plan and you become eligible for CHIP no earlier than the first day of the second calendar
government coverage that is effective retroactively (such month beginning after the eligibility determination.
as Medicaid or CHIP), you will not retroactively lose the
PTC for your coverage. You can get the PTC for your cov- Employer-Sponsored Plans
erage until the first day of the first calendar month after
you are approved for the government coverage. The following employer-sponsored plans are MEC.
Example. In November, Freda enrolled in a qualified 1. Group health insurance coverage for employees un-
health plan for the following year and got APTC for her der:
coverage. Freda lost her part-time job and on April 10 ap-
plied for coverage under the Medicaid program. Freda’s a. An insured plan or coverage offered in the small or
application was approved on May 15, with Medicaid cov- large group market within a state;
erage retroactively effective April 1. For purposes of the b. A governmental plan, such as the Federal Em-
PTC, Freda is considered eligible for government-spon- ployees Health Benefits Program; or
sored coverage on June 1, the first day of the first calen-
dar month after her application was approved. Freda may c. A grandfathered health plan offered in a group
be eligible for the PTC for January through May. market.
Termination for nonpayment of premiums. If Med- 2. A self-insured group health plan for employees.
icaid or CHIP coverage for you or a family member is ter- 3. Coverage under certain expatriate health plans for
minated due to nonpayment of premiums, you cannot get employees (discussed earlier).
the PTC for the coverage of that individual (for the remain-
der of the year of the termination). 4. The Nonappropriated Fund Health Benefits Program
of the Department of Defense.
Determining eligibility for Medicaid or CHIP at enroll-
In general, these employer-sponsored plans may also
ment. An individual is treated as ineligible for Medicaid,
include retiree or COBRA coverage.
CHIP, and similar programs (such as a BHP) for the pe-
riod of coverage under a qualified health plan if, when the Employer-sponsored plans that are MEC are also refer-
individual enrolled in the qualified health plan, the Market- red to as “eligible employer-sponsored plans.”
place determined that the individual was ineligible for
Medicaid or CHIP based on the applicable Medicaid and Exceptions. The following paragraphs discuss when em-
CHIP income standards. However, this exception does ployer-sponsored plans are not considered MEC and the
not apply if you, or the individual you are including in your circumstances in which you may be eligible for the PTC
tax family, with intentional or reckless disregard for the even if you have an offer of coverage under an em-
facts, provided incorrect information to the Marketplace ployer-sponsored plan.
for the year of coverage. You provide information with in- Excepted benefits. Employer-sponsored health cov-
tentional disregard for the facts if you know that the infor- erage that is limited to excepted benefits is not MEC. Ex-
mation provided is inaccurate. You provide information cepted benefits include stand-alone vision and dental
with a reckless disregard for the facts if you make little or plans, workers' compensation coverage, and coverage
no effort to determine whether the information provided is limited to a specified disease or illness.
accurate and your lack of effort to provide accurate infor-
mation is substantially different from what a reasonable Affordability and minimum value. Even if you had
person would do under the circumstances. the opportunity to enroll in coverage offered by your em-
ployer that qualifies as MEC, you are considered eligible
Example. In November, Catelyn enrolled in a qualified for an employer-sponsored plan (and cannot get the PTC
health plan for the following year and got APTC for her for your coverage in a qualified health plan) only if the em-
coverage. The Marketplace determined that Catelyn was ployer-sponsored coverage is affordable (defined later)
ineligible for Medicaid and estimated that her household and the coverage provides minimum value (defined later).

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Your tax family members may also be unable to get the               the time of enrollment, later, for more information on this 
PTC  for  coverage  in  a  qualified  health  plan  for  months     rule.
they were eligible to enroll in employer-sponsored cover-
                                                                    Certain employer arrangements.    An employee’s re-
age offered to them by your employer but only if the cover-
                                                                    quired contribution for employer-sponsored coverage may 
age  qualifies  as  MEC  and  was  affordable  and  provided 
                                                                    be affected by various arrangements offered by the em-
minimum  value  for  you.  In  addition,  if  you  or  your  family 
                                                                    ployer.
member enrolls in the employer coverage that qualifies as 
MEC, the individual enrolled cannot get the PTC for cover-          Wellness  program  incentives.    If  the  employer  that 
age in a qualified health plan, even if the employer cover-         offered you (or your spouse) employer-sponsored cover-
age is not affordable or does not provide minimum value.            age for 2022 also offered a wellness incentive that poten-
                                                                    tially affected the amount that you had to pay toward cov-
Waiting periods and other periods without access 
                                                                    erage,  the  following  rules  apply:  If  the  condition  for 
to benefits. You are not considered eligible for employer 
                                                                    satisfying the wellness incentive (in other words, the con-
coverage,  and  can  get  the  PTC  for  your  coverage  in  a 
                                                                    dition the employee must meet to pay the smaller amount 
qualified  health  plan  if  you  are  otherwise  eligible,  for  a 
                                                                    for coverage) relates exclusively to tobacco use, your re-
month  when  you  cannot  receive  benefits  under  the  em-
                                                                    quired  contribution  is  based  on  the  amount  you  would 
ployer coverage (for example, you are in a waiting period 
                                                                    have paid for coverage if you had satisfied the condition 
before the employer coverage becomes effective). How-
                                                                    for the wellness incentive. Wellness incentives relating ex-
ever, if you could have enrolled in employer coverage that 
                                                                    clusively to tobacco use are treated as satisfied in deter-
is  MEC  and  is  affordable  and  provides  minimum  value 
                                                                    mining  your  required  contribution  regardless  of  whether 
and  you  did  not  enroll  during  an  enrollment  period,  you 
                                                                    you would have actually earned the incentive had you en-
cannot get the PTC for your coverage in a qualified health 
                                                                    rolled  in  the  coverage.  If  factors  other  than  tobacco  use 
plan for the remainder of the plan year to which the enroll-
                                                                    are part of the condition for satisfying the wellness incen-
ment  period  related.  If  the  enrollment  period  related  to 
                                                                    tive,  your  required  contribution  is  based  on  the  amount 
coverage  for  more  than  one  plan  year,  and  you  do  not 
                                                                    you  would  have  paid  for  coverage  had  you  not  satisfied 
have another opportunity to enroll in the employer cover-
                                                                    the wellness incentive.
age for plan years following the initial plan year, you can 
take the PTC for your coverage in a qualified health plan           Example. George  can  enroll  in  employer  coverage. 
during those later plan years, if you are otherwise eligible.       George’s  monthly  premiums  for  self-only  coverage  are 
                                                                    $450. If George, who is a smoker, attends a smoking ces-
Coverage  after  employment  ends. If  your  employ-
                                                                    sation  class,  his  monthly  premiums  will  be  reduced  by 
ment with an employer ends and you are offered employer 
                                                                    $100.  If  George  completes  a  cholesterol  screening,  his 
coverage by your former employer (for example, COBRA 
                                                                    monthly premiums will be reduced by $50. Whether or not 
or  retiree  coverage),  you  are  considered  eligible  for  that 
                                                                    George  actually  completes  either  of  these  wellness  pro-
employer coverage for PTC purposes only for the months 
                                                                    gram incentives, for purposes of determining whether the 
that you are enrolled in the employer coverage. This same 
                                                                    coverage is affordable for George, his required contribu-
rule applies to an individual who may enroll in the cover-
                                                                    tion will be considered to be the amount reduced by the 
age by reason of a relationship to a former employee.
                                                                    $100  incentive  for  attending  a  smoking  cessation  class 
Individual not in your tax family. An individual who                but not reduced by the $50 incentive for completing a cho-
can enroll in your employer coverage who is not a mem-              lesterol screening. Therefore, for purposes of determining 
ber of your tax family (for example, an adult non-depend-           whether his coverage is considered affordable, George’s 
ent child under age 26) is considered eligible for the em-          required contribution is $350.
ployer coverage for PTC purposes only for the months the 
                                                                    Health reimbursement arrangements (HRAs).            If the 
individual is enrolled in the employer coverage.
                                                                    employer that offered you employer-sponsored coverage 
How to determine if the plan is affordable.     Your em-            for 2022 also contributed (or offered to contribute) to an 
ployer coverage is generally considered affordable for you          HRA  that  may  be  used  to  pay  premiums  for  the  em-
and for a family member if your share of the annual cost            ployer-sponsored coverage, your required contribution for 
for self-only coverage, which is sometimes referred to as           the  employer-sponsored  coverage  is  reduced  by  the 
the  “employee  required  contribution,”  is  not  more  than       amount the employer contributed (or offered to contribute) 
9.61% of your tax family’s household income for 2022. For           to the HRA for 2022, as long as you were informed of the 
2023, this threshold will decrease to 9.12%. Self-only cov-         HRA  contribution  offer  by  a  reasonable  time  before  you 
erage  is  used  for  this  calculation  even  if  you  have  a     had to decide whether to enroll in the coverage. Employ-
spouse or dependents and therefore would enroll in cov-             ers may offer you alternative or additional HRA coverage. 
erage  that  is  not  self-only  coverage  (for  example,  family   See Individual coverage HRAs next.
coverage).  However,  employer-sponsored  coverage  is              Individual coverage HRAs.     Starting in 2020, employ-
not considered affordable if, when you or a family member           ers can offer individual coverage HRAs to help employees 
enrolled in a qualified health plan, you gave accurate in-          and their families with their medical expenses. Under an 
formation  about  the  availability  of  employer  coverage  to     individual coverage HRA, employers can reimburse eligi-
the  Marketplace,  and  the  Marketplace  determined  that          ble employees for medical expenses, including premiums 
you were eligible for APTC for the individual’s coverage in         for Marketplace health insurance.
the qualified health plan. See Determining affordability at 

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If you were covered under an individual coverage HRA employer using the contact number provided on the Form
for 2022, you are not allowed a PTC for your 2022 Market- 1095-C.
place health insurance. Also, if another member of your
tax family was covered under an individual coverage HRA Determining affordability at the time of enrollment.
for 2022, you are not allowed a PTC for the family mem- Your employer coverage is not considered affordable if,
ber's 2022 Marketplace health insurance. If you or a family when you enroll in a qualified health plan, the Marketplace
member could have been covered by an individual cover- determines that your required contribution for employer
age HRA for 2022, but you opted out of receiving reim- coverage will be more than 9.61% of what the Market-
bursements under the individual coverage HRA, you may place estimates will be your household income and there-
be allowed a PTC for your, and your family member's, fore that you are eligible for APTC for coverage in the
Marketplace health insurance if the individual coverage qualified health plan. Eligibility for employer coverage in
HRA is considered unaffordable. this situation does not disqualify you from taking the PTC
when you file your tax return, even if your required contri-
Qualified small employer health reimbursement
bution for coverage was not more than 9.61% of the
arrangements (QSEHRAs). If your employer provided
household income on your return. However, you will be
you with a QSEHRA, special rules apply. See Qualified
treated as eligible for affordable employer coverage
Small Employer Health Reimbursement Arrangement,
based on the household income on your tax return if:
later, for more details.
• You did not provide current information to the Market-
Health flex contributions. If the employer that of- place relating to your household income and the re-
fered you (or your spouse) employer-sponsored coverage quired contribution for your employer coverage during
for 2022 also made (or offered to make) a health flex con- each annual re-enrollment period, or
tribution for 2022, your required contribution for the em-
ployer-sponsored coverage is reduced by the amount of • You provided incorrect information to the Marketplace
the health flex contribution (or offer). A health flex contri- about your required contribution with intentional or
bution is an employer contribution to a cafeteria plan that reckless disregard for the facts.
may be used only to pay for medical care (and not taken You provide information with intentional disregard for
as cash or other taxable benefits) and is available for use the facts if you know that the information provided is inac-
toward the purchase of MEC. Cafeteria plan contributions curate. You provide information with a reckless disregard
that may be used for expenses other than medical care for the facts if you make little or no effort to determine
are not health flex contributions and so do not reduce your whether the information provided is accurate and your
required contribution. lack of effort to provide accurate information is substan-
Opt-out payments. If the employer that offered you tially different from what a reasonable person would do
(or your spouse) employer-sponsored coverage for 2022 under the circumstances.

offered you an additional payment if you declined to enroll The employer coverage offered by the various employ-
in the coverage (an “opt-out payment”), your required con- ers in the following examples qualifies as MEC.
tribution for employer-sponsored coverage is increased
by amounts that the employer offered to pay you for de- Example 1. Celia is single and has no dependents.
clining the coverage. In some cases, an employer may Her household income for 2022 was $47,000. Celia’s em-
make this opt-out payment only if the employee both de- ployer offered its employees a health insurance plan that
clines the coverage and also satisfies another condition provided minimum value and for which the required contri-
(such as enrolling in coverage offered by the employee's bution was $3,450 for self-only coverage for 2022 (7.34%
spouse). If your employer imposed other conditions on re- of Celia’s household income). Because Celia’s required
ceiving the opt-out payment (in addition to declining the contribution for self-only coverage did not exceed 9.61%
employer's health coverage), you may treat the opt-out of household income, her employer’s plan is considered
payment as increasing the employee's required contribu- affordable for Celia, and Celia is considered eligible for
tion only if you can demonstrate that you met the condi- the employer coverage for all months in 2022. Celia can-
tions (such as enrolling in coverage offered by your spou- not get the PTC for coverage in a qualified health plan.
se's employer).
Example 2. The facts are the same as in Example 1,
More information about employer arrangements. except that Celia is married to Jon and the employer’s
You should contact your employer if you have questions plan required Celia to contribute $5,300 for coverage for
about the effect of the employer arrangements described Celia and Jon for 2022 (11.28% of Celia’s household in-
above on your required contribution. come). Because Celia’s required contribution for self-only
coverage ($3,450) does not exceed 9.61% of household
If your employer or the employer of a family mem-
income, her employer’s plan is considered affordable for
! ber offered MEC providing minimum value and Celia and Jon. Both Celia and Jon are considered eligible
CAUTION provided you a Form 1095-C and the employer
for the employer coverage for all months in 2022 and can-
also offered a non-health flex contribution or an opt-out
not get the PTC for coverage in a qualified health plan.
payment, the amount reported on line 15 of Form 1095-C
may not accurately reflect the amount of your required Example 3. Don was eligible to enroll in employer cov-
contribution for purposes of the PTC. If you have ques- erage in 2022. Don’s required contribution for self-only
tions about the amount reported on line 15, contact your coverage that provided minimum value was $3,700. Don

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applied for coverage in a qualified health plan through the Example. Elvis was enrolled in a qualified health plan
Marketplace. The Marketplace projected that Don’s 2022 without APTC beginning in January 2022. He began work-
household income would be $37,000 and determined that ing for a new employer in May that offers health insurance
Don’s employer coverage was unaffordable because coverage with a calendar year plan year. Elvis’ required
Don’s required contribution was more than 9.61% of contribution for the employer coverage for the remainder
Don’s household income. Don enrolled in a qualified of the year was $200/month, which would be $2,400 for
health plan through the Marketplace with APTC and not in the full plan year. Elvis does not enroll in the employer
the employer coverage. In December, Don received an coverage or inform the Marketplace of the offer of em-
unexpected $2,500 bonus, which increased his 2022 ployer coverage. Elvis’ household income for the year is
household income to $39,500. Although Don’s required $20,000. Elvis’ employer coverage is considered unaf-
contribution for the employer coverage was not more than fordable for the period May through December because
9.61% of the household income on Don’s tax return, Don his required contribution for the full plan year, $2,400, is
is considered not eligible for the employer coverage for more than 9.61% of his household income. As a result, El-
2022 because the Marketplace estimated that the em- vis could take the PTC for May through December if he
ployer coverage would cost more than 9.61% of Don’s otherwise qualifies.
household income. Don can get the PTC if he otherwise
Coverage year not a calendar year. If your employ-
qualifies.
er’s plan year is not the calendar year and you are a cal-
Example 4. Hal was eligible for employer coverage for endar year taxpayer, you determine whether your cover-
2022. His required contribution for self-only coverage was age is affordable by looking separately at the portion of
$3,400, and Hal enrolled in the coverage. His household the calendar year in each plan year. A coverage period in
income for 2022 was $33,000, which means that his re- 2022 that falls in a plan year beginning in 2021 is consid-
quired contribution was more than 9.61% of his household ered affordable if your required contribution for the entire
income. Even though the employer coverage was not af- plan year is not more than 9.61% of your household in-
fordable, Hal cannot get the PTC for coverage in a quali- come for 2022. A coverage period in 2022 that falls in a
fied health plan because he enrolled in the employer cov- plan year beginning in 2022 is considered affordable if
erage. your required contribution for the entire plan year is not
more than 9.61% of your household income for 2022.
Example 5. Elsa is married and has two dependent
children. Her household income for 2022 was $39,000. El- The employer coverage offered by the various employ-
sa’s employer offered only self-only coverage to employ- ers in the following examples qualifies as MEC.
ees. No family coverage was offered. The plan had a re-
quired contribution of $3,000 for self-only coverage for Example 1. Tim’s employer offers health insurance
2022 (7.69% of Elsa’s household income) and provided coverage with a plan year of July 1 through June 30. His
minimum value. Because Elsa’s required contribution for required contribution for the plan year that began on July
self-only coverage was not more than 9.61% of household 1, 2021, was $250 per month ($3,000 for the entire plan
income, her employer’s plan is considered affordable for year). Tim enrolled in a qualified health plan on January 1,
Elsa. Thus, Elsa is considered eligible for the employer 2022, and did not apply for APTC. Tim’s household in-
coverage for 2022 and cannot get the PTC for coverage in come for 2022 is $30,000. Tim’s required contribution for
a qualified health plan. However, because Elsa’s em- the plan year, $3,000, is 10% of his household income for
ployer did not offer coverage to Elsa’s spouse and chil- 2022. Because 10% is more than 9.61% (the required
dren, Elsa could take the PTC for her spouse and two chil- contribution percentage for the plan year beginning in
dren if they enrolled in a qualified health plan and 2021), Tim’s employer coverage for January 1, 2022,
otherwise qualify. through June 30, 2022, is not considered affordable, and
Tim can take the PTC for those months if he is otherwise
Example 6. The facts are the same as in Example 5, eligible.
except that Elsa’s employer also offers coverage to Elsa’s For the plan year that began on July 1, 2022, Tim’s re-
spouse and children. The premiums for family coverage quired contribution was reduced to $200 per month (or
cost $6,900 (17.69% of Elsa’s household income). Be- $2,400 for the entire plan year). Tim’s required contribu-
cause the required contribution for self-only coverage was tion of $2,400 is 8% of his 2022 household income. Be-
not more than 9.61% of Elsa’s household income, the em- cause 8% is not more than 9.61% (the required contribu-
ployer coverage is considered affordable for Elsa and her tion percentage for the plan year beginning in 2022), Tim’s
family. Elsa cannot take the PTC for anyone in her family. employer coverage for July 1, 2022, through December
Determining affordability for part-year period. If 31, 2022, is considered affordable and he is not eligible
you are employed for part of a year or employed by differ- for the PTC for those months.
ent employers during the year, you determine whether Example 2. Maria’s employer offers health insurance
your coverage is affordable by looking separately at each coverage with a plan year of September 1 through August
coverage period that is less than a full calendar year. For 31. Maria’s required contribution for the employer cover-
each period, the coverage is affordable if your required age for the plan year September 1, 2022, through August
contribution for the entire year would not be more than 31, 2023, is $3,700. Maria’s household income for 2022 is
9.61% of your household income for the year. $37,000. Maria’s employer coverage is considered unaf-
fordable for the period September 1 through December

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31, 2022, because her required contribution for the plan 4. The arrangement is generally provided on the same
year, $3,700, is more than 9.61% of her 2022 household terms to all eligible employees. However, the employ-
income. If Maria enrolls in a qualified health plan for 2023 er's QSEHRA may exclude employees who haven't
and requests APTC, the Marketplace will determine completed 90 days of service, employees who
whether the employer coverage is considered affordable haven't attained age 25 before the beginning of the
for the period January 1, 2023, through August 31, 2023, plan year, part time or seasonal employees, employ-‐
by comparing Maria’s required contribution for the plan ees covered by a collective bargaining agreement if
year beginning in 2022, $3,700, to her estimated 2023 health benefits were the subject of good-faith bargain-
household income. ing, and employees who are nonresident aliens with
no earned income from sources within the United
How to determine if a plan provides minimum value. States.
An employer-sponsored plan provides minimum value
only if the plan pays at least 60% of the total allowed costs If you are provided a QSEHRA, and it is considered af-
of benefits for a standard population and provides sub- fordable coverage for a month, no PTC is allowed for that
stantial coverage of inpatient hospitalization services and month. If the QSEHRA is not considered affordable cover-
physician services. A plan meets the 60% rule only if an age for 1 or more months, you may still be eligible for the
employee’s expected cost-sharing (deductibles, co-pays, PTC. If you are eligible for the PTC for any month for
and co-insurance) under the plan is no more than 40% of which you are provided a QSEHRA, you must reduce your
the cost of the benefits. This percentage is based on ac- PTC (but not below -0-) for that month by the monthly
tuarial principles using benefits provided to a standard QSEHRA permitted benefit amount. The monthly permit-
population and is not based on what you actually pay for ted benefit amount is the maximum QSEHRA benefit
cost sharing. amount an eligible employee is allowed per month. See
Your employer must provide you with a summary of Permitted benefit reported on Form W-2, later, and Work-
benefits and coverage (SBC) on or before the first day of sheet Q for more information.
the open enrollment period for the plan you are enrolled in
Written notice of QSEHRA. If you were provided a
for the current coverage period. The employer must also
QSEHRA during 2022, your employer should have provi-
provide you with SBCs you request for other plans in
ded written notice to you by the later of October 3, 2021,
which you can enroll. If you are not enrolled in a plan, the
or 90 days before the first day of the plan year of the
employer must provide you with the SBCs for all plans in
QSEHRA, or if you're an employee who is not eligible to
which you can enroll. The SBC will tell you whether an
participate at the beginning of the year, the date on which
employer-sponsored plan provides minimum value. If your
you're first eligible to participate in the QSEHRA. The in-
employer sent you a Form 1095-C, line 14 of that form will
formation in this notice is necessary to determine how the
include an indicator code telling you if your employer of-
QSEHRA affects your PTC. The permitted benefit for
fered you a health plan in the previous year that provided
self-only coverage as reported by the employer in the
minimum value.
written notice is used to determine whether the QSEHRA
is considered affordable coverage, regardless of whether
Qualified Small Employer Health the permitted benefit provided to you is for self-only or
Reimbursement Arrangement family coverage. If the notice provided to you does not in-
clude a permitted benefit amount for self-only coverage,
(QSEHRA)
you must contact your employer to get that information.
Use Worksheet N to determine whether your QSEHRA is
Under a QSEHRA, an eligible employer can reimburse eli-
considered affordable coverage for the months of the year
gible employees for medical expenses, including premi-
that you were provided the QSEHRA. You will need the
ums for a qualified health plan purchased through the
notice provided by your employer and the permitted bene-
Marketplace. An eligible employer is one that, in general,
fit for self-only coverage to complete Worksheet N.
employs fewer than 50 full-time employees and does not
offer a group health plan. Permitted benefit reported on Form W-2. Your em-
ployer should have reported your annual permitted benefit
A QSEHRA is an arrangement that meets all the follow-
(self-only or family amount, as applicable) in box 12 of
ing requirements.
your Form W-2 with code FF. Your permitted benefit
1. The arrangement is funded solely by the employer, amount, as reported to you by your employer on Form
and no salary reduction contributions may be made W-2, is used to calculate the amount by which you must
under the arrangement. reduce your PTC, if you are otherwise eligible for the PTC.
Use Worksheet Q to figure your monthly PTC for months
2. The arrangement provides, after the eligible em-
in which you were provided a QSEHRA.
ployee provides proof of coverage, for the payment or
reimbursement of the medical expenses incurred by APTC for 2022 and 2023. If APTC was paid for your
the employee or the employee's family members. 2022 Marketplace coverage, your QSEHRA permitted
3. The amount of payments and reimbursements benefit for 2022 was not considered by the Marketplace in
doesn’t exceed $5,450 ($11,050 for family coverage) calculating the amount of your 2022 APTC. Furthermore,
for 2022. if you requested APTC for your 2023 Marketplace

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coverage,  the  Marketplace  did  not  consider  your  2023 
permitted benefit in calculating the amount of your 2023 
APTC.  If  you  are  provided  a  QSEHRA  for  2023,  you 
should contact the Marketplace and ask the Marketplace 
to reduce the amount of APTC to be paid on your behalf 
for 2023 to limit the risk of having excess APTC for 2023.

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Worksheet N. Worksheet To Determine if the QSEHRA Is 
Considered Affordable                                                                Keep for Your Records
Note. See Special instructions for Worksheet N if your SLCSP premium was not the same for all months of 2022 or you 
changed employers during 2022.
1. Enter the amount from Form 8962, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                  1.  
2. Multiply line 1 by 0.0961 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        2.  
3. Enter the number of months you were provided the QSEHRA in 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                      3.  
4. Divide line 2 by 12.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      4.  
5. If you enrolled in a qualified health plan, enter the monthly premium you would pay for self-only coverage under 
    the second lowest cost silver plan (SLCSP) offered by the Marketplace where you enrolled in coverage. If you did 
    not enroll in a qualified health plan, enter the monthly premium that the oldest member of your coverage family 
    who is enrolled in a qualified health plan would pay for self-only coverage under the SLCSP offered by the 
    Marketplace where that family member enrolled. See Applicable SLCSP premium tools, later, to learn how to 
    retrieve the applicable SLCSP premium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                   5.  
6. Enter the self only coverage permitted benefit from the written notice provided by your employer. If you were ‐
    provided the QSEHRA for less than 12 months in 2022, see Part year coverage‐ , later, for what amount to enter 
    on line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.  
7. Divide line 6 by line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      7.  
8. Subtract line 7 from line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        8.  
9. Compare lines 4 and 8.
     • If line 4 is less than line 8, the QSEHRA is not considered affordable. Stop here. Complete Worksheet Q.
     • If line 4 is greater than or equal to line 8, the QSEHRA is considered affordable. Skip Worksheet Q. Stop 
       here and do not file Form 8962 if you were provided a QSEHRA for every month you were covered by a 
       qualified health plan and no APTC was paid for you or another individual in your tax family. Otherwise, enter 
       "QSEHRA" in the top margin of Form 8962. If you are completing Form 8962, lines 12 through 23, stop here 
       and enter -0- on lines 12 through 23, column (e), for each month you were provided the QSEHRA. If you are 
       completing Form 8962, line 11, and you were provided the QSEHRA for all of 2022, stop here and enter -0- 
       on line 11, column (e). If you were not provided the QSEHRA for all of 2022, complete lines 10 through 13 
       below.
10. Enter the smaller of Form 8962, line 11, column (a) or (d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        10.  
11. Divide line 10 by 12.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      11.  
12. Multiply line 11 by line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      12.  
13. Subtract line 12 from line 10. Enter the result here and on Form 8962, line 11, column (e) . . . . . . . . . . . . . . . . . .                                      13.  

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Special instructions for Worksheet N if you did not Enter the smaller of the 2 amounts on each line in column
have the same SLCSP for all months of 2022 or A for the months you were provided a QSEHRA.
changed employers during 2022. You must complete
a separate worksheet through line 8 for each part of the Column B. The amount you enter in column B depends
year in which you had a different SLCSP premium for on whether the QSEHRA is considered affordable cover-
self-only coverage while provided a QSEHRA, or you age for the month. For the months the QSEHRA is consid-
were provided a QSEHRA from different employers with ered affordable coverage, enter in column B the amount
different self-only permitted benefits. For example, Bob you entered in column A. For the months the QSEHRA is
was employed for all of 2022 by an employer that provides not considered affordable coverage, complete column B
a QSEHRA to its employees. Bob changed Marketplace as follows.
policies in May of 2022 because of a change in residence. • If you completed Part I, enter the amount from line 3
As a result, Bob’s SLCSP premium for self-only coverage on the lines for the months you completed column A.
was different for the period January through May than for
the period June through December. To determine the af- • If you skipped Part I, enter the monthly permitted ben-
fordability of the QSEHRA provided to Bob, Bob must efit amount (the amount from box 12, code FF, of
complete a separate Worksheet N for the period January Form W-2, divided by the number of months you were
through May and the period June through December. provided the QSEHRA) on the lines for the months
Once you have completed the separate worksheets you completed column A.
through line 8, read the following. To determine whether the QSEHRA is considered af-
fordable coverage for any month, see Worksheet N.
• If the Worksheets N show that the QSEHRA is unaf-
fordable for at least 1 month (line 4 is less than line 8 Self-only permitted benefit for some months and
on at least one of the worksheets), skip lines 9 through family permitted benefit for others. Your permitted
13 and complete Worksheet Q. benefit is reported in box 12 of Form W-2 using code FF.
• If the Worksheets N show that the QSEHRA is afford- However, if you received a self-only permitted benefit for
able for all months of 2022 (line 4 is greater than or part of the year and a family permitted benefit for another
equal to line 8 in all the worksheets), follow the in- part of the year, the amount reported on your Form W-2
structions on line 9 of the worksheet relating to “If reflects that change. For purposes of this worksheet, di-
line 4 is greater than or equal to line 8.” Complete lines vide the self-only permitted benefit as described in the
10 through 13 if you are instructed to do so. written notice from your employer by 12.0 to determine
your column B monthly permitted benefit for the months in
Part year coverage—Instruction for line 6. ‐ If you were which you were provided a permitted benefit for self-only
provided a QSEHRA for less than 12 months in 2022, the coverage. Divide the family permitted benefit as described
written notice your employer sent to you may have provi- in the written notice from your employer by 12.0 to deter-
ded the self-only coverage permitted benefit for only the mine your column B monthly permitted benefit for the
months you were provided the QSEHRA or the self-only months in which you were provided a permitted benefit for
coverage permitted benefit for the entire year (if the notice family coverage. If you were provided the QSEHRA for
provided to you does not include a permitted benefit less than 12 months in 2022, see Part year coverage for ‐
amount for self-only coverage, you must contact your em- taxpayers with changes in permitted benefits next for what
ployer to get that information). If the notice provided the amount to enter on line 6 of Worksheet N.
permitted benefit amount just for the months you were Part year coverage for taxpayers with changes in ‐
provided the QSEHRA, then enter that amount on line 6. If permitted benefits. If you received a self-only permitted
the notice provided the self-only coverage permitted ben- benefit for part of the year and a family permitted benefit
efit for the entire year, figure the amount to enter on line 6 for another part of the year and you were provided a
as follows. QSEHRA for less than 12 months in 2022, you should
1. Divide the self only coverage permitted benefit for the ‐ consult the written notice your employer sent to you to de-
entire year by 12.0. termine the amount to put in column B. The notice your
employer sent to you may have included the permitted
2. Multiply the result by the number of months you were benefit for only the months you were provided the
provided the QSEHRA. QSEHRA or the permitted benefit for the entire year. If the
notice provided the permitted benefit for the entire year,
Instructions for Worksheet Q, Part III divide the self-only coverage permitted benefit for the en-
tire year by 12.0 and enter that amount in column B for the
Column A. If you completed Form 8962, lines 12 through months you received a self-only permitted benefit. Then,
23, enter the smaller of column (a) or (d) on the lines in divide the family coverage permitted benefit for the entire
Part III for the months you were provided a QSEHRA. If year by 12.0 and enter that amount in column B for the
you completed Form 8962, line 11, and were instructed to months you received a family permitted benefit. If the no-
complete Part III in the second bullet under Before you be- tice provided the permitted benefit for only the months you
gin, divide the amount on line 11, column (a), by 12.0. were provided the QSEHRA, divide that amount by the
Then, divide the amount on line 11, column (d), by 12.0.

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Worksheet Q. Worksheet To Figure Monthly Credit Amount 
if You Have a QSEHRA                                                                                     Keep for Your Records
Before you begin:
 •  See Worksheet N to determine whether the QSEHRA is considered affordable coverage for any month. If the QSEHRA is considered 
    affordable coverage for some months but not others, see the instructions for column B below for the amount you enter in column B for the 
    affordable months. 
 •  If the monthly permitted benefit was the same for each month you were provided the QSEHRA and the QSEHRA was not considered 
    affordable for all of those months, go to Part I. If the monthly permitted benefit was not the same for each month you were provided the 
    QSEHRA or the QSEHRA was considered affordable for some but not all the months it was provided, go to Part III. Skip Parts I and II.
 
Caution. If you received a self only permitted benefit for part of the year and a family permitted benefit for another part of the year, you must ‐
complete Part III even though the amount reported on your Form W 2 reflects this change.‐
Part I: Monthly Permitted Benefit
 1. Enter the amount from box 12, code FF, of Form W 2, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .‐                    1.   
 2. Enter the number of months you were provided the QSEHRA in 2022      . . . . . . . . . . . . . . . . . . . . . . . . .                            2.   
 3. Divide line 1 by line 2. Then, do one of the following . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                3.   
    •    If you are completing Form 8962, line 11, go to Part II below.
    •    If you are completing Form 8962, lines 12 through 23, go to Part III below. Skip Part II.
Part II: Annual Calculation
 4. Enter the smaller of Form 8962, line 11, column (a) or (d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                    4.   
 5. Divide line 4 by 12.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.   
 6. Enter the smaller of line 3 or line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .       6.   
 7. Multiply line 6 by line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.   
 8. Subtract line 7 from line 4. Enter the result here and on Form 8962, line 11, column (e). Enter “QSEHRA” 
    in the top margin of Form 8962. Skip Part III below    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              8.   
    Note. If the result is  0  and the amount you will enter on line 11, column (f), is also  0 , stop here. Do not ‐ ‐ ‐ ‐
    file Form 8962.
Part III: Monthly Calculation
    Month            A. Tentative monthly premium tax credit           B. Monthly permitted benefit (see                                              C. Subtract col. B from col. A. If less 
                             (see instructions)                             instructions)                                                                  than zero, enter  0 .‐ ‐
 9. January
10. February
11. March
12. April
13. May
14. June
15. July
16. August
17. September
18. October
19. November
20. December
21. If you are completing Form 8962, lines 12 through 23, stop here and enter the amounts from column C in 
    column (e) for the months you completed column A. Enter “QSEHRA” in the top margin of Form 8962.
    Note. If all entries in columns (e) and (f) are  0  or blank, do not file Form 8962.‐ ‐
22. If you are completing Form 8962, line 11, add the amounts in column C above and enter the result here. If 
    line 22 is  0  and no APTC was paid for you or another individual in your tax family, stop here and do not ‐ ‐
    file Form 8962. Otherwise, do one of the following . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                22.  
    •    If you were provided the QSEHRA for all of 2022, stop here and also enter the result on Form 8962, 
         line 11, column (e). Enter “QSEHRA” in the top margin of Form 8962.
    •    If you were not provided the QSEHRA for all of 2022, complete lines 23 through 27 below to figure 
         the amount to enter on Form 8962, line 11, column (e).
23. Enter the smaller of Form 8962, line 11, column (a) or (d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                    23.  
24. Divide line 23 by 12.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  24.  
25. Multiply line 24 by the number of months you were provided the QSEHRA in 2022 . . . . . . . . . . . . . . . .                                     25.  
26. Subtract line 25 from line 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     26.  
27. Add lines 22 and 26. Enter the result here and on Form 8962, line 11, column (e). Enter “QSEHRA” in the 
    top margin of Form 8962 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .       27.  

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number of months you were provided that permitted bene-
fit under the QSEHRA and enter the amount in column B
for the appropriate months. Individuals Not Lawfully

Present in the United States
Grandfathered Health Plan
Enrolled in a Qualified Health
A grandfathered health plan means any group health plan,
group health insurance coverage, or individual health in- Plan
surance coverage to which section 1251 of the ACA ap-
plies (in general, certain group health plans and health in- The PTC is not allowed for the coverage of an individual
surance coverage existing as of March 23, 2010, for as who is not lawfully present in the United States. All APTC
long as the coverage maintains that status under the ap- paid for an individual not lawfully present who enrolls in a
plicable rules). Health plans must disclose if they are qualified health plan must be figured. If all family members
grandfathered. For more information about grandfathered enrolled in a qualified health plan are not lawfully present,
health plans, see HealthCare.gov/Health-Care-Law- see the discussion immediately below. If you or a member
Protections/Grandfathered-Plans/. of your family is not lawfully present and was enrolled in a
qualified health plan with family members who are lawfully
Other Coverage Designated by the present for 1 or more months of the year, you must use
the instructions under Lawfully Present and Not Lawfully
Department of Health and Human Present Family Members Enrolled, later, to find out how
Services (HHS) much APTC, if any, was allowable.
HHS has designated the following health benefit plans or For more information about who is treated as law-
arrangements as MEC. TIP fully present for this purpose, go to
HealthCare.gov/Immigrants/Immigration-Status/.
1. Employer coverage provided to business owners who
are not employees.
All Enrolled Family Members Not
2. Coverage under a group health plan provided through
insurance regulated by a foreign government if: Lawfully Present

a. A covered individual is physically absent from the If all family members enrolled in a qualified health plan are
United States for at least 1 day during the month, not lawfully present, no PTC is allowed. Complete lines on
or Form 8962 as explained below. Leave all other lines
blank.
b. A covered individual is physically present in the
United States for a full month and the coverage Lines 1, 2a, 3, 4, and 5. Enter -0-.
provides health benefits within the United States
while the individual is on expatriate status. Line 9. Complete line 9 as provided in the Form 8962 in-
structions to determine whether you must complete Part
3. Coverage of pregnancy-related services that consists
IV for an allocation of policy amounts. Complete Part IV if
of full Medicaid benefits.
instructed to do so by Table 3 in the Form 8962 instruc-
4. Other specific programs listed at CMS.gov/CCIIO/ tions. Do not complete Part V.
Programs-and-Initiatives/Health-Insurance-Market-
Reforms/Minimum-Essential-Coverage.html (click on Line 11, column (f) (or lines 12 through 23, column
the link for “Approved Plans”). These programs in- (f), if you complete Part IV). If you checked the “No”
clude certain: box on line 9, enter the total of your Form(s) 1095-A, Part
III, line 33C, on line 11, column (f). If you checked the
a. Self-insured university student health plans; and “Yes” box on line 9, complete lines 12 through 23, column
b. Coverage resembling coverage under a state’s (f), as provided in the Form 8962 instructions.
CHIP program that generally requires the payment
Line 24. Enter -0-.
of premiums with little or no government subsidy,
often called CHIP buy-in programs. Lines 25, 27, and 29. Enter the amount from line 11, col-
In general, if you were eligible for coverage that HHS has umn (f), (or the total of lines 12 through 23, column (f)) on
designated as MEC, you are not eligible to claim the PTC each line. Then, follow the instructions for line 29.
for coverage through the Marketplace. However, you are
considered as eligible for MEC under a self-insured uni-
versity student health plan or a CHIP buy-in program that
has been designated as MEC only if you are enrolled in
the coverage.

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Lawfully Present and Not Lawfully age family. Situation 1 applies if you have family mem-
bers who are not lawfully present that are enrolled for all
Present Family Members Enrolled or a part of the year, there are no changes in your cover-
Before you read the following discussion, first fa- age family during the year (counting only lawfully present
TIP miliarize yourself with the definitions of tax family family members), and there are no enrollment changes in-
and coverage family discussed under Terms You volving your lawfully present family members enrolled in
May Need To Know, earlier. the coverage during the year. If Situation 1 applies, you
should enter on Form 8962 for every month of the year the
If you or a member of your family is not lawfully present enrollment premiums and applicable SLCSP premium the
and was enrolled in a qualified health plan with family Marketplace reports on Form 1095-A for the months when
members who are lawfully present for 1 or more months of only lawfully present individuals were enrolled in the cov-
the year, you may take the PTC only for the coverage of erage. If a not lawfully present family member was enrol-
the lawfully present family members. You must determine led for the entire year, see No reference month, later.
how much APTC was paid for the coverage of a not law- Example 1. Andrew enrolls himself and his three de-
fully present family member. Complete Form 8962 using pendents, Terri, Phil, and Anne in a qualified health plan.
the following steps. Anne is not lawfully present in the United States. The
monthly enrollment premiums for the plan are $1,000. No
Step 1. Complete Part I according to the instructions. If one in Andrew’s family is eligible for MEC (other than Mar-
you are not eligible for the PTC, skip the rest of these ketplace coverage) and the applicable SLCSP premium
steps, complete Form 8962 through line 27, and then see that would apply to all four members of Andrew’s family is
How To Determine the Excess APTC That Must Be Re- $1,200. There are no changes involving the lawfully
paid, later. present members of the coverage family during the year.
Step 2. Determine your monthly enrollment premiums Anne is disenrolled from coverage as of April 1. The
and applicable SLCSP premium using the instructions un- monthly enrollment premiums for Andrew and his other
der How To Determine Your Monthly Enrollment Premi- two dependents are $800 and the applicable SLCSP pre-
ums and SLCSP Premium, later. mium that applies to Andrew’s coverage family of three is
$900. The Marketplace reports the following amounts on
Step 3. Complete line 9, including Parts IV and V if in- Form 1095-A, Part III.
structed to do so.
Months Column A Column B
Step 4. If Situation 1 (discussed later) applies to you, do
one of the following. January, February, March. . . . . . $1,000 $1,200
April through December. . . . . . . . $800 $900
• If the enrolled lawfully present family members are en-
rolled for all 12 months of 2022, check the “Yes” box When completing Form 8962, Andrew enters $9,600
on line 10 and complete line 11, and lines 24 through ($800 x 12) as the enrollment premiums on line 11, col-
29, as appropriate. umn (a), and $10,800 ($900 x 12) as the premium for the
• If the enrolled lawfully present family members are en- applicable SLCSP on line 11, column (b).
rolled for less than 12 months, check the “No” box on
line 10, skip line 11, and complete lines 12 through 29, Situation 2—Changes in enrollment or coverage fam-
as appropriate. ily involving a lawfully present family member. Situa-
tion 2 applies if you have family members who are not
If Situation 2 (discussed later) applies to you, check the lawfully present that are enrolled for all or part of the year,
“No” box on line 10, skip line 11, and complete lines 12 and there are either changes in your coverage family dur-
through 25. Then, do one of the following. ing the year (counting only lawfully present family mem-
• If line 24 is less than line 25, you have excess APTC. bers) or enrollment changes involving your lawfully
See How To Determine the Excess APTC That Must present family members enrolled in the coverage during
Be Repaid, later. the year. If Situation 2 applies, use these rules to deter-
mine the enrollment premiums and the applicable SLCSP
• If line 24 is equal to or greater than line 25, complete premium for the months any not lawfully present family
line 26 as instructed. (Do not follow the instructions members are enrolled. First, use Worksheet A to deter-
under How To Determine the Excess APTC, later.) mine if you have a reference month for enrollment premi-
ums or for the applicable SLCSP premium. You may have
How To Determine Your Monthly Enrollment a reference month for enrollment premiums (discussed
Premiums and Applicable SLCSP Premium next) or a reference month for the applicable SLCSP pre-
mium (discussed later), or for both.
See Situation 1 or Situation 2 next for how to determine
your monthly enrollment premium and applicable SLCSP Reference month for enrollment premiums. A ref-
premium. erence month for enrollment premiums is a month in
which the not lawfully present family member is not enrol-
Situation 1—Not lawfully present family members en- led in coverage and there are no other changes in the
rolled and no other changes in enrollment or cover- members of your family who are enrolled in the coverage.

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In other words, your enrolled family members are the enrollment premiums and the applicable SLCSP premium
same during the reference month as for a month the not for January through March (the months Anne was enrolled
lawfully present member was enrolled, except that the not in coverage) because Andrew’s coverage family and en-
lawfully present family member is not enrolled. Enter on rolled family members for April through August (Andrew,
Form 8962, Part II, column (a), the enrollment premiums Phil, and Terri) are the same as for January through
for the reference month as the enrollment premiums for March except for Anne who is not lawfully present. (Sep-
the months the not lawfully present family member was tember through December are also reference months for
enrolled. enrollment premiums.) The enrollment premiums and
SLCSP premium for April through August are the same
Reference month for SLCSP premium. A reference
amounts they would have been for January through March
month for the applicable SLCSP premium is a month in
without Anne. Therefore, for the months January through
which the not lawfully present family member is not enrol-
March, Andrew enters on Form 8962, lines 12 through 23,
led in coverage and there are no other changes in your
$800 (the enrollment premiums for April through August)
coverage family. In other words, your coverage family is
in column (a) and $900 (the SLCSP premium that applies
the same during the reference month as for a month the
to the coverage family for April through August) in column
not lawfully present family member was enrolled, except
(b).
the not lawfully present family member is not included in
your coverage family. Enter on Form 8962, Part II, column Example 3. The facts are the same as in Example 1,
(b), the applicable SLCSP premium for the reference earlier, except that Andrew becomes eligible for em-
month as the applicable SLCSP premium for the months ployer-sponsored coverage on April 1, notifies the Market-
the not lawfully present family member was enrolled. place, but remains enrolled in the qualified health plan.
The Marketplace reports the following amounts on Form
No reference month. If you do not have a reference
1095-A, Part III.
month for enrollment premiums, you may have to contact
your insurance company to find out what the amount of
the enrollment premiums would have been if the policy Months Column A Column B
had covered only lawfully present family members. If you January, February, March . . . . . . $1,000 $1,200
do not have a reference month for the applicable SLCSP April through December . . . . . . . . $800 $400
premium, you must look up the SLCSP premium that ap-
plies to your coverage family (without any not lawfully Andrew does not have a reference month for the appli-
present family members). See Determining the Premium cable SLCSP premium for the months Anne was enrolled
for the Applicable Second Lowest Cost Silver Plan in the qualified health plan because there is another
(SLCSP), later. change in his coverage family for the months April through
You may use Worksheet A to determine whether December (Andrew is not in the coverage family because
TIP you have any reference months. he is eligible for employer-sponsored coverage). Thus,
there are no months when Andrew’s coverage family is
the same (except for Anne) before and after Anne is dis-
Example 2. The facts are the same as in Example 1, enrolled from coverage. Andrew must look up the SLCSP
earlier, except that Andrew becomes eligible for em- premium that applies to his coverage family without Anne.
ployer-sponsored coverage on September 1, notifies the Andrew determines that the correct applicable SLCSP
Marketplace, but remains enrolled in the qualified health premium to enter on Form 8962 for the months January
plan (although he cannot take the PTC for his coverage through March for a coverage family consisting of Andrew,
for the months after August). The applicable SLCSP pre- Terri, and Phil is $900.
mium that applies to Terri and Phil is only $400. The Mar- April through December are reference months for An-
ketplace reports the following amounts on Form 1095-A, drew for enrollment premiums because the family mem-
Part III. bers who are enrolled for those months are the same fam-
ily members who were enrolled in January through March,
Months Column A Column B except for Anne.
Therefore, for the months January through March, An-
January, February, March . . . . . . $1,000 $1,200
drew enters on Form 8962, lines 12 through 23, $800 (the
April through August. . . . . . . . . . $800 $900 enrollment premiums for April through December) in col-
September through December. . . $800 $400 umn (a) and $900 (the SLCSP premium that would apply
to the coverage family of Andrew, Terri, and Phil) in col-
Andrew must complete lines 12 through 23 of Form umn (b).
8962. April through August are reference months for both

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Worksheet A. Do You Have Any Reference Months? Keep for Your Records
Use this worksheet to determine whether you have any reference months.
Months in 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Oct. Nov. Dec.
1. Check a box for each month in which any
family members not lawfully present were
enrolled in coverage . . . . . . . . . . . . . . . . . . . .
2. Check a box for each month in which:
• Only lawfully present family members
were enrolled in coverage; and
• There were no other changes in
members of your tax family* who are
enrolled in coverage, as compared to a
month for which you checked a box on
line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The months for which you checked boxes
on line 2 are your reference months for
enrollment premiums. Use the enrollment
premium reported on Form 1095-A, Part III,
column A, for the reference month as your
enrollment premium on Form 8962 for the
month(s) you checked on line 1.

Note. If you did not check any boxes on this
line, see No reference month, earlier.
3. Check a box for each month in which:
• Only lawfully present family members
were enrolled in coverage; and
• There were no other changes in your
coverage family,* as compared to a
month for which you checked a box on
line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The months for which you checked boxes
on line 3 are your reference months for the
applicable SLCSP premium. Use the
applicable SLCSP premium reported on
Form 1095-A, Part III, column B, for the
reference month as your applicable SLCSP
premium on Form 8962 for the month(s) you
checked on line 1.

Note. If you did not check any boxes on this
line, see No reference month, earlier.
* See Terms You May Need To Know, earlier, for the definitions of tax family and coverage family.

How To Determine the Excess APTC That members who are lawfully present for 1 or more
Must Be Repaid months of the year.
• You have excess APTC on line 27 of Form 8962.
The excess APTC (see the instructions for Form 8962,
line 28) applies only to excess APTC for coverage of law- • Your excess APTC on line 27 of Form 8962 is more
than your amount from Table 5 in the Form 8962 in-
fully present individuals. Excess APTC that relates to the
structions.
coverage of individuals who are not lawfully present must
be figured without limitation. Use Worksheet B to deter- If line 27 is not more than your amount from Table 5 in
mine the amount of excess APTC if all of the following ap- the Form 8962 instructions, do not complete Worksheet
ply. B. Leave line 28 of Form 8962 blank, enter the amount
• You or a member of your family is not lawfully present from line 27 on line 29, and follow the instructions for
and is enrolled in a qualified health plan with family

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line 29. If you must complete Worksheet B, see the illus- SLCSP premium ($900) for January through March
trated example. because Andrew’s coverage family for these months (An-
drew, Phil, and Terri) is the same as for January through
March except for Anne. September through December
Illustrated Example of Determining the are not reference months for the applicable SLCSP pre-
Excess APTC That Must Be Repaid mium (and Andrew doesn’t check these boxes) because,
as explained above, there was another change in his cov-
Andrew enrolls himself and his three dependents, Terri, erage family beginning in September.
Phil, and Anne in a qualified health plan. Anne is not law-
fully present in the United States and is disenrolled from Step 3. Andrew checks the “No” box on line 9 because
the coverage as of April 1. Andrew becomes eligible for he is neither allocating policy amounts with another tax-
employer-sponsored coverage on September 1, notifies payer nor using the alternative calculation for year of mar-
the Marketplace, but remains enrolled in the qualified riage.
health plan. The Marketplace reports the following
amounts on Form 1095-A, Part III. Step 4. Because Situation 2 (discussed earlier) applies to
Andrew, he checks the “No” box on line 10, skips line 11,
and completes lines 12 through 25. On lines 12 through
Months Column A Column B Column C 14, column (a), he enters $800 as determined on Work-
January, February, sheet A, line 2. On lines 12 through 14, column (b), he en-
March . . . . . . . . . . . . $1,000 $1,200 $953 ters $900 as determined on Worksheet A, line 3.
April through Andrew’s PTC on line 24 ($4,768) is less than his
August . . . . . . . . . . . . $800 $900 $653 APTC on line 25 ($6,736), and his excess APTC on
September through line 27 ($1,968) is greater than his Table 5 repayment limi-
December. . . . . . . . . $800 $400 $153 tation amount ($1,650) in the Form 8962 instructions. Ac-
cording to the instructions under How To Determine the
Excess APTC That Must Be Repaid, earlier, Andrew must
Step 1. Andrew completes Part I of Form 8962 (not illus- complete Worksheet B to figure the amount of excess
trated). His household income for the year on his Form APTC.
8962, line 3, is $72,875, which is 275% of the federal pov-
erty line. The annual contribution amount Andrew enters Andrew completes Worksheet B as follows.
on line 8a is $3,644 and the monthly contribution amount Line 1. Andrew enters $953. This is the monthly APTC
he enters on line 8b is $304. shown on Form 1095-A, Part III, column C, for January,
Step 2. Andrew determines his monthly enrollment pre- February, and March (the months that Anne was enrolled
miums and applicable SLCSP premium using the instruc- in coverage).
tions under How To Determine Your Monthly Premium Line 2. Andrew enters $596. This is the amount from
and Applicable SLCSP Premium, earlier. Situation 2 in Form 8962, Part II, column (e), for January through March
that discussion applies to Andrew because he has a law- and represents the applicable monthly SLCSP premium
fully present family member enrolled in coverage and for April through August (reference months for the applica-
there are changes in his coverage family in 2022, counting ble SLCSP premium) for Andrew, Terri, and Phil of $900
only lawfully present family members: beginning in Sep- minus the monthly contribution amount of $304 from Form
tember, only Phil and Terri are in the coverage family. An- 8962, line 8b.
drew is no longer in the coverage family because he be-
comes eligible for employer-sponsored coverage. Line 4. Andrew enters $1,000. This is the monthly pre-
Andrew completes Worksheet A as explained below to mium for January through March shown on Form 1095-A,
determine his reference months for the enrollment premi- Part III, column A.
ums and the applicable SLCSP premium for the months Line 5. Andrew enters $1,200. This is the applicable
Anne was enrolled. (Andrew’s Worksheet A is shown SLCSP premium shown on Form 1095-A, Part III, column
later.) B.
Line 1. He checks the boxes for January, February, Line 6. Andrew enters $304. This is the monthly contri-
and March because those are the months in which Anne bution amount from Form 8962, line 8b.
is enrolled in Marketplace coverage.
Lines 7 through 14. Andrew completes these lines as
Line 2. He checks the boxes for April through Decem- instructed on Worksheet B.
ber. Those months are reference months for enrollment
premiums ($800) for January through March because his Line 15. Line 14 is more than line 13. Accordingly, An-
tax family for these months (Andrew, Phil, and Terri) is the drew enters the amount from line 13 ($1,650) on Form
same as for January through March except for Anne. 8962, lines 28 and 29.

Line 3. He checks the boxes for April through August.
These months are reference months for the applicable

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Worksheet B. Excess APTC That Must Be Repaid                                                        Keep for Your Records
 Complete columns only for the months a not lawfully present family member was enrolled in coverage. (If you comple-
ted Worksheet A, these are the months for which you checked a box on line 1 of the worksheet.)
Months in 2022 . . . . . .   Jan. Feb. Mar. Apr. May                             Jun.     Jul. Aug. Sep. Oct.                     Nov.                                                 Dec.
1.  Enter APTC from 
    Form 1095-A, Part 
    III, column 
    C . . . . . .
2.  Enter the monthly 
    credit amount from 
    Form 8962, Part II, 
    column (e) . . . . .
3.  Subtract line 2 
    from line 1. If zero 
    or less, leave this 
    line blank and skip 
    lines 4 through 10 
    for the 
    month . . . . . . . .
4.  Enter the monthly 
    premium amount 
    from Form 1095-A, 
    Part III, column A . .
5.  Enter the SLCSP 
    premium from 
    Form 1095-A, Part 
    III, column B . . . . . .
6.  Enter the monthly 
    contribution 
    amount from Form 
    8962, line 8b . . . . .
7.  Subtract line 6 
    from line 5 . . . . .
8.  Enter the smaller 
    of line 4 or 
    line 7 . . . . .
9.  Subtract line 8 
    from line 1. If zero 
    or less, 
    enter -0- . . . . .
10. Subtract line 9 
    from line 3 . . . . .
11. Add the amounts on line 10. If all of your line 3 results were zero or less, stop here. None of your excess APTC was from 
    individuals who were not lawfully present. Enter the repayment limitation amount from Table 5 in the Form 8962 instructions 
    on Form 8962, line 28, and continue to line 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .            11.
12. Enter the repayment limitation amount from Table 5 in the Form 8962 instructions      . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                           12.
13. Add lines 11 and 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Enter the amount from Form 8962, line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .            14.
15. Compare lines 13 and 14.
    •   If line 14 is more than line 13, enter the amount from line 13 on Form 8962, lines 28 and 29, and follow the instructions for 
        line 29.
    •   If line 14 is less than or equal to line 13, leave Form 8962, line 28, blank and enter the amount from line 27 on line 29.

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Andrew’s Worksheet A. Do You Have Any Reference Months?
Use this worksheet to determine whether you have any reference months.
Months in 2022
Check a box for each month in which any
family members not lawfully present were
enrolled in coverage
Check a box for each month in which:
• Only lawfully present family members
were enrolled in coverage; and
• There were no other changes in
members of your tax family* who are
enrolled in coverage, as compared to a
month for which you checked a box on
line 1
The months for which you checked boxes
on line 2 are your reference months for
enrollment premiums. Use the enrollment
premium reported on Form 1095-A, Part III,
column A, for the reference month as your
enrollment premium on Form 8962 for the
month(s) you checked on line 1.

Note. If you did not check any boxes on this
line, see No reference month, earlier.
Check a box for each month in which:
• Only lawfully present family members
were enrolled in coverage; and
• There were no other changes in your
coverage family,* as compared to a
month for which you checked a box on
line 1
The months for which you checked boxes
on line 3 are your reference months for the
applicable SLCSP premium. Use the
applicable SLCSP premium reported on
Form 1095-A, Part III, column B, for the
reference month as your applicable SLCSP
premium on Form 8962 for the month(s) you
checked on line 1.

Note. If you did not check any boxes on this
line, see No reference month, earlier.
*See Terms You May Need To Know, earlier, for the denitions of tax famliy and coverage family.

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Andrew's Worksheet B. Excess APTC That Must Be Repaid
Complete columns only for the months a not lawfully present family member was enrolled in coverage. (If you comple-
ted Worksheet A, these are the months for which you checked a box on line 1 of the worksheet.)
Months in 2022 . . . . . .    Jan.  Feb.  Mar. Apr. May                          Jun.     Jul. Aug. Sep. Oct.                     Nov.                                                  Dec.
1.  Enter APTC from 
    Form 1095-A, Part 
    III, column 
    C . . . . . .             $953  $953  $953
2.  Enter the monthly 
    credit amount from 
    Form 8962, Part II, 
    column 
    (e) . . . . . . . . . . . 596   596   596
3.  Subtract line 2 
    from line 1. If zero 
    or less, leave this 
    line blank and skip 
    lines 4 through 10 
    for the 
    month . . . . . . . .     357   357   357
4.  Enter the monthly 
    premium amount 
    from Form 1095-A, 
    Part III, column A . .    1,000 1,000 1,000
5.  Enter the SLCSP 
    premium from 
    Form 1095-A, Part 
    III, column 
    B . . . . . .             1,200 1,200 1,200
6.  Enter the monthly 
    contribution 
    amount from Form 
    8962, line 8b . . . . .   304   304   304
7.  Subtract line 6 
    from line 5 . . . . .     896   896   896
8.  Enter the smaller 
    of line 4 or 
    line 7 . . . . .          896   896   896
9.  Subtract line 8 
    from line 1. If zero 
    or less, 
    enter -0- . . . . .       57    57    57
10. Subtract line 9 
    from line 3 . . . . .     300   300   300
11. Add the amounts on line 10. If all of your line 3 results were zero or less, stop here. None of your excess APTC was from 
    individuals who were not lawfully present. Enter the repayment limitation amount from Table 5 in the Form 8962 instructions 
    on Form 8962, line 28, and continue to line 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .            11. 900
12. Enter the repayment limitation amount from Table 5 in the Form 8962 instructions      . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                           12. 1,650
13. Add lines 11 and 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. 2,550
14. Enter the amount from Form 8962, line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .            14. 1,968
15. Compare lines 13 and 14.
    •   If line 14 is more than line 13, enter the amount from line 13 on Form 8962, lines 28 and 29, and follow the instructions for 
        line 29.
    •   If line 14 is less than or equal to line 13, leave Form 8962, line 28, blank and enter the amount from line 27 on line 29.

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Determining the Premium for Allocating Policy Amounts for

the Applicable Second Lowest Individuals With No One in

Cost Silver Plan (SLCSP) Their Tax Family

If you or a member of your family enrolls in a qualified If an individual you enrolled in coverage is not included in
health plan and APTC is paid for the coverage, the Mar- any tax family, you must reconcile the APTC paid for the
ketplace will generally identify the applicable SLCSP pre- individual’s coverage, even if you are claimed as a de-
mium and report it on Form 1095-A. The Marketplace de- pendent by another taxpayer. If you are enrolled in the
termines the applicable SLCSP premium based on your same policy as the individual not included in any tax fam-
address and the members of your coverage family. Pro- ily, you have to allocate policy amounts even though the
viding correct information on your application for financial conditions in the Form 8962 instructions for line 9 are not
assistance and notifying the Marketplace if you move or met. Use the example below to complete Form 8962 if
the members of your coverage family change are neces- your family size is zero but you have to allocate policy
sary for the Marketplace to report a correct applicable amounts.
SLCSP premium. If the Marketplace does not have accu-
Example. Mark enrolls himself and his child, Donna, in
rate and updated information, the applicable SLCSP pre-
a qualified health plan with coverage effective for all of
mium the Marketplace reports on Form 1095-A may not
2022. The Form 1095-A he received from the Marketplace
be accurate for all months and you will need to determine
shows that $6,000 of APTC was paid for their coverage
the correct applicable SLCSP premium for those months.
($500 is entered in Part III, column C, for each of lines 21
See Applicable SLCSP premium tools below.
through 32). Mark files an income tax return for 2022 on
If you did not request financial assistance (APTC) and Form 1040 and does not include anyone in his tax family.
the Marketplace has an applicable SLCSP premium tool Mark’s parents, Steve and Sherry, include Mark in their
(discussed in the next paragraph), the Marketplace will tax family. No one includes Donna in their tax family. Be-
not report an applicable SLCSP premium (Part III, column cause Mark enrolled Donna in coverage and no one in-
B, will report -0- or be blank). If you did not request finan- cludes Donna in their tax family, Mark must reconcile the
cial assistance (APTC) and the Marketplace does not APTC paid for Donna’s coverage. Steve and Sherry must
have an applicable SLCSP premium tool, it may report an reconcile the APTC paid for Mark’s coverage. Because
SLCSP premium that applies to everyone enrolled in your Steve and Sherry must reconcile the APTC paid for
qualified health plan because it may not be able to identify Mark’s coverage and Mark must reconcile the APTC paid
the members of your coverage family from the information for Donna’s coverage, Mark must complete Part IV of
on your application. If you take the PTC on your tax return, Form 8962 to allocate policy amounts with Steve and
you will need to determine the SLCSP premium that ap- Sherry. Mark, Sherry, and Steve do not agree on an allo-
plies to your coverage family for each month of coverage. cation percentage. Mark completes Form 8962 as follows.
Applicable SLCSP premium tools. Only the Marketpla- Lines 1, 2a, 3, 4, and 5. Mark enters -0-.
ces are able to provide applicable SLCSP premiums. The Line 9. Mark reads Allocating policy amounts under
federally facilitated Marketplace and most state Market- Line 9 in the Form 8962 instructions. Although the first
places have provided applicable SLCSP premium tools condition in that discussion is not met, the allocation rules
that, as you prepare your tax return, you may use to look still apply because the APTC must be reported on two
up the SLCSP premium that applies to your coverage separate returns (Mark's for Donna; Steve and Sherry's
family for each month. If you enrolled through the federally for Mark). He checks “Yes” on line 9. Then, he reads Ta-
facilitated Marketplace, you will find the tool at ble 3 in the instructions. According to Step 3 in Table 3, he
HealthCare.gov/Tax-Tool/. must allocate in Part IV using the rules under Allocation
If you enrolled through a state-based Marketplace, you Situation 4. Other situations where a policy is shared be-
may find information about whether your state has an ap- tween two tax families in the Form 8962 instructions.
plicable SLCSP premium tool on the state-based Market-
place’s website. If the website does not have an applica- Line 30 (Part IV). Mark enters the Marketplace-as-
ble SLCSP premium tool, you will need to contact the signed policy number in column (a), Steve’s SSN in col-
state-based Marketplace directly for the correct SLCSP umn (b), “01” in column (c), and “12” in column (d). He
premium. leaves columns (e) and (f) blank because he is not an ap-
plicable taxpayer. He enters “0.50” in column (g). This is
the allocation percentage based on the rules under Allo-
cation Situation 4. Other situations where a policy is
shared between two tax families in the Form 8962 instruc-
tions.

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Lines 12 through 23, column (f).     Mark enters $250                Allocation Among Two Taxpayers 
on each line (0.50 x the $500 APTC shown on his Form 
1095-A).                                                             Who Divorced or Legally Separated in 
                                                                     2022 and One or More Other 
Lines  25,  27,  and  29.   Mark  enters  $3,000  APTC, 
which  is  the  total  of  lines  12  through  23,  column  (f),  on Taxpayers
these lines and on his Schedule 2 (Form 1040), line 2.
                                                                     Use this section to allocate policy amounts from a quali-
                                                                     fied health plan if you meet either of the following condi-
                                                                     tions and no other allocations for the policy are necessary.
Allocation of Policy Amounts                                           You are allocating enrollment premiums, applicable 
                                                                     •
Among Three or More                                                    SLCSP premiums, and APTC with a former spouse as 
                                                                       a result of your divorce or legal separation in 2022 and 
Taxpayers                                                              are also allocating amounts with another taxpayer who 
                                                                       is including an individual in their tax family who, when 
This section covers allocations of policy amounts (enroll-             you were married to the former spouse, was enrolled 
ment premiums, applicable SLCSP premiums, and APTC)                    in a qualified health plan with members of your and 
among three or more taxpayers.                                         your former spouse’s tax families.
Before you read this section, first read Part IV—Alloca-             • You are the taxpayer who is including in your tax fam-
tion  of  Policy  Amounts  in  the  Form  8962  instructions.          ily an individual enrolled in the plan with tax family 
Then, use the following instructions to complete Part IV of            members of taxpayers who must also allocate policy 
Form 8962 if one qualified health plan covers individuals              amounts as a result of divorce or separation in 2022.
from three or more tax families in the same month. Specif-            Example. Kara and David and their two children, Mer-
ically, these instructions apply to:                                 edith and Sam, enroll in a qualified health plan for 2022. 
• Taxpayers who must allocate policy amounts because                 Kara  and  David  were  married  at  the  beginning  of  2022 
  of a divorce or legal separation in 2022 and must also             and divorce in 2022. Meredith and Sam move in with their 
  allocate policy amounts with another taxpayer (for ex-             grandmother, Lydia, in May of 2022. Lydia claims Mere-
  ample, a grandparent who includes in their tax family              dith and Sam as dependents on her 2022 income tax re-
  a child enrolled with the former spouses);                         turn.  Kara,  David,  and  Lydia  use  this  section  to  allocate 
                                                                     policy amounts to compute their respective PTC and rec-
• Taxpayers who must allocate policy amounts because 
                                                                     oncile the PTC with the APTC paid.
  they are legally married but are not filing a joint return 
                                                                      Kara and David use the allocation method under Rules 
  (for example, filing their returns as married filing sepa-
                                                                     for the Taxpayers Who Divorced or Legally Separated in 
  rately), and must also allocate policy amounts with an-
                                                                     2022 and Are Also Allocating With Another Taxpayer next.
  other taxpayer (for example, a grandparent who in-
                                                                      Lydia  uses  the  allocation  method  under Rules  for  the 
  cludes in their tax family a child enrolled with the 
                                                                     Taxpayer(s) Allocating With Taxpayers Who Divorced or 
  spouses); and
                                                                     Legally Separated in 2022, later.
• Other taxpayers who are including an individual in 
  their tax family who is enrolled in a qualified health             Rules for the Taxpayers Who Divorced or 
  plan together with members of two or more other tax                Legally Separated in 2022 and Are Also 
  families.
                                                                     Allocating With Another Taxpayer
No APTC.   If you or a member of your tax family is en-
rolled  in  a  qualified  health  plan  with  members  of  two  or   Use this allocation method if you divorced or legally sepa-
more other tax families and no APTC is paid for coverage             rated  during  the  year  and  you  must  allocate  policy 
under the plan, use the instructions for Form 8962 under             amounts (enrollment premiums, applicable SLCSP premi-
Allocation Situation 3 No APTC . to allocate the enrollment          ums, and APTC) with your former spouse as well as with 
premiums  from  the  qualified  health  plan  among  the  tax        another taxpayer who is including in their tax family an in-
families. You allocate the enrollment premiums in propor-            dividual enrolled in a qualified health plan with members 
tion to the SLCSP premium that applies to each taxpayer              of your and your former spouse’s tax families.
who has a coverage family member enrolled in the plan. 
                                                                     Step 1. Determine an allocation percentage with your for-
For purposes of this enrollment premium allocation, only 
                                                                     mer spouse. You use this percentage to allocate the total 
coverage family members enrolled in the plan are consid-
                                                                     enrollment  premiums,  the  applicable  SLCSP  premiums, 
ered  in  determining  the  SLCSP  premium  that  applies  to 
                                                                     and APTC for coverage under the plan during the months 
each  taxpayer.  You  and  the  other  taxpayers  must  com-
                                                                     you  were  married.  You  will  find  these  amounts  on  your 
plete column (e) on the appropriate line in Part IV to allo-
                                                                     Form(s)  1095-A,  Part  III,  columns  A,  B,  and  C,  respec-
cate the enrollment premiums to each family. Leave col-
                                                                     tively.  You  and  your  former  spouse  can  allocate  these 
umns (f) and (g) blank. See Missing or incorrect SLCSP 
                                                                     amounts using any percentage you agree on from -0- to 
premium on Form 1095-A under Line 10  in the Form 8962 
                                                                     100,  but  you  must  allocate  all  amounts  using  the  same 
instructions to determine your applicable SLCSP premium 
                                                                     percentage. If you do not agree on a percentage, you and 
to use for the allocation.

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your former spouse must allocate 50% of each of these Column (c). Enter the first month you are allocating
amounts to each of you. policy amounts. For example, if you are allocating a per-
centage from January through June, enter “01” in column
Step 2. Separately from the first allocation, determine an (c).
allocation percentage with the taxpayer(s) who included in
their tax family the individual(s) enrolled in the plan with a Column (d). Enter the last month you are allocating
member of your tax family or a member of your former policy amounts. For example, if you are allocating a per-
spouse’s tax family. You may agree on any allocation per- centage from January through June, enter “06” in column
centage from -0- to 100. You may use the percentage you (d).
agreed on for every month that this allocation rule applies, Column (e). Enter the decimal from Worksheet C,
or you may agree on different percentages for different line 5.
months. However, you must use the same allocation per-
centage for all policy amounts (enrollment premiums, ap- Column (f). Enter the decimal from Worksheet C,
plicable SLCSP premiums, and APTC) in a month. If you line 5.
cannot agree on an allocation percentage, the allocation Column (g). Enter the decimal from Worksheet C,
percentage is equal to the number of individuals the other line 5.
taxpayer includes in their tax family for the tax year who
were enrolled in the plan for which you are allocating pol-
Rules for the Taxpayer(s) Allocating With
icy amounts, divided by the total number of individuals en-
rolled in the qualified health plan. The allocation percent- Taxpayers Who Divorced or Legally
age is the percentage that applies to the amounts the Separated in 2022
other taxpayer must use to compute the PTC and recon-
Use this allocation method if you are including in your tax
cile it with APTC. You and your former spouse must com-
family one or more individuals who were enrolled in a
pute the PTC and reconcile APTC using the remaining
qualified health plan with members of the tax families of
amounts.
other taxpayers who must also allocate policy amounts as
Step 3. Complete Worksheet C below. a result of divorce or legal separation in 2022.

Worksheet C. Allocations for the Divorced or Step 1. Determine an allocation percentage with one of
Legally Separated Taxpayers the former spouses. You may agree on any allocation per-
1. Enter as a decimal your percentage from centage from -0- to 100. You may use the percentage you
Step 1 above . . . . . . . . . . . . . . . . . . . . . . . 1. agreed on for every month during which this allocation
2. Enter 1.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 1.0 rule applies, or you may agree on different percentages
for different months. However, you must use the same al-
3. Enter as a decimal the total of the location percentage for all policy amounts (enrollment pre-
percentage(s) from Step 2 above miums, applicable SLCSP premiums, and APTC) in a
allocated to the other taxpayer(s). month. If you cannot agree on an allocation percentage,
Note. See Example 2, later, for details on
the allocation percentage is equal to the number of indi-
adding the percentages for multiple
taxpayers . . . . . . . . . . . . . . . . . . . . . . . . . . 3. viduals you include in your tax family for the tax year who
were enrolled in the qualified health plan for which you are
4. Subtract line 3 from line 2 . . . . . . . . . . . . . 4. allocating policy amounts, divided by the total number of
5. Multiply line 1 by line 4. Enter the result as individuals enrolled in the plan. The allocation percentage
a decimal. This is your allocation is the percentage that applies to the amounts you must
percentage. Go to Step 4 below . . . . . . . . 5. use to compute the PTC and reconcile it with APTC. The
former spouse must compute the PTC and reconcile
Step 4. If you use the same percentage in Step 2 above APTC using the remaining amounts.
for every month to which this allocation method applies,
use only one of lines 30 through 33 in Part IV to report the Step 2. Allocate the policy amounts with the second for-
allocation. If you use different percentages for different mer spouse using the same rules as Step 1 above. Enter
months under Step 2, use a separate line in Part IV for the percentage on line 4 of Worksheet D.
each allocation percentage. Complete the line as ex-
plained below. Step 3. Complete Worksheet D below.

Column (a). Enter the Marketplace-assigned policy
number from Form 1095-A, line 2. If the policy number on
the Form 1095-A is more than 15 characters, enter only
the last 15 characters.
Column (b). Enter the SSN of your former spouse.

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Worksheet D. Taxpayer Allocating With effective October 1. Lydia is enrolled in employer-spon-
Divorced or Separated Taxpayers sored coverage.
On their respective tax returns, Kara files as single and
1. Enter the decimal from line 1 of the includes only herself in her tax family; David files as single
Worksheet C completed by one of the and includes only himself in his tax family; and Lydia files
former spouses from Step 1 above . . . . . . . 1.
as head of household and includes Meredith and Sam in
2. Enter as a decimal the percentage from her tax family.
Step 1 above . . . . . . . . . . . . . . . . . . . . . . . . 2. Under Step 1 of Rules for the Taxpayers Who Divorced
3. Multiply line 1 by line 2 . . . . . . . . . . . . . . . . 3. or Legally Separated in 2022 and Are Also Allocating With
4. Enter the decimal from line 1 of the Another Taxpayer, Kara and David agree to allocate the
Worksheet C completed by the other former policy amounts 30% to Kara and 70% to David. Under
spouse from Step 2 above . . . . . . . . . . . . . 4. Step 2 of that method (Kara, David) and under Rules for
5. Enter as a decimal the percentage from the Taxpayer(s) Allocating With Taxpayers Who Divorced
Step 2 above . . . . . . . . . . . . . . . . . . . . . . . . 5. or Legally Separated in 2022 (Lydia), Kara and Lydia
6. Multiply line 4 by line 5 . . . . . . . . . . . . . . . . . 6. agree to allocate 80% of the policy amounts to Lydia, and
David and Lydia agree to allocate 50% of the policy
7. Add line 3 and line 6. This is the allocation amounts to Lydia. Each of them completes a worksheet
percentage. Go to Step 4 below . . . . . . . . . 7.
as shown below and uses it to complete Part IV.
Kara completes Worksheet C as follows.
Step 4. If you use the same percentages in Steps 1 and 2 Kara's Worksheet C. Allocations for Divorced
above for every month to which this allocation method ap-
or Legally Separated Taxpayers
plies, use only one of lines 30 through 33 in Part IV to re-
port the allocation. If you use different percentages for dif- 1. Enter as a decimal your percentage from
ferent months in Step 1 or Step 2, use a separate line in Step 1 above . . . . . . . . . . . . . . . . . . . . . 1. 0.30
Part IV for each allocation percentage. Complete the line 2. Enter 1.0 . . . . . . . . . . . . . . . . . . . . . . . . . 2. 1.0
as explained below. 3. Enter as a decimal the total of the
Column (a). Enter the Marketplace-assigned policy percentages from Step 2 above
number from Form 1095-A, line 2. If the policy number on allocated to the other taxpayer(s) . . . . 3. 0.80
the Form 1095-A is more than 15 characters, enter only 4. Subtract line 3 from line 2 . . . . . . . . . . . 4. 0.20
the last 15 characters. 5. Multiply line 1 by line 4. Enter the result
Column (b). Enter the SSN of the former spouse as a decimal. This is the allocation
whose percentage you entered on Worksheet D, line 1. percentage. Go to Step 4 below . . . . . . 5. 0.06
After completing Worksheet C, Kara completes Form
Column (c). Enter the first month you are allocating
8962, Part IV, line 30, as follows.
policy amounts. For example, if you are allocating a per-
centage from January through June, enter “01” in column Column (a). Kara enters the Marketplace-assigned
(c). policy number from Form 1095-A, line 2.
Column (d). Enter the last month you are allocating Column (b). Kara enters David's SSN.
policy amounts. For example, if you are allocating a per-
Column (c). Kara enters “01.”
centage from January through June, enter “06” in column
(d). Column (d). Kara enters “09.”
Column (e). Enter the decimal from Worksheet D, Columns (e), (f), and (g). Kara enters “0.06.”
line 7.
After completing Part IV, Kara multiplies the amounts
Columns (f) and (g). Enter the decimal from Work- from Form 1095-A, Part III, by the corresponding percen-
sheet D, line 7. tages in Part IV, and enters these allocated amounts on
Example 1. Kara and David were married at the be- Form 8962, lines 12 through 20, columns (a), (b), and (f).
ginning of 2022 and have two children, Meredith and On each of those lines, she will enter $42 in column (a)
Sam. Kara enrolled herself, David, Meredith, and Sam in a (enrollment premiums of $700 x 0.06), $39 in column (b)
qualified health plan with coverage effective January 1. (applicable SLCSP premium of $650 x 0.06), and $26 in
For each month of coverage, the enrollment premiums column (f) (APTC of $425 x 0.06). She completes her
were $700, the applicable SLCSP premium for a coverage Form 8962, lines 21 through 23, columns (a), (b), and (f),
family of four was $650, and the APTC was $425. by entering the monthly amounts from her separate Form
Meredith and Sam moved in with their grandmother, 1095-A for her self-only coverage from October through
Lydia, in May. Kara and David divorced in September. December. She does not allocate those amounts.
Kara enrolled in a new qualified health plan for self-only
David completes Worksheet C as follows.
coverage. David became eligible for and enrolled in em-
ployer-sponsored self-only coverage. Meredith and Sam
became eligible for and enrolled in government-spon-
sored coverage. All of the new plans have coverage

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David's Worksheet C. Allocations for                                 Lydia's Worksheet D. Taxpayer Allocating 
Divorced or Legally Separated Taxpayers                              With Divorced or Legally Separated 
1. Enter as a decimal your percentage                                Taxpayers 
   from Step 1 above . . . . . . . . . . . . . . . .         1. 0.70 1. Enter the decimal from line 1 of the 
2. Enter 1.0 . . . . . . . . . . . . . . . . . . . . . . . . 2. 1.0     Worksheet C completed by one of the 
3. Enter as a decimal the total of the                                  former spouses from Step 1 
   percentages from Step 2 above                                        above  . . . . . . . . . . . . . . . . . . . . . . . . .  1. 0.30
   allocated to the other                                            2. Enter as a decimal the percentage 
   taxpayer(s)  . . . . . . . . . . . . . . . . . . . . . .  3. 0.50    from Step 1 above . . . . . . . . . . . . . . .           2. 0.80
4. Subtract line 3 from line 2  . . . . . . . . . .          4. 0.50 3. Multiply line 1 by line 2 . . . . . . . . . . . .         3. 0.24
5. Multiply line 1 by line 4. Enter the result                       4. Enter the decimal from line 1 of the 
   as a decimal. This is the allocation                                 Worksheet C completed by the other 
   percentage. Go to Step 4 below . . . . .                  5. 0.35    former spouse from Step 2 
                                                                        above . . . . . . . . . . . . . . . . . . . . . . . . .   4. 0.70
After completing Worksheet C, David completes Form                   5. Enter as a decimal the percentage 
8962, Part IV, line 30, as follows.                                     from Step 2 above . . . . . . . . . . . . . . .           5. 0.50
                                                                     6. Multiply line 4 by line 5 . . . . . . . . . . . .         6. 0.35
Column  (a). David  enters  the  Marketplace-assigned 
policy number from Form 1095-A, line 2.                              7. Add line 3 and line 6. This is the 
                                                                        allocation percentage. Go to Step 4 
Column (b).  David enters Kara's SSN.                                   below . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 0.59
Column (c). David enters “01.”
                                                                     After completing Worksheet D, Lydia completes Form 
Column (d).  David enters “09.”                                      8962, Part IV, line 30, as follows.
Columns (e), (f), and (g). David enters “0.35.”                      Column  (a). Lydia  enters  the  Marketplace-assigned 
After completing Part IV, David multiplies the amounts               policy number from Form 1095-A, line 2.
from Form 1095-A, Part III, by the corresponding percen-             Column (b). Lydia enters Kara's SSN.
tages in Part IV, and enters these allocated amounts on 
Form 8962, lines 12 through 20, columns (a), (b), and (f).           Column (c). Lydia enters “01.”
On each of those lines, he will enter $245 in column (a)             Column (d). Lydia enters “09.”
(enrollment premiums of $700 x 0.35), $228 in column (b) 
(applicable SLCSP premium of $650 x 0.35), and $149 in               Columns (e), (f), and (g).    Lydia enters “0.59.”
column  (f)  (APTC  of  $425  x  0.35).  David  leaves  Form 
8962, lines 21 through 23, blank because he was not en-              After completing Part IV, Lydia multiplies the amounts 
rolled  in  a  qualified  health  plan  during  October  through     from Form 1095-A, Part III, by the corresponding percen-
December.                                                            tages in Part IV, and enters these allocated amounts on 
                                                                     Form 8962, lines 12 through 20, columns (a), (b), and (f). 
Lydia completes Worksheet D as follows.                              On each of those lines, she will enter $413 in column (a) 
                                                                     (enrollment premiums of $700 x 0.59), $384 in column (b) 
                                                                     (applicable SLCSP premium of $650 x 0.59), and $251 in 
                                                                     column  (f)  (APTC  of  $425  x  0.59).  Lydia  leaves  Form 
                                                                     8962, lines 21 through 23, blank because she, Meredith, 
                                                                     and Sam were not enrolled in a qualified health plan dur-
                                                                     ing October through December.
                                                                     Example 2.  The facts are the same as in                        Example 1, 
                                                                     except  that  in  May,  Meredith  moved  in  with  her  grand-
                                                                     mother, Lydia, and Sam moved in with his aunt, Kimberly.
                                                                     On their respective tax returns, Kara files as single and 
                                                                     includes only herself in her tax family; David files as single 
                                                                     and includes only himself in his tax family; Lydia files as 
                                                                     head of household and includes Meredith in her tax fam-
                                                                     ily; and Kimberly files as head of household and includes 
                                                                     Sam  in  her  tax  family.  Kimberly  is  enrolled  in  em-
                                                                     ployer-sponsored coverage.
                                                                     Under Step 1 of Rules for the Taxpayers Who Divorced 
                                                                     or Legally Separated in 2022 and Are Also Allocating With 
                                                                     Another Taxpayer, Kara and David agree to allocate the 
                                                                     policy  amounts  40%  to  Kara  and  60%  to  David.  Under 
                                                                     Step 2 of that method (Kara, David) and under                   Rules for 

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the Taxpayer(s) Allocating With Taxpayers Who Divorced                             After completing Worksheet C, David completes Form 
or Legally Separated in 2022 (Lydia, Kimberly), Kara and                           8962, Part IV, line 30, as follows.
Lydia agree to allocate 50% of the policy amounts to Ly-
                                                                                   Column  (a). David  enters  the  Marketplace-assigned 
dia, and Kara and Kimberly agree to allocate 25% of the 
                                                                                   policy number from Form 1095-A, line 2.
policy amounts to Kimberly. David and Lydia agree to allo-
cate 20% of the policy amounts to Lydia, and David and                             Column (b).  David enters Kara's SSN.
Kimberly agree to allocate 25% of the policy amounts to 
                                                                                   Column (c). David enters “01.”
Kimberly. Each of them completes a worksheet as shown 
below and uses it to complete Part IV.                                             Column (d).  David enters “09.”
Kara completes Worksheet C as follows.
                                                                                   Columns (e), (f), and (g).    David enters “0.33.”
Kara's Worksheet C. Allocations for Divorced 
or Legally Separated Taxpayers                                                     After  completing  Part  IV,  David  completes  his  Form 
1. Enter as a decimal your percentage                                              8962 in the same manner described in                         Example 1, earlier, 
   from Step 1 above . . . . . . . . . . . . . . . . .         1.       0.40       but applies the different allocation percentage.

2. Enter 1.0 . . . . . . . . . . . . . . . . . . . . . . . . . 2.       1.0        Lydia completes Worksheet D as follows.
3. Enter as a decimal the total of the                                             Lydia's Worksheet D. Taxpayer Allocating 
   percentages from Step 2 above                                                   With Divorced or Legally Separated 
   allocated to the other 
   taxpayer(s)  . . . . . . . . . . . . . . . . . . . . . . .  3.       0.75*      Taxpayers
4. Subtract line 3 from line 2  . . . . . . . . . . .          4.       0.25       1. Enter the decimal from line 1 of the 
                                                                                      Worksheet C completed by one of the 
5. Multiply line 1 by line 4. Enter the result 
                                                                                      former spouses from Step 1 
   as a decimal. This is the allocation                                                                                                                  0.40
   percentage. Go to Step 4 below . . . . . .                  5.       0.10          above  . . . . . . . . . . . . . . . . . . . . . . . . .  1.
                                                                                   2. Enter as a decimal the percentage 
* This is the total of Kara's agreed percentages with Lydia and                       from Step 1 above . . . . . . . . . . . . . . .           2.       0.50
Kimberly (0.50 + 0.25).                                                            3. Multiply line 1 by line 2 . . . . . . . . . . . .         3.       0.20
After  completing  Worksheet  C,  Kara  completes  Form                            4. Enter the decimal from line 1 of the 
8962, Part IV, line 30, as follows.                                                   Worksheet C completed by the other 
Column  (a). Kara  enters  the  Marketplace-assigned                                  former spouse from Step 2 
policy number from Form 1095-A, line 2.                                               above . . . . . . . . . . . . . . . . . . . . . . . . .   4.       0.60
                                                                                   5. Enter as a decimal the percentage 
Column (b). Kara enters David's SSN.                                                  from Step 2 above . . . . . . . . . . . . . . .           5.       0.20
Column (c). Kara enters “01.”                                                      6. Multiply line 4 by line 5 . . . . . . . . . . . .         6.       0.12
Column (d). Kara enters “09.”                                                      7. Add line 3 and line 6. This is the 
                                                                                      allocation percentage. Go to Step 4 
Columns (e), (f), and (g).  Kara enters “0.10.”                                       below . . . . . . . . . . . . . . . . . . . . . . . . . . 7.       0.32

After  completing  Part  IV,  Kara  completes  her  Form                           After completing Worksheet D, Lydia completes Form 
8962 in the same manner described in                           Example 1, earlier, 8962, Part IV, line 30, as follows.
but applies the different allocation percentage.
                                                                                   Column  (a). Lydia  enters  the  Marketplace-assigned 
David completes Worksheet C as follows.                                            policy number from Form 1095-A, line 2.
David's Worksheet C. Allocations for 
                                                                                   Column (b).  Lydia enters Kara's SSN.
Divorced or Legally Separated Taxpayers
                                                                                   Column (c). Lydia enters “01.”
1. Enter as a decimal your percentage 
   from Step 1 above . . . . . . . . . . . . . . . .           1.       0.60       Column (d).  Lydia enters “09.”
2. Enter 1.0 . . . . . . . . . . . . . . . . . . . . . . . .   2.       1.0        Columns (e), (f), and (g).    Lydia enters “0.32.”
3. Enter as a decimal the total of the 
   percentages from Step 2 above                                                   After  completing  Part  IV,  Lydia  completes  her  Form 
   allocated to the other                                                          8962 in the same manner as in Example 1, earlier, but ap-
   taxpayer(s)  . . . . . . . . . . . . . . . . . . . . . .    3.       0.45*      plies the different allocation percentage.
4. Subtract line 3 from line 2  . . . . . . . . . .            4.       0.55
                                                                                   Kimberly completes Worksheet D as follows.
5. Multiply line 1 by line 4. Enter the result 
   as a decimal. This is the allocation 
   percentage. Go to Step 4 
   below . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.       0.33
* This is the total of David's agreed percentages with Lydia 
and Kimberly (0.20 + 0.25). 

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Kimberly's Worksheet D. Taxpayer Allocating Example. Pat and Jamie were married for all of 2022
With Divorced or Legally Separated and have three children, Jason, Alicia, and Dawn. All five
Taxpayers individuals enrolled in a qualified health plan and were
covered for all of 2022. At enrollment, Pat and Jamie ex-
1. Enter the decimal from line 1 of the pected to file a joint return and include the children in their
Worksheet C completed by one of the tax family for the year of coverage. However, Pat and Ja-
former spouses from Step 1 mie change their minds and file as married filing sepa-
above . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0.40 rately and each includes only themselves in their respec-
2. Enter as a decimal the percentage tive tax family. Neither checks the box in the top
from Step 1 above . . . . . . . . . . . . . . . 2. 0.25 right-hand corner of Form 8962. Jason, Alicia, and Dawn
3. Multiply line 1 by line 2 . . . . . . . . . . . . 3. 0.10 moved in with their uncle, Andy, in April. Andy files as
4. Enter the decimal from line 1 of the head of household and includes Jason, Alicia, and Dawn
Worksheet C completed by the other in his tax family.
former spouse from Step 2 Pat and Jamie use the allocation method under Rules
above . . . . . . . . . . . . . . . . . . . . . . . . . 4. 0.60 for the Married Taxpayers Not Filing a Joint Return and
5. Enter as a decimal the percentage Also Allocating With Another Taxpayer next.
from Step 2 above . . . . . . . . . . . . . . . 5. 0.25 Andy uses the allocation method under Rules for the
Taxpayer(s) Allocating With Married Taxpayers Not Filing
6. Multiply line 4 by line 5 . . . . . . . . . . . . 6. 0.15
a Joint Return, later.
7. Add line 3 and line 6. This is the
allocation percentage. Go to Step 4
below . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 0.25 Rules for the Married Taxpayers Not Filing a
Joint Return and Also Allocating With
After completing Worksheet D, Kimberly completes Another Taxpayer

Form 8962, Part IV, line 30, as follows. Use this allocation method if you are married but not filing
Column (a). Kimberly enters the Marketplace-as- a joint return and you must allocate policy amounts with
signed policy number from Form 1095-A, line 2. your spouse and with a taxpayer who is including in their
tax family an individual enrolled in a qualified health plan
Column (b). Kimberly enters Kara's SSN. with members of your and your spouse’s tax families. Un-
Column (c). Kimberly enters “01.” der this method, you must first allocate 50% each of en-
rollment premiums and APTC to yourself and your
Column (d). Kimberly enters “09.” spouse. Line 4 of Worksheet E accomplishes this 50% al-
Columns (e), (f), and (g). Kimberly enters “0.25.” location. Complete the steps below to determine the
amounts to enter on your Form 8962, Part IV.
After completing Part IV, Kimberly completes her Form
8962 in the same manner described for Lydia in Exam- Step 1. Determine the applicable SLCSP for your cover-
ple 1, earlier, but applies the different allocation percent- age family. See Determining the Premium for the Applica-
age. ble Second Lowest Cost Silver Plan (SLCSP), earlier. For
this purpose, your coverage family or your spouse’s cov-
erage family (but not both) should include the individuals
Allocation Among Taxpayers Who Are the other taxpayer is including in their tax family and who
Married But Not Filing a Joint Return was enrolled in a qualified health plan with your and your
and One or More Other Taxpayers spouse’s tax family members. Enter the applicable
SLCSP premium you determined on line 5 of Worksheet
Use this section if you meet either of the following condi- E.
tions and no other allocations for the policy are necessary.
Step 2. Separately from the first allocation (the 50%
• You are allocating enrollment premiums and APTC spousal allocation), determine an allocation percentage
with a spouse to whom you are legally married but not with the taxpayer(s) including in their tax family the individ-
filing a joint return in 2022 and you are also allocating ual(s) enrolled in the plan. You may agree on any alloca-
enrollment premiums, applicable SLCSP premiums, tion percentage from -0- to 100. You may use the percent-
and APTC with another taxpayer who is including in age you agreed on for every month in which this allocation
their tax family an individual who was enrolled in a rule applies, or you may agree on different percentages
qualified health plan with members of your and your for different months. However, you must use the same al-
spouse’s tax families. location percentage for all policy amounts (enrollment pre-
• You are the taxpayer who is including in your tax fam- miums, applicable SLCSP premiums, and APTC) in a
ily an individual who was enrolled in the plan with tax month. If you cannot agree on an allocation percentage,
family members of taxpayers who must also allocate the allocation percentage is equal to the number of indi-
policy amounts because the taxpayers are legally viduals the other taxpayer includes in their tax family for
married but not filing a joint return in 2022. the tax year who were enrolled in the qualified health plan
for which you are allocating amounts, divided by the total

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number of individuals enrolled in the plan. The allocation enter the decimal from line 4 of Worksheet E in column
percentage is the percentage that applies to the amounts (e).
the other taxpayer must use to compute the PTC and rec-
Column (f). If your filing status is married filing sepa-
oncile it with APTC. You must compute the PTC and rec-
rately and you did not check the box in the top right-hand
oncile APTC using the remaining amounts.
corner of Form 8962, leave column (f) blank. If you
checked the box, or Exception 1—Certain married per-
Step 3. Complete Worksheet E below. sons living apart under Married taxpayers (discussed ear-
Worksheet E. Allocations for Married lier under Terms You May Need To Know) applies to you,
enter the decimal from line 3 of Worksheet E in column (f)
Taxpayers Not Filing a Joint Return
and include the amount from line 6 of Worksheet E in the
1. Enter 1.0 . . . . . . . . . . . . . . . . . . . . . . . 1. 1.0 totals on the appropriate lines of Form 8962, column (b),
2. Enter as a decimal the total of the for the months allocated.
percentage(s) from Step 2 above Column (g). Enter the decimal from line 4 of Work-
allocated to the other sheet E.
taxpayer(s) . . . . . . . . . . . . . . . . . . . . . 2.
3. Subtract line 2 from line 1 . . . . . . . . . 3. Rules for the Taxpayer(s) Allocating With
4. Divide line 3 by 2.0. Enter the result as Married Taxpayers Not Filing a Joint Return
a decimal . . . . . . . . . . . . . . . . . . . . . . 4.
5. Enter the applicable SLCSP premium Use this allocation method if you are including in your tax
as determined in Step 1 above. Then, family an individual who was enrolled in a qualified health
go to line 6 if you checked the box in plan with tax family members of taxpayers who must also
the top right-hand corner of Form allocate policy amounts because the taxpayers are legally
8962, or Exception 1—Certain married married but not filing a joint return in 2022.
persons living apart under Married
taxpayers (discussed earlier under Step 1. Determine an allocation percentage with one of
Terms You May Need To Know) the spouses. You may agree on any allocation percentage
applies to you. Otherwise, stop from -0- to 100. You may use the percentage you agreed
here . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. on for every month in which this allocation rule applies, or
6. Multiply line 5 by line 3. Complete you may agree on different percentages for different
Form 8962, Part IV, as instructed in months. However, you must use the same allocation per-
Step 4 below . . . . . . . . . . . . . . . . . . . . 6. centage for all policy amounts (enrollment premiums, ap-
plicable SLCSP premiums, and APTC) in a month. If you
Step 4. If you use the same percentage for every month cannot agree on an allocation percentage, the allocation
during which this allocation method applies, use only one percentage is equal to the number of individuals you will
of lines 30 through 33 in Part IV to report the allocation. If include in your tax family for the tax year who were enrol-
you use different percentages for different months under led in the qualified health plan for which you are allocating
Step 2, use a separate line in Part IV for each allocation policy amounts, divided by the total number of individuals
percentage. Complete the line as explained below. enrolled in the plan. The allocation percentage is the per-
centage that applies to the amounts you must use to com-
Column (a). Enter the Marketplace-assigned policy pute the PTC and reconcile it with APTC. The spouses
number from Form 1095-A, line 2. If the policy number on must compute the PTC and reconcile APTC using the re-
the Form 1095-A is more than 15 characters, enter only maining amounts. Enter the percentage as a decimal on
the last 15 characters. line 1 of Worksheet F.
Column (b). Enter the SSN of your spouse.
Step 2. Allocate the policy amounts with the second
Column (c). Enter the first month you are allocating spouse using the same rules as Step 1 above. Enter the
policy amounts. For example, if you are allocating a per- percentage as a decimal on line 3 of Worksheet F.
centage from January through June, enter “01” in column
(c). Step 3. Complete Worksheet F below.
Column (d). Enter the last month you are allocating
policy amounts. For example, if you are allocating a per-
centage from January through June, enter “06” in column
(d).
Column (e). If your filing status is married filing sepa-
rately and you did not check the box in the top right-hand
corner of Form 8962, leave column (e) blank. If you
checked the box, or Exception 1—Certain married per-
sons living apart under Married taxpayers (discussed ear-
lier under Terms You May Need To Know) applies to you,

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Worksheet F. Taxpayer Allocating With percentage from January through June, enter “06” in col-
Married Taxpayers Not Filing a Joint Return umn (d).
Part I: Allocation Percentage for Enrollment Premiums Column (e). Enter the decimal from Worksheet F,
and APTC Paid line 5.
1. Enter as a decimal the percentage Column (f). Leave column (f) blank.
from Step 1 above . . . . . . . . . . . . . . . . 1.
Column (g). Enter the decimal from Worksheet F,
2. Divide line 1 by 2.0. Enter the result as line 5.
a decimal . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Enter as a decimal the percentage Example. Pat and Jamie were married for all of 2022
from Step 2 above . . . . . . . . . . . . . . . . 3. and have three children, Jason, Alicia, and Dawn. All five
4. Divide line 3 by 2.0. Enter the result as individuals enrolled in a qualified health plan and were
a decimal . . . . . . . . . . . . . . . . . . . . . . . . 4. covered for all of 2022. For each month of coverage, the
enrollment premiums were $1,000, the premium for the
5. Add lines 2 and 4. Enter the result as a
applicable SLCSP for a coverage family of five was $800,
decimal. This is your allocation
percentage for enrollment premiums and the APTC was $200. At enrollment, Pat and Jamie ex-
and APTC paid . . . . . . . . . . . . . . . . . . . 5. pected to file a joint return and include the children in their
tax family.
Part II: Allocation of the Applicable SLCSP Premium Jason, Alicia, and Dawn moved in with their uncle,
6. Enter the amount of the applicable Andy, in April. On their respective tax returns, Pat and Ja-
SLCSP premium from line 5 of mie file as married filing separately and each includes only
Worksheet E completed by the spouse themselves in their respective tax family. Neither checks
in Step 1 above . . . . . . . . . . . . . . . . . . . 6. the box in the top right-hand corner of Form 8962. Andy
7. Enter the decimal from line 1 of this files as head of household and includes Jason, Alicia, and
worksheet . . . . . . . . . . . . . . . . . . . . . . . 7. Dawn in his tax family.
8. Multiply line 6 by line 7 . . . . . . . . . . . . . 8. Pat and Jamie allocate the enrollment premiums and
the APTC 50% to Pat and 50% to Jamie. Under Step 1 of
9. Enter the amount of the applicable Rules for the Married Taxpayers Not Filing a Joint Return
SLCSP premium from line 5 of and Also Allocating With Another Taxpayer, earlier, Pat
Worksheet E completed by the spouse and Jamie determine that Pat’s coverage family will in-
in Step 2 above . . . . . . . . . . . . . . . . . . . 9.
clude Pat, Jason, and Alicia and that Jamie’s coverage
10. Enter the decimal from line 3 of this family will include Jamie and Dawn. Pat and Jamie each
worksheet . . . . . . . . . . . . . . . . . . . . . . . 10.
look up their applicable SLCSP premiums. The applicable
11. Multiply line 9 by line 10 . . . . . . . . . . . . 11. SLCSP premium for Pat’s coverage family of three is $450
12. Add lines 8 and 11. This is the and the applicable SLCSP premium for Jamie’s coverage
applicable SLCSP premium allocated family of two is $400.
to you that you must include on lines Under Step 2 of Rules for the Married Taxpayers Not
12 through 23, column (b), for the Filing a Joint Return and Also Allocating With Another
months in which this allocation Taxpayer (Pat, Jamie) and under Rules for the Tax-
applies . . . . . . . . . . . . . . . . . . . . . . . . . . 12. payer(s) Allocating With Married Taxpayers Not Filing a
Joint Return (Andy), earlier, Pat and Andy agree to allo-
Step 4. If you use the same percentage for every month cate 67% of the policy amounts to Andy, and Jamie and
during which this allocation method applies, use only one Andy agree to allocate 50% of the policy amounts to
of lines 30 through 33 in Part IV to report the allocation. If Andy. Pat, Jamie, and Andy each complete a worksheet
you use different percentages for different months, use a as shown below and use it to complete Part IV.
separate line in Part IV for each allocation percentage. Pat completes Worksheet E as follows.
Complete the line as explained below.
Column (a). Enter the Marketplace-assigned policy
number from Form 1095-A, line 2. If the policy number on
the Form 1095-A is more than 15 characters, enter only
the last 15 characters.
Column (b). Enter the SSN of the spouse whose per-
centage you entered on Worksheet F, line 1.
Column (c). Enter the first month you are allocating
policy amounts. For example, if you are allocating a per-
centage from January through June, enter “01” in column
(c).
Column (d). Enter the last month you are allocating
policy amounts. For example, if you are allocating a

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Pat's Worksheet E. Allocations for Married                              Jamie's Worksheet E. Allocations for Married 
Taxpayers Not Filing a Joint Return                                     Taxpayers Not Filing a Joint Return
1. Enter 1.0 . . . . . . . . . . . . . . . . . . . . . . . .    1. 1.0  1. Enter 1.0 . . . . . . . . . . . . . . . . . . . . . . .    1. 1.0
2. Enter as a decimal the total of the                                  2. Enter as a decimal the total of the 
   percentage(s) from Step 2 above                                         percentage(s) from Step 2 above 
   allocated to the other                                                  allocated to the other 
   taxpayer(s)  . . . . . . . . . . . . . . . . . . . . . .     2. 0.67    taxpayer(s)  . . . . . . . . . . . . . . . . . . . . .     2. 0.50
3. Subtract line 2 from line 1 . . . . . . . . . .              3. 0.33 3. Subtract line 2 from line 1 . . . . . . . . .              3. 0.50
4. Divide line 3 by 2.0. Enter the result as                            4. Divide line 3 by 2.0. Enter the result as 
   a decimal  . . . . . . . . . . . . . . . . . . . . . . .     4. 0.17    a decimal  . . . . . . . . . . . . . . . . . . . . . .     4. 0.25
5. Enter the applicable SLCSP premium                                   5. Enter the applicable SLCSP premium 
   as determined in Step 1 above. Then,                                    as determined in Step 1 above. Then, 
   go to line 6 if you checked the box in                                  go to line 6 if you checked the box in 
   the top right-hand corner of Form                                       the top right-hand corner of Form 
   8962, or Exception 1—Certain married                                    8962, or Exception 1—Certain married 
   persons living apart under Married                                      persons living apart under Married 
   taxpayers (discussed earlier under                                      taxpayers (discussed earlier under 
   Terms You May Need To Know)                                             Terms You May Need To Know) 
   applies to you. Otherwise, stop                                         applies to you. Otherwise, stop 
   here . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 450     here . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 400
6. Multiply line 5 by line 3. Complete                                  6. Multiply line 5 by line 3. Complete 
   Form 8962, Part IV, as instructed in                                    Form 8962, Part IV, as instructed in 
   Step 4 below . . . . . . . . . . . . . . . . . . . . .       6.         Step 4 below . . . . . . . . . . . . . . . . . . . .       6.  
After  completing  Worksheet  E,  Pat  completes  Form 
8962, Part IV, line 30, as follows.                                     After completing Worksheet E, Jamie completes Form 
                                                                        8962, Part IV, line 30, as follows.
Column (a). Pat enters the Marketplace-assigned pol-
icy number from Form 1095-A, line 2.                                    Column  (a). Jamie  enters  the  Marketplace-assigned 
                                                                        policy number from Form 1095-A, line 2.
Column (b). Pat enters Jamie’s SSN.
                                                                        Column (b).  Jamie enters Pat’s SSN.
Column (c). Pat enters “01.”
                                                                        Column (c).  Jamie enters “01.”
Column (d). Pat enters “12.”
                                                                        Column (d).  Jamie enters “12.”
Column (e). Pat leaves this column blank.
                                                                        Column (e).  Jamie leaves this column blank.
Column (f). Pat leaves this column blank.
                                                                        Column (f). Jamie leaves this column blank.
Column (g). Pat enters “0.17.”
                                                                        Column (g).  Jamie enters “0.25.”
After completing Part IV, Pat multiplies the APTC from 
Form 1095-A, Part III, column C, by the percentage in Part              After  completing  Part  IV,  Jamie  multiplies  the  APTC 
IV, column (g), and enters $34 (APTC of $200 x 0.17) on                 from Form 1095-A, Part III, column C, by the percentage 
Form  8962,  lines  12  through  23,  column  (f).  Pat  leaves         in  Part  IV,  column  (g),  and  enters  $50  (APTC  of  $200  x 
lines  12  through  23,  columns  (a)  through  (e),  blank  be-        0.25) on Form 8962, lines 12 through 23, column (f). Ja-
cause he is not eligible to take the PTC.                               mie leaves lines 12 through 23, columns (a) through (e), 
                                                                        blank because she is not eligible to take the PTC.
Jamie completes Worksheet E as follows.
                                                                        Andy completes Worksheet F as follows.

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Andy's Worksheet F. Taxpayer Allocating                                  On each of those lines, he will enter $590 in column (a) 
With Married Taxpayers Not Filing a Joint                                (enrollment premiums of $1,000 x 0.59), $502 in column 
Return                                                                   (b) (applicable SLCSP premium allocated to him on Work-
                                                                         sheet F, line 12), and $118 in column (f) (APTC of $200 x 
Part I: Allocation Percentage for Enrollment Premiums                    0.59).
and APTC Paid
1.  Enter as a decimal the percentage                                    Other Taxpayers Allocating Policy 
    from Step 1 above . . . . . . . . . . . . . . . .           1.  0.67
                                                                         Amounts With Two or More Other 
2.  Divide line 1 by 2.0. Enter the result as 
    a decimal . . . . . . . . . . . . . . . . . . . . . . . .   2.  0.34 Taxpayers

3.  Enter as a decimal the percentage                                    If you or another person in your tax family was enrolled in 
    from Step 2 above . . . . . . . . . . . . . . . .           3.  0.50 a qualified health plan with individuals in at least two other 
4.  Divide line 3 by 2.0. Enter the result as                            tax families, APTC was paid for coverage under the pol-
    a decimal . . . . . . . . . . . . . . . . . . . . . . . .   4.  0.25 icy, and you don't meet the rules for divorce or for married 
5.  Add lines 2 and 4. Enter the result as a                             individuals filing separate returns, you and the taxpayers 
    decimal. This is your allocation                                     who are including in their tax family the individuals not in 
    percentage for enrollment premiums                                   your tax family should use the instructions for Form 8962 
    and APTC paid . . . . . . . . . . . . . . . . . . .         5.  0.59 under Allocation Situation 4. Other situations where a pol-
Part II: Allocation of the Applicable SLCSP Premium                      icy is shared between two tax families to allocate amounts 
                                                                         from the qualified health plan. There must be an allocation 
6.  Enter the amount of the applicable                                   percentage for each taxpayer who is including in their tax 
    SLCSP premium from line 5 of                                         family  an  individual  who  is  enrolled  in  a  qualified  health 
    Worksheet E completed by the spouse                                  plan with a member of your tax family. If you cannot agree 
    in Step 1 above . . . . . . . . . . . . . . . . . . .       6.  450
                                                                         on an allocation percentage with all taxpayers who are in-
7.  Enter the decimal from line 1 of this                                cluding enrolled individuals in a tax family, the allocation 
    worksheet . . . . . . . . . . . . . . . . . . . . . . .     7.  0.67
                                                                         percentage for a particular taxpayer is equal to the num-
8.  Multiply line 6 by line 7 . . . . . . . . . . . . .         8.  302  ber of individuals the taxpayer will include in their tax fam-
9.  Enter the amount of the applicable                                   ily  for  the  tax  year  who  were  enrolled  in  the  qualified 
    SLCSP premium from line 5 of                                         health  plan  for  which  you  are  allocating  policy  amounts, 
    Worksheet E completed by the spouse                                  divided by the total number of individuals enrolled in the 
    in Step 2 above . . . . . . . . . . . . . . . . . . .       9.  400  plan.
10. Enter the decimal from line 3 of this                                Example 1. Erik enrolled himself and his sons, Bill and 
    worksheet . . . . . . . . . . . . . . . . . . . . . . .     10. 0.50
                                                                         Arvind,  in  a  qualified  health  plan  with  coverage  effective 
11. Multiply line 9 by line 10 . . . . . . . . . . . .          11. 200  for  all  of  2022.  For  the  year,  the  enrollment  premiums 
12. Add lines 8 and 11. This is the                                      were $8,000; the premium for the applicable SLCSP for a 
    applicable SLCSP premium allocated                                   coverage  family  consisting  of  Erik,  Bill,  and  Arvind  was 
    to you that you must include on lines                                $9,000; and the APTC paid for their coverage was $4,500. 
    12 through 23, column (b), for the                                   In March, Bill dropped out of school to work full-time and 
    months in which this allocation                                      moved  permanently  into  his  own  apartment.  In  May,  Ar-
    applies . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 502  vind moved in with his mother Sharon, where he lived until 
                                                                         the end of 2022. On their respective tax returns, Erik files 
After  completing  Worksheet  F,  Andy  completes  Form                  as  single  and  includes  only  himself  in  his  tax  family,  Bill 
8962, Part IV, line 30, as follows.                                      files as single and includes only himself in his tax family, 
                                                                         and Sharon files as head of household and includes her-
Column  (a). Andy  enters  the  Marketplace-assigned                     self and Arvind in her tax family.
policy number from Form 1095-A, line 2.                                  Erik  and  Bill  agree  to  allocate  25%  of  the  policy 
Column (b).  Andy enters Pat’s SSN.                                      amounts to Bill. Erik and Sharon agree to allocate 40% of 
                                                                         the policy amounts to Sharon. Erik allocates the remaining 
Column (c).  Andy enters “01.”                                           35% of the policy amounts to himself.
Column (d).  Andy enters “12.”                                           Bill completes Form 8962, Part IV, line 30, as follows.
Column (e).  Andy enters “0.59.”                                         Column (a). Bill enters the Marketplace-assigned pol-
                                                                         icy number from Form 1095-A, line 2.
Column (f).  Andy leaves this column blank.
                                                                         Column (b). Bill enters Erik's SSN.
Column (g).  Andy enters “0.59.”
                                                                         Column (c). Bill enters “01.”
After completing Part IV, Andy multiplies the amounts                    Column (d). Bill enters “12.”
from Form 1095-A, Part III, by the corresponding percen-
tages in Part IV, and enters these allocated amounts on                  Columns  (e),  (f),  and  (g).    Bill  enters  an  allocation 
Form 8962, lines 12 through 23, columns (a), (b), and (f).               percentage of “0.25” in columns (e), (f), and (g).

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After completing Part IV, Bill multiplies the amounts is 34%, which is the percentage of policy amounts not al-
from Form 1095-A, Part III, by the corresponding percen- located to Bill and Sharon. Each taxpayer completes Part
tages in Part IV, and enters these allocated amounts on IV as explained in Example 1 using these percentages.
his Form 8962, lines 12 through 23, columns (a), (b), and
(f). The sum of his monthly entries will be $2,000 in col-
umn (a) (enrollment premiums of $8,000 x 0.25), $2,250 in
Alternative Calculation for Year
column (b) (applicable SLCSP premium of $9,000 x 0.25),
and $1,125 in column (f) (APTC of $4,500 x 0.25). of Marriage
Sharon completes Form 8962, Part IV, line 30, as fol-
If you got married during 2022 and APTC was paid for an
lows.
individual in your tax family, you may want to use the alter-
Column (a). Sharon enters the Marketplace-assigned native calculation for year of marriage, an optional calcula-
policy number from Form 1095-A, line 2. tion that may reduce the amount of excess APTC you
would have to repay under the general rules. Before you
Column (b). Sharon enters Erik’s SSN.
read this section, first read the instructions for line 9 in the
Column (c). Sharon enters “01.” Instructions for Form 8962. Complete Table 4 and, if re-
quired, Worksheet 3 in those instructions.
Column (d). Sharon enters “12.”
If you do not meet either of the above conditions,
Columns (e), (f), and (g). Sharon enters an allocation ! you are not eligible to elect the alternative calcu-
percentage of “0.40” in columns (e), (f), and (g). CAUTION lation. Leave Form 8962, Part V, blank.
After completing Part IV, Sharon multiplies the amounts
from Form 1095-A, Part III, by the corresponding percen- If you are eligible, electing the alternative calculation
tages in Part IV, and enters these allocated amounts on may reduce the amount of excess APTC you have to re-
Form 8962, lines 12 through 23, columns (a), (b), and (f). pay. Electing the alternative calculation is optional. Work-
The sum of her monthly entries will be $3,200 in column sheet V will tell you whether the alternative calculation will
(a) (enrollment premiums of $8,000 x 0.40), $3,600 in col- benefit you.
umn (b) (applicable SLCSP premium of $9,000 x 0.40),
and $1,800 in column (f) (APTC of $4,500 x 0.40). Before you begin the steps, determine your alterna-
tive family size and your spouse’s alternative family size
Erik completes Form 8962, Part IV, line 30, as follows. using the instructions under Alternative Family Size next.
Then, read Table A to determine which steps to complete.
Column (a). Erik enters the Marketplace-assigned
policy number from Form 1095-A, line 2.
Alternative Family Size
Column (b). Erik enters either Bill’s SSN or Sharon’s
SSN. Alternative family size is used to determine an alternative
Column (c). Erik enters “01.” monthly contribution amount (see Monthly contribution
amount under Terms You May Need To Know, earlier) on
Column (d). Erik enters “12.” Worksheets I and III, which may reduce the amount of ex-
Columns (e), (f), and (g). Erik enters an allocation cess APTC for the pre-marriage months that you must re-
percentage of “0.35” in columns (e), (f), and (g), which is pay.
the percentage of policy amounts not allocated to Bill or
When determining your alternative family size, include
Sharon.
yourself and any individual in the tax family who qualifies
After completing Part IV, Erik multiplies the amounts as your dependent for the year under the rules explained
from Form 1095-A, Part III, by the corresponding percen- in the Instructions for Form 1040 or the Instructions for
tages in Part IV, and enters these allocated amounts on Form 1040-NR. Do not include any individual who does
his Form 8962, lines 12 through 23, columns (a), (b), and not qualify as your dependent under those rules or who is
(f). The sum of his monthly entries will be $2,800 in col- included in your spouse’s alternative family size.
umn (a) (enrollment premiums of $8,000 x 0.35), $3,150 in
When determining your spouse’s alternative family
column (b) (applicable SLCSP of $9,000 x 0.35), and
size, include your spouse and any individual in the tax
$1,575 in column (f) (APTC of $4,500 x 0.35).
family who qualifies as your spouse’s dependent for the
Example 2. The facts are the same as in Example 1, year under the rules explained in the Instructions for Form
except Erik and Bill cannot agree on an allocation per- 1040 or the Instructions for Form 1040-NR. Do not include
centage. Because Erik did not agree on an allocation per- any individual who does not qualify as your spouse’s de-
centage with all taxpayers who are including individuals in pendent under those rules or who is included in your alter-
a tax family, Bill and Sharon determine their allocation native family size.
percentages of 33% by dividing the number of enrolled in-
dividuals each will include in their tax family (1 each for Bill Note. You may include an individual who qualifies as
and Sharon) by the number of individuals enrolled in the the dependent of both you and your spouse in either alter-
plan (3, Erik, Bill, and Arvind). Erik’s allocation percentage native family size.

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Example 1. Ron, Suzy, and their son Max have lived Step 1
together since July 2021. Ron and Suzy got married in Au-
gust 2022. Each of them had coverage under a qualified Complete Worksheet I if there is an individual included in
health plan for the months before September. Max quali- your alternative family size who was enrolled in a qualified
fies as Ron’s dependent under the rules explained in the health plan for 1 or more of your pre-marriage months.
Instructions for Form 1040. Max also qualifies as Suzy’s Worksheet for Line 4 of Worksheet I
dependent under those rules. Ron and Suzy can include
Max in either alternative family size. Use this worksheet to figure the amount to enter on line 4
of Worksheet I.
Example 2. Rob and his son Liam lived together from
January through May 2022. On June 10, 2022, Rob mar- 1. Enter the amount from line 2 of Worksheet I . . . . . . . 1.
ried Tara. She moved in with Rob and Liam on June 11. 2. Enter the amount from line 3 of
Each of them had coverage under a qualified health plan Worksheet I . . . . . . . . . . . . . . . . . . . 2.
for the months before July. Liam qualifies as Rob’s de- 3. Multiply the amount on line 2 by 4.0 . . . . . . . . . . . . . 3.
pendent under the rules explained in the Instructions for 4. Is the amount on line 1 more than the amount on
Form 1040. Liam also qualifies as Tara’s dependent un- line 3?
der those rules. (Liam is Tara’s stepchild and lived with Yes. Enter 401 here and on line 4 of Worksheet I.
Tara for more than half of 2022.) Rob and Tara can in- No. Divide the amount on line 1 by the amount on
clude Liam in either alternative family size. line 2. If the result is not a whole percentage, do not
round; instead, multiply this number by 100 (to
Example 3. Stacey and her daughter Leia lived to- express it as a percentage) and then drop any
gether from January through July 2022. Stacey married numbers after the decimal point. Enter the result here
Vince in August 2022 and Vince moved in with Stacey and and on line 4 of Worksheet I. For example, for 0.9984,
Leia. Each of them had coverage under a qualified health enter the result as 99; for 1.8565, enter the result as
185; and for 3.997, enter the result as 399 . . . . . . . . 4.
plan for the months before September. Leia qualifies as
Stacey’s dependent under the rules explained in the In-
structions for Form 1040. Leia does not qualify as Vince’s Step 2
dependent under those rules because Leia did not live
with Vince for more than half of 2022. Stacey must include Complete Worksheet II to determine your alternative
Leia in her alternative family size. Vince cannot include monthly credit amounts to include on Form 8962, lines 12
Leia in his alternative family size. through 23, column (e), for your pre-marriage months. En-
ter in columns A and B on Worksheet II the amounts from
Table A. Which Steps To Complete
columns A and B in Part III of the Form(s) 1095-A that re-
Answer the following questions to determine which ports coverage for all individuals in your tax family enrol-
steps to complete. led in a qualified health plan for 1 or more pre-marriage
months, including yourself, who are (1) included in Part II
1. Have you determined your and your spouse's alternative family of a Form 1095-A sent to you for the pre-marriage months,
size as explained earlier under Alternative Family Size?
or (2) not included in Part II of the Form 1095-A sent to
Yes. Go to question 2. you or to your spouse, but who are included in your alter-
No. Read Alternative Family Size. Then, go to question 2. native family size.
2. Is there an individual in your alternative family size (including
yourself) who was enrolled in a qualified health plan for 1 or more Missing or incorrect SLCSP premium. For your
of your pre-marriage months?* pre-marriage months, if there were changes in your cover-
Yes. Complete Steps 1, 2, and 5. Go to question 3. age family that you did not report to the Marketplace or
No. Go to question 3. APTC was not paid for the coverage, or there is an individ-
3. Is there an individual in your spouse’s alternative family size ual in your coverage family not included in Part II of the
(including your spouse) who was enrolled in a qualified health plan Form 1095-A sent to you who is included in your alterna-
for 1 or more of your pre-marriage months?* tive family size, you may have to determine a new pre-
Yes. Complete Steps 3, 4, and 5. Go to question 4. mium for your applicable SLCSP for those months. See
No. Go to question 4. Determining the Premium for the Applicable Second Low-
est Cost Silver Plan (SLCSP), earlier.
4. The instructions for Step 5 will prompt you to complete Worksheet
V. If you check the “Yes” box on Worksheet V, line 14, complete
Steps 6, 7, and 8. Step 3
* Your pre-marriage months include the month you got married.
Complete Worksheet III if there is an individual included in
If you completed Part IV of Form 8962, do not in- your spouse’s alternative family size who was enrolled in a
TIP clude any amounts from Form(s) 1095-A that qualified health plan for 1 or more of your pre-marriage
were allocated to another taxpayer when complet- months.
ing the steps for your and your spouse's alternative calcu- Worksheet for Line 4 of Worksheet III
lation.
Use this worksheet to figure the amount to enter on line 4
of Worksheet III.

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1. Enter the amount from line 2 of Worksheet III . . . . . 1. your spouse may have to determine a new premium for
the applicable SLCSP for those months. See Determining
2. Enter the amount from line 3 of
Worksheet III . . . . . . . . . . . . . . . . . . . 2. the Premium for the Applicable Second Lowest Cost Sil-
3. Multiply the amount on line 2 by 4.0 . . . . . . . . . . . . 3. ver Plan (SLCSP), earlier.
4. Is the amount on line 1 more than the amount on
line 3? Step 5
Yes. Enter 401 here and on line 4 of Worksheet III.
No. Divide the amount on line 1 by the amount on After you have completed Steps 1 and 2 and/or Steps 3
line 2. If the result is not a whole percentage, do not and 4, complete Worksheet V to determine what entries
round; instead, multiply this number by 100 (to you must make on Form 8962, lines 12 through 23, for
express it as a percentage) and then drop any your pre-marriage months.
numbers after the decimal point. Enter the result here
and on line 4 of Worksheet III. For example, for
0.9984, enter the result as 99; for 1.8565, enter the Step 6
result as 185; and for 3.997, enter the result
as 399 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Complete Form 8962, lines 35 and 36, using the following
instructions. Follow these instructions only if you checked
the “Yes” box on Worksheet V, line 14.
Step 4
Line 35.
Complete Worksheet IV to determine your spouse's alter-
native monthly credit amounts to include on Form 8962, • Column (a): Enter the family size from Worksheet I,
lines 12 through 23, column (e), for your pre-marriage line 1.
months. Enter in columns A and B on Worksheet IV the • Column (b): Enter the amount from Worksheet I,
amounts from columns A and B in Part III of the Form(s) line 7.
1095-A that reports coverage for all individuals in your tax
family enrolled in a qualified health plan for 1 or more • Column (c): Enter the month from Worksheet I, line 8.
pre-marriage months, including your spouse, who are (1) • Column (d): Enter the month from Worksheet I, line 9.
included in Part II of a Form 1095-A sent to your spouse
for the pre-marriage months, or (2) not included in Part II Line 36.
of the Form 1095-A sent to you or to your spouse, but who Column (a): Enter the family size from Worksheet III,
•
are included in your spouse's alternative family size. line 1.
Missing or incorrect SLCSP premium. For your • Column (b): Enter the amount from Worksheet III,
pre-marriage months, if there were changes in your spou- line 7.
se’s coverage family that your spouse did not report to the
Marketplace or APTC was not paid for the coverage, or • Column (c): Enter the month from Worksheet III,
line 8.
there is an individual in your spouse’s coverage family not
included in Part II of the Form 1095-A sent to your spouse • Column (d): Enter the month from Worksheet III,
who is included in your spouse’s alternative family size, line 9.

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Step 7                                                       Column  (d). Subtract  column  (c)  from  column  (b)  and 
                                                             enter the result. If zero or less, enter -0-.
Complete  Form  8962,  lines  12  through  23,  columns  (a) 
through (f), using the following instructions. Follow these  Column  (e). For  your  pre-marriage  months,  enter  the 
instructions only if you checked the “Yes” box on Work-      amounts from lines 1 through 12, column A, of Worksheet 
sheet V, line 14.                                            V  in  the  boxes  for  the  corresponding  months  in  column 
                                                             (e).
Column (a). Enter the amounts from column (a) of Work-        For the months you were married for the entire month, 
sheet 3 in the Form 8962 instructions.                       enter the smaller of column (a) or (d).

Column (b). Enter the amounts from column (b) of Work-       Column (f). Enter the amounts from column (f) of Work-
sheet 3 in the Form 8962 instructions.                       sheet 3 in the Form 8962 instructions.

Column (c). For pre-marriage months, enter the totals of     Step 8
Worksheet II, column C, and Worksheet IV, column C. For 
example, if you entered $200 on Worksheet II, column C,      Continue to Form 8962, line 24, and complete the rest of 
lines 1 through 5, and you entered $250 on Worksheet IV,     the form.
column C, lines 3 through 5, enter $200 on lines 12 and 
13, and $450 on lines 14 through 16 of Form 8962, col-       Line 26. Enter -0-.
umn (c).
For the months you were married for the entire month,        Lines 27 through 29. If line 24 is less than line 25, com-
enter the amount from Form 8962, line 8b.                    plete these lines. Otherwise, leave these lines blank.

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Worksheet I. Your Alternative Monthly Contribution Amount                                         Keep for Your Records
1. Alternative family size: Enter the total number of individuals in your alternative family size 
   (discussed earlier) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          1.  
2. One-half of household income: Divide Form 8962, line 3, by 2.0. Round to the nearest whole 
   dollar amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        2.  
3. Alternative federal poverty line: Enter the federal poverty line amount as determined by your 
   alternative family size on line 1 above and the federal poverty table you used on Form 8962, 
   line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.  
4. Alternative household income as a percentage of federal poverty line: Enter the amount from the 
   worksheet under Step 1.
   Continue to Step 3 if you checked the “Yes” box for question 3 in Table A. Otherwise, if you did not 
   complete Part IV of Form 8962, check the “No” box on line 9 of Form 8962 and continue to line 10. If 
   you completed Part IV of Form 8962, check the “No” box on line 10, and see Lines 12 Through 
   23—Monthly Calculation in the Instructions for Form 8962 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                       4.  
5. Alternative applicable figure: Using your line 4 percentage, locate your applicable figure in Table 2 
   in the Instructions for Form 8962 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                  5.  
6. Multiply line 2 by line 5 and enter the result rounded to the nearest whole dollar amount . . . . . . . . .                                                      6.  
7. Alternative monthly contribution amount: Divide line 6 by 12.0 and enter the result rounded to the 
   nearest whole dollar amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                  7.  
8. Alternative start month: Enter the first full month you or any individual included in your alternative 
   family size on line 1 had coverage under a qualified health plan. For example, enter “02” if you were 
   enrolled in a qualified health plan with coverage effective on February 1 . . . . . . . . . . . . . . . . . . . . . .                                            8.  
9. Alternative stop month: Enter the last month you or any individual included in your alternative family 
   size on line 1 had coverage under a qualified health plan or the month in which you got married, 
   whichever is earlier. For example, enter “09” if you had coverage under a qualified health plan for 
   all of 2022 and you got married on September 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                               9.  

Worksheet II. Your Alternative Monthly Credit Amounts for 
Pre-Marriage Months                                                                               Keep for Your Records
Complete this worksheet only for months beginning with the month on line 8 of Worksheet I and ending with the month 
on line 9 of Worksheet I. For example, if you entered “02” on Worksheet I, line 8, and “10” on Worksheet I, line 9, com-
plete only lines 2 through 10 of this worksheet.
   Monthly      A. Form(s) 1095-A,  B. Form(s) 1095-A,         C. Worksheet I,   D. Subtract C from                                                                     E. Smaller of 
   Calculation       lines 21–32,         lines 21–32,                    line 7 B (If zero or less,                                                                    column A or 
                       column A*             column B*                                            enter -0-.)                                                           column D
1 January
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September
10 October
11 November
12 December
* See Step 2, earlier, for instructions on the Form 1095-A amounts to report on this worksheet.

After completing this worksheet: Continue to Step 3 if you checked the “Yes” box for question 3 in Table A. Otherwise, go to 
Step 5.

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Worksheet III. Your Spouse's Alternative Monthly 
Contribution Amount                                                                            Keep for Your Records
1. Alternative family size: Enter the total number of individuals in your spouse's alternative family size 
   (discussed earlier) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      1.  
2. One-half of household income: Divide Form 8962, line 3, by 2.0. Round to the nearest whole 
   dollar amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    2.  
3. Alternative federal poverty line: Enter the federal poverty line amount as determined by your 
   spouse's alternative family size on line 1 above and the federal poverty table you used on Form 
   8962, line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.  
4. Alternative household income as a percentage of federal poverty line: Enter the amount from the 
   worksheet under Step 3. If you completed Step 2, continue to Step 5. If you did not complete Step 2 
   and you did not complete Part IV of Form 8962, check the “No” box on line 9 of Form 8962 and 
   continue to line 10. If you did not complete Step 2 and you completed Part IV of Form 8962, check 
   the “No” box on line 10, and see Lines 12 Through 23—Monthly Calculation in the Instructions for 
   Form 8962 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    4.  
5. Alternative applicable figure: Using your line 4 percentage, locate your applicable figure in Table 2 in 
   the Instructions for Form 8962 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .               5.  
6. Multiply line 2 by line 5 and enter the result rounded to the nearest whole dollar amount . . . . . . . . . .                                                  6.  
7. Alternative monthly contribution amount: Divide line 6 by 12.0 and enter the result rounded to the 
   nearest whole dollar amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              7.  
8. Alternative start month: Enter the first full month your spouse or any individual included in your 
   spouse's alternative family size on line 1 had coverage under a qualified health plan. For example, 
   enter “05” if your spouse was enrolled in a qualified health plan with coverage effective on May 1 . . .                                                       8.  
9. Alternative stop month: Enter the last month your spouse or any individual included in your spouse's 
   alternative family size on line 1 had coverage under a qualified health plan or the month in which 
   you got married, whichever is earlier. For example, enter “07” if your spouse's coverage under a 
   qualified health plan (and the coverage of all individuals included in your spouse's alternative family 
   size) terminated July 31 and you got married on September 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                      9.  

Worksheet IV. Your Spouse's Alternative Monthly Credit 
Amounts for Pre-Marriage Months                                                                Keep for Your Records
Complete this worksheet only for months beginning with the month on line 8 of Worksheet III and ending with the 
month on line 9 of Worksheet III. For example, if you entered “05” on Worksheet III, line 8, and “10” on Worksheet III, 
line 9, complete only lines 5 through 10 of this worksheet.
   Monthly     A. Form(s) 1095-A,  B. Form(s) 1095-A,       C. Worksheet III,      D. Subtract C from                                                                 E. Smaller of 
   Calculation lines 21–32,             lines 21–32,            line 7             B (If zero or less,                                                                column A or 
               column A*                column B*                                  enter -0-.)                                                                        column D
1 January
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September
10 October
11 November
12 December
* See Step 4, earlier, for instructions on the Form 1095-A amounts to report on this worksheet.

After completing this worksheet: Continue to Step 5.

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Worksheet V. Alternative Calculation for Year of Marriage 
Totals Worksheet                                                                                                      Keep for Your Records
Column A. Complete column A below only for the months you have entries in column E of                                                    Worksheet II and/or Work-
sheet IV. Leave column A blank for all other months. Add the amounts in column E of Worksheets II and IV separately for 
each month and enter the total in column A below on the line for the same month.
Column B. Complete column B below for any month you have an entry in column A. For each month, enter the corre-
sponding amount from lines 1 through 12, column (e), of Worksheet 3 under Line 9 in the Instructions for Form 8962.
                                                                                                                    A. Total alternative B. Premium assistance 
                    Monthly Calculation                                                                             premium assistance     amounts (regular 
                                                                                                                      amounts              calculation)
1     January . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     1
2     February . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      2
3     March . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     3
4     April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5     May . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   5
6     June . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6
7     July . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7
8     August . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    8
9     September . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         9
10    October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     10
11    November . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        11
12    December . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        12
13 Totals: Enter the total of column A, lines 1 through 12, and the 
      total of column B, lines 1 through 12 . . . . . . . . . . . . . . . . . . . . . . . . .                     13
14    Is line 13, column A, more than line 13, column B?
        Yes. Your alternative calculation reduces your excess APTC. If you did not complete Part IV of Form 8962, check the “Yes” 
      box on line 9. Also check the “No” box on line 10. Continue to Steps 6, 7, and 8, earlier.
       
        No. The alternative calculation does not reduce your excess APTC. Leave Form 8962, Part V, blank.
       • If you did not complete Part IV of Form 8962, check the “No” box on line 9 and continue to Form 8962, line 10. If you are 
         required to use lines 12 through 23 of Form 8962, enter the amounts from lines 1 through 12 of Worksheet 3 in the Form 
         8962 instructions on the lines for the corresponding months and columns on Form 8962.
       • If you completed Part IV of Form 8962, check the “No” box on line 10. Enter the amounts from lines 1 through 12 of 
         Worksheet 3 in the Form 8962 instructions on the lines for the corresponding months and columns on Form 8962, lines 12 
         through 23.

Example of the Alternative                                          January  1  through  July  31.  The  Marketplace  sent  him  a 
                                                                    Form 1095-A (not illustrated) showing his enrollment infor-
Calculation for Year of Marriage                                    mation for this 7-month period.
The  following  example  describes  the  alternative  calcula-                                                    From August 1 through December 31, 2022, Paulette, 
tion for year of marriage for Paulette Oak and Quentin Ce-          Quentin, and Quentin’s two dependent children were en-
dar.                                                                rolled  together  in  a  different  qualified  health  plan.  The 
                                                                    Marketplace  sent  them  a  Form  1095-A  (not  illustrated) 
In  2022,  Paulette  and  Quentin  were  single  and  main-
                                                                    showing their enrollment information for this 5-month pe-
tained separate residences until they got married on July 
                                                                    riod.
18.
Paulette  has  no  dependents.  She  was  enrolled  in  a                                                         Paulette and Quentin first complete lines 1 through 8 of 
qualified health plan from January 1 through July 31. The           Form 8962. Then, they read the instructions for line 9 and 
Marketplace  sent  her  a  Form  1095-A  (not  illustrated)         complete Table 4 (not illustrated) and Worksheet 3 (not il-
showing  her  enrollment  information  for  this  7-month  pe-      lustrated) in the Form 8962 instructions and Worksheets I 
riod.                                                               through V (not illustrated) in this publication. Using the in-
                                                                    formation in the worksheets and on Forms 1095-A (not il-
Quentin  has  two  dependent  children.  He  and  his  two          lustrated), they complete lines 9 through 29, 35, and 36 of 
children  were  enrolled  in  a  qualified  health  plan  from      Form 8962.

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Paulette and Quentin's Form 8962, Lines 1 Line 10. As explained under Step 5 (Worksheet V), later,
Through 11 they check “No” on line 10.

Paulette and Quentin fill out Form 8962 (not illustrated), Line 11. Because Paulette and Quentin checked “No” on
lines 1 through 11, as follows. line 10, they skip line 11 and complete lines 12 through 23
to figure their monthly PTC.
Line 1. They enter “4” because this is the number of indi-
viduals they included in their tax family. Step 1 (Paulette's Worksheet I)

Line 2a. They enter $98,000, which they figured using Line 1. They enter “1” as Paulette’s alternative family size
Worksheet 1-1 (not illustrated) in the Form 8962 instruc- because she can include only herself. She can’t include
tions. either of Quentin’s children in her alternative family size
because neither of them lived with her for more than half
Line 2b. They leave line 2b blank because neither of of 2022 and she could not claim them as dependents.
Quentin’s dependent children is required to file a federal
income tax return. Lines 2 through 9. They complete these lines according
to the instructions on the worksheet.
Line 3. They enter $98,000, the sum of lines 2a and 2b.
Line 4. They enter $26,500 from Table 1-1 in the Form Step 2 (Paulette's Worksheet II)
8962 instructions. This is the federal poverty line for a
family size of 4. They also check box c on line 4. They complete Worksheet II only for January through July
(the month Paulette and Quentin got married). They com-
Line 5. Using Worksheet 2 in the Form 8962 instructions, plete columns A and B using the amounts shown on Pau-
they divide line 3 ($98,000) by line 4 ($26,500) to get lette’s Form 1095-A. They complete columns C and D ac-
370%. cording to the instructions shown on the worksheet.

Line 7. They enter their applicable figure of 0.0775 from Step 3 (Quentin's Worksheet III)
Table 2 in the Instructions for Form 8962. According to the
fourth column of Table 2, 0.0775 is the applicable figure if Line 1. They enter “3” as Quentin's alternative family size
the amount on line 5 is 370%. consisting of Quentin and his two dependent children.

Line 8a. They multiply line 3 ($98,000) by line 7 (0.0775) Lines 2 through 9. They complete these lines according
and enter the result, $7,595. to the instructions on the worksheet.
Line 8b. They divide line 8a ($7,595) by 12.0 and enter
the result, $633. Step 4 (Quentin's Worksheet IV)

Line 9. Paulette and Quentin read the instructions for They complete Worksheet IV only for January through
line 9, which explain that because they got married in July (the month Paulette and Quentin got married). They
2022, they may be eligible to complete Part V (not illustra- complete columns A and B using the amounts shown on
ted) to elect the alternative calculation for year of mar- Quentin’s Form 1095-A. They complete columns C and D
riage. This calculation may reduce the amount of excess according to the instructions shown on the worksheet.
APTC they would otherwise have to repay.
The preliminary steps in determining whether they may Step 5 (Worksheet V)
be eligible are to complete Table 4 and Worksheet 3 in the
Form 8962 instructions. (Both the table and worksheet for Quentin and Paulette complete Worksheet V only for the
Paulette and Quentin are not illustrated.) Worksheet 3 months they have entries in column E of Worksheets II
would show that if Paulette and Quentin do not elect the and IV (January through July). They qualify for the alterna-
alternative calculation, their total PTC will be $7,101 tive calculation for year of marriage because line 13, col-
(line 13, column (e)). The excess APTC they will have to umn A ($5,740), is more than line 13, column B ($4,431).
pay with their tax return is $1,309, which is the difference Accordingly, they check “Yes” on line 14. They also check
between $8,410 (APTC for the year on line 13, column (f)) “Yes” on Form 8962, line 9; check “No” on line 10; and
and $7,101. continue to Steps 6, 7, and 8 in this publication.
Because Paulette and Quentin checked the “Yes” box
on line 14 of Worksheet 3, they complete Worksheets I Step 6
through V (not illustrated) to determine if the alternative
calculation for year of marriage will benefit them. They Paulette and Quentin complete lines 35 and 36 as ex-
complete Worksheets I through V before they check any plained below.
of the boxes on line 9. As explained under Step 5 (Work-
sheet V), later, they qualify for the alternative calculation Line 35.
for year of marriage and check “Yes” on line 9.
• Column (a): They enter “1,” Paulette's alternative
family size from Worksheet I, line 1.

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• Column (b): They enter $327, Paulette's alternative Column (d). They enter the difference between columns
monthly contribution amount from Worksheet I, line 7. (c) and (b).

• Column (c): They enter “01,” the alternative start Column (e). On lines 12 through 18, they enter $820, the
month from Worksheet I, line 8. monthly amounts from column A of Worksheet V. On lines
• Column (d): They enter “07,” the alternative stop 19 through 23, they enter $534, the smaller of column (a)
month from Worksheet I, line 9. or (d).

Line 36. Column (f). On lines 12 through 18, they enter $794 and
$573 on lines 19 through 23, the monthly amounts from
• Column (a): They enter “3,” Quentin's alternative fam-
column (f) of Worksheet 3.
ily size from Worksheet III, line 1.
• Column (b): They enter $119, Quentin's alternative Step 8
monthly contribution amount from Worksheet III,
line 7. Paulette and Quentin complete lines 24 through 29 as ex-
plained below.
• Column (c): They enter “01,” the alternative start
month from Worksheet III, line 8. Line 24. They add the amounts on lines 12 through 23,
• Column (d): They enter “07,” the alternative stop column (e), and enter the total, $8,410. (As explained ear-
month from Worksheet III, line 9. lier under Line 9, their total PTC would be only $7,101 if
they did not elect the alternative calculation.)
Step 7
Line 25. They add the amounts on lines 12 through 23,
column (f), and enter the total, $8,423.
Paulette and Quentin complete lines 12 through 23 as
explained below. Line 26. According to Step 8, they enter -0- because they
elected the alternative calculation for year of marriage.
Column (a). On lines 12 through 18, they enter $1,500
and $1,350 on lines 19 through 23, the monthly amounts Line 27. They subtract line 24 from line 25 and enter the
from column (a) of Worksheet 3 (not illustrated). difference, $13.

Column (b). On lines 12 through 18, they enter $1,266 Line 28. They enter the repayment limitation of $2,800
and $1,167 on lines 19 through 23, the monthly amounts from Table 5 in the Form 8962 instructions.
from column (b) of Worksheet 3.
Line 29. They enter $13. This is the smaller of line 27 or
Column (c). On lines 12 through 18, they enter $446, the line 28. They also enter $13 on Schedule 2 (Form 1040),
monthly totals from Worksheet II, column C, and Work- line 2 (non illustrated). (As explained earlier under Line 9,
sheet IV, column C. On lines 19 through 23, they enter the excess APTC they would have to pay would be $1,309
$633, the amount from Form 8962, line 8b. if they did not elect the alternative calculation.)

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If you meet the requirements described above, do the
following.
Self-Employed Health
• If you are filing Schedule 1 (Form 1040), complete
Insurance Deduction and PTC lines 18 (Penalty on early withdrawal of savings) and
19a (Alimony paid). Also, figure any write-in adjust-
This part provides special instructions for figuring the ments you will enter on the dotted line next to line 26.
self-employed health insurance deduction and PTC if you
• Complete line 20 of Schedule 1 (Form 1040) if you
or your spouse was self-employed, you or a member of
made contributions to a traditional individual retire-
your tax family was enrolled in a qualified health plan in
ment arrangement (IRA) and you (and your spouse if
2022, and you may be eligible for the PTC. Because the
filing a joint return) were not covered by a retirement
amount of the self-employed health insurance deduction
plan at work or through self-employment.
may affect the amount of the PTC, and the amount of the
PTC may affect the amount of the deduction, a taxpayer • If you elect to report your child’s interest and divi-
who may be eligible for both may have difficulty determin- dends on your tax return, complete Form 8814, Paren-
ing the amounts of those items. A taxpayer who may be ts’ Election To Report Child’s Interest and Dividends.
eligible for both may follow the instructions in this part to
determine amounts of the self-employed health insurance Using this information, do the following.
deduction and PTC that are allowable under the law. 1. If you have health insurance premiums for which you
Using the special instructions in this part is op- cannot claim the PTC (see Nonspecified premiums,
later), first complete Worksheet P or, if required,
! tional. If you are eligible for both a self-employed Worksheet 6-A in chapter 6 of Pub. 535 but only with
CAUTION health insurance deduction and the PTC for the
same premiums, you may use any computation method respect to those premiums. Skip Worksheets W and
that results in reporting amounts that satisfy the rules for X if either of the following applies.
both the deduction and PTC, as long as the sum of the de- a. You completed Worksheet P and line 2 is less
duction claimed for the premiums and the PTC computed, than or equal to line 1.
taking the deduction into account, is less than or equal to
the enrollment premiums. b. You completed Worksheet 6-A in chapter 6 of
Pub. 535 and line 13 is equal to or less than line 3.
Before you complete any of the worksheets in this part, 2. Then, complete Worksheet W and Worksheet X. You
you should first do the following. have to complete Worksheet X only if APTC was paid
• Read the instructions for line 17 of Schedule 1 (Form to your insurer on your behalf for the months you were
1040) to find out if you meet the requirements for self-employed. If APTC was not paid to your insurer
claiming the self-employed health insurance deduc- on your behalf for the months you were self-em-
tion. ployed, skip Worksheet X.
• Read the Instructions for Form 8962 to find out if you 3. After completing Worksheets W and X, you may
meet the requirements for claiming the PTC except for choose to use either the Simplified Calculation
the requirement that your household income be at Method or the Iterative Calculation Method to com-
least 100% of the federal poverty line for your family pute your self-employed health insurance deduction
size for 2022. You will determine whether you meet and PTC. The Simplified Calculation Method is
the 100% requirement in the process of completing shorter, but in some cases will not produce a result as
these instructions. favorable as the Iterative Calculation Method.

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Worksheet P. Self-Employed Health Insurance Deduction
for Nonspecified Premiums Keep for Your Records

Before you begin: Read Exceptions, later, to see if you can use this worksheet instead of Pub. 535 to figure your deduction for
nonspecified premiums. Also read the definitions of specified premiums and nonspecified premiums.
1. Enter the total amount of nonspecified premiums paid in 2022 for health insurance coverage
established under your business (or the S corporation in which you were a more-than-2%
shareholder) for 2022 for you, your spouse, and your dependents. Your insurance can also
cover your child who was under age 27 at the end of 2022, even if the child was not your
dependent. But do not include amounts for any month you were eligible to participate in an
employer-sponsored health plan or amounts paid from retirement plan distributions that were
nontaxable because you are a retired public safety officer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
2. Enter your net profit* and any other earned income** from the business under which the
insurance plan is established, minus any deductions on lines 15 and 16 of Schedule 1 (Form
1040). Do not include Conservation Reserve Program payments exempt from
self-employment tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Self-employed health insurance deduction for nonspecified premiums. Enter the
smaller of line 1 or line 2. Do not include this amount in figuring any medical expense
deduction on Schedule A (Form 1040) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
• If line 2 is equal to or less than line 1, stop here. Do not read the rest of these special
instructions. Enter this amount on line 17 of Schedule 1 (Form 1040). Use Form 8962 to
figure the PTC for specified premiums.
• If line 2 is more than line 1, complete Worksheet W. Also complete Worksheet X if APTC
was paid to your insurer on your behalf for the months you were self-employed. If APTC
was not paid to your insurer on your behalf for the months you were self-employed, skip
Worksheet X.

* If you used either optional method to figure your net earnings from self-employment, do not enter your net profit. Instead, enter the
amount from Schedule SE, line 4b.

** Earned income includes net earnings and gains from the sale, transfer, or licensing of property you created. However, it does
not include capital gain income. If you were a more-than-2% shareholder in the S corporation under which the insurance plan is
established, earned income is your Medicare wages (box 5 of Form W-2) from that corporation.

insurer on your behalf for the months you were
Instructions for Worksheet P self-employed. If APTC was not paid to your insurer
on your behalf for the months you were self-employed,
Use Worksheet P to figure the amount you can deduct for skip Worksheet X.
nonspecified premiums.
Nonspecified Premiums
Exceptions. Use Worksheet 6-A in chapter 6 of Pub. 535
instead of Worksheet P to figure your deduction for non- A nonspecified premium is either of the following.
specified premiums if any of the following applies. (Only
• A premium for health insurance coverage established
include nonspecified premiums on line 1 or 2 of Work-
under your business (or the S corporation in which
sheet 6-A.)
you were a more-than-2% shareholder) but paid for
• You had more than one source of income subject to coverage in a plan that is not a qualified health plan.
self-employment tax.
• The portion of the premium for coverage in a plan that
• You file Form 2555. is a qualified health plan established under your busi-
• You are using amounts paid for qualified long-term ness (or the S corporation in which you were a
care insurance to figure the deduction. more-than-2% shareholder) but that is attributable to
individuals not in your coverage family.
After you complete Worksheet 6-A, follow the instruc-
tions below. Calculate how much of these nonspecified premiums
• If line 13 is equal to or less than line 3, stop here. Do are fully deductible by entering this amount on line 1 of
not read the rest of these special instructions. Enter Worksheet P or, if required, on line 1 or 2 of Worksheet
the amount from line 14 of Worksheet 6-A on line 17 6-A in chapter 6 of Pub. 535. Complete the remainder of
of Schedule 1 (Form 1040). Use Form 8962 to figure the appropriate worksheet.
the PTC for specified premiums.
• If line 13 is more than line 3, complete Worksheet W.
Also complete Worksheet X if APTC was paid to your

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The following are examples of nonspecified premiums. premiums allocable to your coverage family discussed
next.
• Premiums paid for a qualified health plan other than
during a coverage month. Plan covering individuals not in your coverage fam-
• Premiums paid to cover an individual other than you, ily. If the plan covers individuals who are not in your cov-
your spouse, or your dependents. erage family, use only the portion of the premiums for the
specified qualified health plan that is allocable to your cov-
• Premiums for qualified long-term care insurance.
erage family. You determine the specified premiums that
• Dental insurance premiums. are allocable to your coverage family by multiplying the
• Medicare premiums you voluntarily paid to obtain in- enrollment premiums for the months you were self-em-
surance in your name that is similar to qualifying ployed and the plan covered non-coverage family mem-
health insurance. bers by a fraction. The numerator of the fraction is the pre-
mium for the applicable SLCSP for your coverage family.
Example. In 2022, you were self-employed and were The denominator of the fraction is the total of (1) the pre-
enrolled in a qualified health plan through the Market- mium for the applicable SLCSP for your coverage family,
place. You enrolled your dependent, 22-year-old daughter and (2) the premium for the applicable SLCSP for the indi-
in individual market coverage not offered through the Mar- viduals who are not in your coverage family.
ketplace. This coverage has an annual premium of Example. Gary was self-employed in 2022 and enrol-
$3,000. This $3,000 premium is a nonspecified premium led in a qualified health plan. APTC was paid to his insurer
because it is for coverage under a plan that is not a quali- on his behalf. The policy covers Gary, Gary's wife Sue,
fied health plan. Include this $3,000 premium on Work- and Gary’s two dependent daughters. Sue is not in the
sheet P, line 1, or, if required, on line 1 of Worksheet 6-A coverage family because she is eligible to enroll in her
in chapter 6 of Pub. 535. employer’s health insurance. The enrollment premium is
$15,000. The premium for the applicable SLCSP covering
Specified Premiums Gary and his two daughters is $12,000 and the premium
for the applicable SLCSP covering Sue is $6,000. Gary
Specified premiums are the premiums for a specified figures the amount of specified premiums by multiplying
qualified health plan or plans for which you may otherwise the $15,000 enrollment premium by a fraction. The numer-
claim as a self-employed health insurance deduction on ator of the fraction is the premium for his applicable
line 17 of Schedule 1 (Form 1040). Generally, these are SLCSP ($12,000). The denominator of the fraction is the
the premiums paid for the months you were self-em- total of the premiums for the applicable SLCSP of both
ployed. If you were self-employed for part of a month, the Gary and Sue ($18,000). The result is $10,000 ($15,000
entire premium for that month is a specified premium. A enrollment premium x ($12,000/$18,000)) of specified
specified qualified health plan is a qualified health plan premiums, which Gary enters on Worksheet W, line 1, and
that covers one or more members of your coverage family Worksheet X, line 27. The remaining $5,000 of enrollment
for a month for which your enrollment premium(s) has premium ($15,000 enrollment premium – $10,000 speci-
been paid by the due date prescribed under Enrollment fied premiums) is attributable to Sue's coverage and is a
premiums, earlier. Qualified health plan, coverage family, nonspecified premium that Gary enters on Worksheet P,
and enrollment premiums are defined earlier under Terms line 1.
You May Need To Know.

Example. You were enrolled in a qualified health plan
through the Marketplace for all of 2022 and you were
self-employed from September 15 through December 31.
Only the premiums for the last 4 months are specified pre-
miums and only those premiums are entered on Work-
sheet W, line 1, and Worksheet X, line 27, if you are re-
quired to complete those worksheets. You are not allowed
a self-employed health insurance deduction for the Janu-
ary through August premiums because you were not
self-employed during those months. Those premiums are
neither specified premiums nor nonspecified premiums.
However, you may be allowed a PTC for your coverage
for January through August.

Plan covering individuals in another tax family. If the
plan covers at least one individual in your tax family and
one individual in another tax family, you may have to allo-
cate policy amounts between your tax family and the other
tax family. See Line 9 in the Form 8962 instructions for in-
structions on how to allocate policy amounts. Do this allo-
cation before you determine the portion of the specified

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Worksheet W. Figuring the Limit on the Self-Employed 
Health Insurance Deduction for Specified Premiums                                             Keep for Your Records
Caution. If you have more than one trade or business under which a qualified health plan is established, complete lines 
4 through 13 separately for each trade or business. Add the amounts on line 13 for all the trades or businesses. Then, 
complete lines 14 through 17 once for all trades or businesses.
1.  Enter your specified premiums. See Specified Premiums under Instructions for Worksheet 
    P, earlier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   1.   
2.  Enter the APTC from Form 1095-A, Part III, column C, that is attributable to the premiums on 
    line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.   
3.  Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              3.   
4.  Enter your net profit* and any other earned income** from the business under which the qualified 
    health plan is established. Do not include Conservation Reserve Program payments exempt from 
    self-employment tax. If the business is an S corporation, skip to line 11 . . . . . . . . . . . . . . . . . . . . . .                                          4.   
5.  Enter the total of all net profits* from: Schedule C (Form 1040), line 31; Schedule F (Form 1040), 
    line 34; or box 14, code A, of Schedule K-1 (Form 1065), plus any other income allocable to the 
    profitable businesses. Do not include Conservation Reserve Program payments exempt from 
    self-employment tax. See the Instructions for Schedule SE (Form 1040). Do not include any net 
    losses shown on these schedules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        5.   
6.  Divide line 4 by line 5  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           6.   
 7. Multiply line 15 of Schedule 1 (Form 1040) by line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                               7.   
8.  Subtract line 7 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              8.   
9.  Enter the amount, if any, from line 16 of Schedule 1 (Form 1040) attributable to the same 
    business for which the qualified health plan is established . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                  9.   
10. Subtract line 9 from line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              10.  
11. Enter your Medicare wages (box 5 of Form W-2) from an S corporation in which you are a 
    more-than-2% shareholder and in which the qualified health plan is established . . . . . . . . . . . . . . .                                                   11.  
12. Enter any amount from Form 2555, line 45, attributable to the amount entered on line 4 or line 11 
    above  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   12.  
    Note. If you are not filing Form 2555, enter -0-.
13. Subtract line 12 from line 10 or 11, whichever applies  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                13.  
14. Enter your self-employed health insurance deduction for nonspecified premiums from Worksheet 
    P, line 3, or Worksheet 6-A, line 14, in chapter 6 of Pub. 535 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                   14.  
15. Subtract line 14 from line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                15.  
16. Enter the smaller of line 3 or line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                   16.  
17. Add lines 14 and 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .            17.  
18. Is line 2 blank or -0-? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          18.  
      Yes. Skip line 19 and Worksheet X. Use one of the methods that follow Worksheet X to figure 
    the PTC and self-employed health insurance deduction for specified premiums.
      No. Go to line 19.
19. Subtract line 16 from line 15. Then, go to Worksheet X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                   19.  
* If you used either optional method to figure your net earnings from self-employment from any business, do not enter your net profit from the 
business. Instead, enter the amount attributable to that business from Schedule SE, line 4b.
 
 ** Earned income includes net earnings and gains from the sale, transfer, or licensing of property you created. However, it does not include 
capital gain income.

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Worksheet X. Figuring Household Income and the 
Repayment Limitation                                                                         Keep for Your Records
Complete this worksheet only if APTC was paid to your insurer on your behalf for the months you were self-employed.
Part I: Taxpayer's Modified AGI

1.   Combine the amounts from:
     •  Form 1040, 1040-SR, or 1040-NR, lines 2a, 9, and the excess, if any, of line 6a over 
        line 6b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      1.   
     Note. See the instructions if you are filing Form 8582, 8814, or 8815.
2.   Enter any amounts from Form 2555, lines 45 and 50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                   2.   
3.   Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         3.   
4.   Enter the total of the amounts from:
     •  Schedule 1 (Form 1040), lines 11 through 16, 18, and 19a, plus any write-in adjustments 
        you entered on the dotted line next to Schedule 1 (Form 1040), line 26 . . . . . . . . . . . . . . . . . .                                               4.   
     Note. See the instructions if you made contributions to a traditional IRA.                                                                                       
5.   Enter the amount from Worksheet W, line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                              5.   
6.   Enter the amount from Worksheet W, line 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                              6.   
7.   Add lines 4, 5, and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           7.   
8.   Subtract line 7 from line 3. Then, go to Part II if you are claiming dependents on your tax return. If 
     you are not claiming any dependents on your tax return, skip Part II and go to Part III . . . . . . . . . .                                                 8.   
Part II: Dependents’ Modified AGI

Note. Use Part II to figure the combined modified AGI for the dependents you included in your tax family. Only include the modified 
AGI of those dependents who are required to file a return. Do not include the modified AGI of dependents who are filing a tax return 
only to claim a refund of tax withheld or estimated tax.

9.   Enter the combined AGI for your dependents from Form 1040, 1040-SR, or 1040-NR, 
     line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.   
10.  Enter any tax-exempt interest for your dependents from Form 1040, 1040-SR, or 1040-NR, 
     line 2a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.  
11.  Enter any amounts for your dependents from Form 2555, lines 45 and 50 . . . . . . . . . . . . . . . . . . .                                                 11.  
12.  Enter for each of your dependents the excess, if any, of Form 1040 or 1040-SR, line 6a, over 
     line 6b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.  
13.  Add lines 9 through 12. Then, go to Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        13.  

                                                                                                                                                                 Continued on next page

Instructions for Worksheet X                                  If you are filing Form 8815, Exclusion of Interest From 
                                                              Series EE and I U.S. Savings Bonds Issued After 1989, do 
Line 1. If you are filing Form 8582, Passive Activity Loss    not  complete  the  form  until  you  are  instructed  to  do  so 
Limitations, and both lines 1d and 3 of that form are los-    later. Include on line 1 the amount from Schedule B (Form 
ses:                                                          1040), line 2.

•  Do not complete Part II or III of that form until you are  Line 4.           Include your IRA deduction on line 4 only if you 
   instructed to do so later, and                             (and your spouse if filing a joint return) were                                                         not covered 
•  Do not include any losses from rental real estate activ-   by a retirement plan at work or through self-employment.
   ities on line 1.
                                                              Line  25.         Also  enter  this  amount  on  line  28  of  the  Form 
If  you  are  filing  Form  8814,  and  the  amount  on  Form 8962 you attach to your tax return if you are required to 
8814, line 4, is more than $1,150, you must also include      complete that line and you do not complete                                                              Worksheet Y. 
the following amounts on line 1.                              Do not enter an amount from Table 5 in the Form 8962 in-
•  The tax-exempt interest from Form 8814, line 1b.           structions.
•  The lesser of Form 8814, line 4 or line 5.
•  Any nontaxable social security benefits your child re-
   ceived.

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Worksheet X. Figuring Household Income and the 
Repayment Limitation (continued)                                                                                   Keep for Your Records
Part III: Repayment Limitation
14.  Household income. Add lines 8 and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                       14.   
15.  Enter the smaller of Worksheet W, line 19, or $650 ($325 if your filing status is single) . . . . . . . . .                                              15.   
16.  Subtract line 15 from line 14. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        16.   
17a. Enter the number of qualifying individuals in your tax family 
     (including yourself) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   17a.  
17b. Enter the federal poverty line amount as determined by the family size on line 17a and federal 
     poverty Table 1-1, 1-2, or 1-3 for your state of residence during 2022 in the Form 8962 
     instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17b.  
18.  Divide line 16 by line 17b. If the result is not a whole percentage, do not round; instead, multiply 
     this number by 100 (to express it as a percentage) and then drop any numbers after the decimal 
     point. For example, for 0.9984, enter the result as 99; for 1.8565, enter the result as 185; and for 
     3.997, enter the result as 399 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .             18.   %
     •  If the result is less than 200, enter $650 ($325 if your filing status is single) on line 25. Skip 
        lines 19 through 24.
     •  If the result is 200 or more, go to line 19.
19.  Enter the smaller of Worksheet W, line 19, or $1,650 ($825 if your filing status is single) . . . . . . .                                                19.   
20.  Subtract line 19 from line 14. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        20.   
21.  Divide line 20 by line 17b. If the result is not a whole percentage, do not round; instead, multiply 
     this number by 100 (to express it as a percentage) and then drop any numbers after the decimal 
     point. For example, for 0.9984, enter the result as 99; for 1.8565, enter the result as 185; and for 
     3.997, enter the result as 399 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .             21.   %
     •  If the result is less than 300, enter $1,650 ($825 if your filing status is single) on line 25. Skip 
        lines 22 through 24.
     •  If the result is 300 or more, go to line 22.
22.  Enter the smaller of Worksheet W, line 19, or $2,800 ($1,400 if your filing status is single) . . . . .                                                  22.   
23.  Subtract line 22 from line 14. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        23.   
24.  Divide line 23 by line 17b. If the result is not a whole percentage, do not round; instead, multiply 
     this number by 100 (to express it as a percentage) and then drop any numbers after the decimal 
     point. For example, for 0.9984, enter the result as 99; for 1.8565, enter the result as 185; and for 
     3.997, enter the result as 399 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .             24.   %
     •  If the result is less than 400, enter $2,800 ($1,400 if your filing status is single) on line 25.
     •  If the result is 400 or more, enter the amount from Worksheet W, line 2, on line 25. 
25.  Enter the amount you were instructed to enter here by line 18, 21, or 24. See instructions . . . . . .                                                   25.   
Part IV: Maximum Self-Employed Health Insurance Deduction 
26.  Add lines 6 and 25  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      26.   
27.  Enter the amount from Worksheet W, line 1  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         27.   
28.  Enter the smaller of line 26 or line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                28.   
29.  Enter the amount from Worksheet W, line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                           29.   
30.  Enter the smaller of line 28 or line 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                30.   
31.  Add lines 5 and 30. Then, use one of the methods that follow to figure the PTC and the 
     self-employed health insurance deduction for specified premiums . . . . . . . . . . . . . . . . . . . . . . . . .                                        31.   

Iterative Calculation Method                                       Step 1

Follow the steps below to figure your self-employed health         Figure your AGI, modified AGI, and household income us-
insurance deduction and PTC under the Iterative Calcula-           ing                                  Worksheet X, line 31, as your self-employed health in-
tion Method. You do not have to use this method. You can           surance deduction. If you did not fill out Worksheet X, use 
use the Simplified Calculation Method (discussed later) or         the amount from                                 Worksheet W, line 17. Use Worksheets 
any computation method that satisfies each set of rules as         1-1 and 1-2 in the Form 8962 instructions to figure modi-
long as the sum of the deduction claimed for the premi-            fied AGI and household income.
ums and the PTC computed, taking the deduction into ac-                                                   If you are claiming any of the following deductions 
count, is less than or equal to the premiums.                                                           ! or  exclusions,  see                                Special  Instructions  for 
        Do  not  round  to  whole  dollars  when  performing       CAUTION                                Self-Employed Individuals Who Claim Certain De-
                                                                   ductions/Exclusions, later, before you complete Step 1.
!       the computations under this method. Instead, use 
CAUTION dollars  and  cents.  This  is  necessary  so  you  can 
                                                                   1. Passive activity losses from rental real estate activi-
complete Step 6.                                                                                        ties and lines 1d and 3 of Form 8582 are losses.
                                                                   2. IRA deduction and you (or your spouse if filing a joint 
                                                                                                        return) were covered by a retirement plan at work or 
                                                                                                        through self-employment. 

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3. Exclusion of interest from series EE and I U.S. sav- 1. Enter the amount from Worksheet
ings bonds issued after 1989. W, line 1. . . . . . . . . . . . . . . . . . . . . . . 1. .
Caution. If the amounts on lines 12 through
4. Student loan interest deduction. 23, column (e), of your Step 2 Form 8962 are
not the same for each month and you had
specified premiums for less than 12 months,
Step 2 skip lines 2 through 5 below and enter on
line 6 the total of those column (e) amounts
Figure the total PTC on Form 8962 using the AGI, modi- for the months you paid specified premiums.
fied AGI, and household income you determined in Step 2. Enter the total PTC (Form 8962, line 24) you
1. Enter the modified AGI and household income from figured in Step 2, earlier. . . . . . . . . . . . . 2. .
Step 1 on the Form 8962. When figuring the PTC, use all 3. Enter the number of months in 2022 for
which specified premiums were paid. . . . . 3.
enrollment premiums for qualified health plans in which
Note. Self-employment for part of a month
you or an individual in your tax family enrolled. Complete counts as a full month of self-employment.
this Form 8962 only through line 24. Do not attach this 4. Enter the number of months someone in your
Form 8962 to your tax return. coverage family was enrolled in the qualified
health plan. . . . . . . . . . . . . . . . . . . . . . 4.
Cannot take the PTC. If you are not eligible to take the
5. Divide line 3 by line 4. . . . . . . . . . . . . . . 5.
PTC, stop here. Do not use this method. Instead, figure
your self-employed health insurance deduction using the 6. Multiply line 5 by line 2. . . . . . . . . . . . . . 6. .
Self-Employed Health Insurance Deduction Worksheet in 7. Subtract line 6 from line 1 . . . . . . . . . . . . 7. .
the Instructions for Form 1040 or the Instructions for Form 8. Enter the amount from Worksheet X, line 30.
1040-NR; or, if required, Worksheet 6-A in chapter 6 of If you did not complete Worksheet X, enter
the amount from Worksheet W, line 16. . . . 8. .
Pub. 535. If you are following the instructions under Spe-
9. Enter the smaller of line 7 or line 8. Then, go
cial Instructions for Self-Employed Individuals Who Claim to Step 4 next. . . . . . . . . . . . . . . . . . . . 9. .
Certain Deductions/Exclusions, later, make this determi-
nation when you complete the final iteration of Step 2. Re-
More than one trade or business. If you have more
figure the deductions/exclusions if you are not eligible for
than one trade or business under which you established a
the PTC.
qualified health plan, you must complete lines 1 through 7
separately for each trade or business. Use the following
Step 3 instructions to complete the Step 3 Worksheet.
Figure your self-employed health insurance deduction for Line 1. Enter the amounts for the separate trade or
specified premiums by completing the following work- business.
sheet. If the Caution under line 1 applies to you, skip lines 2
If you have more than one trade or business un- through 5. Enter on line 6 the total of the column (e)
amounts for the months you paid specified premiums that
! der which you established a qualified health plan, are allocable to the specified premiums you entered on
CAUTION see More than one trade or business below be-
fore you complete the Step 3 Worksheet. line 1 for the separate trade or business. You can allocate
the column (e) amounts using any reasonable method.
Step 3 Worksheet One reasonable method is based on enrollment premiums
for each plan. Under this method, multiply the total of the
Enter amounts in dollars and cents. Do not round to whole column (e) amounts for the months you paid specified
dollars. premiums by a fraction. The numerator of the fraction is
the amount of specified premiums you entered on line 1
for the separate trade or business. The denominator of the
fraction is the total of the column (a) amounts for the
months you paid specified premiums.
Line 2. Enter the Step 2 PTC that is allocable to the
specified premiums you entered on line 1 for the separate
trade or business. You can allocate the Step 2 PTC using
any reasonable method. One reasonable method is based
on enrollment premiums for each plan. Under this method,
multiply the Step 2 PTC by a fraction. The numerator of
the fraction is the amount of specified premiums you en-
tered on line 1 for the separate trade or business. The de-
nominator of the fraction is the amount on line 11, column
(a), or the total of lines 12 through 23, column (a), of the
Step 2 Form 8962.
Lines 3 through 6. Complete these lines for the plan
established under the separate trade or business.

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Line 7. After you complete this line for each trade or Line 1. Enter the amount from the Step 3 Worksheet
business, add the amounts on line 7 for all the trades or for the same separate trade or business for which you are
businesses. Use the total of the line 7 amounts to com- completing the Step 5 Worksheet.
plete lines 8 and 9. If the Caution under line 1 applies to you, skip lines 2
and 3. Enter on line 4 the total of the column (e) amounts
Lines 8 and 9. Complete these lines once for all
for the months you paid specified premiums that are allo-
trades or businesses.
cable to the specified premiums you entered on line 1 for
the separate trade or business. Allocate the column (e)
Step 4 amounts using the same method you used on the Step 3
Worksheet.
Refigure the total PTC on another Form 8962. Complete
this Form 8962 through line 29. When refiguring the total Line 2. Enter the Step 4 PTC that is allocable to the
PTC, use all enrollment premiums for qualified health premiums you entered on line 1 for the separate trade or
plans in which you or any individual in your tax family en- business. Use the same allocation method you used on
rolled. Determine AGI, modified AGI, and household in- the Step 3 Worksheet.
come using the total of the Step 3 Worksheet, line 9, and
Line 3. Enter the amount from the Step 3 Worksheet
Worksheet W, line 14, as your self-employed health insur-
for the same separate trade or business for which you are
ance deduction. Use Worksheets 1-1 and 1-2 in the Form
completing the Step 5 Worksheet.
8962 instructions to figure modified AGI and household in-
come. Line 5. After you complete this line for each trade or
business, add the amounts on line 5 for all the trades or
Step 5 businesses. Use the total of the line 5 amounts to com-
plete lines 6 and 7.
Refigure your self-employed health insurance deduction
for specified premiums by completing the Step 5 Work- Lines 6 and 7. Complete these lines once for all
sheet. trades or businesses.

If you have more than one trade or business un- Step 6
! der which you established a qualified health plan,
CAUTION see More than one trade or business, later, before
Answer the following three questions.
you complete the Step 5 Worksheet.
1. Is the change in the self-employed health insurance
Step 5 Worksheet deduction from Step 3 to Step 5 less than $1.00?
Yes No
Enter amounts in dollars and cents. Do not round to whole
dollars. 2. Is the change in the total PTC from Step 2 to Step 4
less than $1.00?
1. Enter the amount from line 1 of the Step Yes No
3 Worksheet. . . . . . . . . . . . . . . . . . . . . 1. .
Caution. If you skipped lines 2 through 5 of 3. Did you answer “Yes” to both questions 1 and 2?
the Step 3 Worksheet, skip lines 2 and 3 Yes. You can claim a PTC for the amount you fig-
below and enter on line 4 the total of the ured in Step 4. Attach the Form 8962 you used in
column (e) amounts from your Step 4 Form Step 4 to your tax return. You can claim a self-em-
8962 for the months you paid specified
premiums. ployed health insurance deduction for the specified
2. Enter the total PTC (Form 8962, line 24) you premiums equal to the amount on line 7 of the Step 5
figured in Step 4, earlier. . . . . . . . . . . . . 2. . Worksheet.
3. Enter the amount from line 5 of the Step
3 Worksheet. . . . . . . . . . . . . . . . . . . . . 3. Note. Your self-employed health insurance deduction
4. Multiply line 3 by line 2. . . . . . . . . . . . . . 4. . is the total of the Step 5 Worksheet, line 7, and Work-
5. Subtract line 4 from line 1 . . . . . . . . . . . . 5. . sheet W, line 14. Enter this total on line 17 of Sched-
6. Enter the amount from Worksheet X, line 30. ule 1 (Form 1040).
If you did not complete Worksheet X, enter
the amount from Worksheet W, line 16. . . . 6. . No. Repeat Step 4 and Step 5 (using amounts de-
7. Enter the smaller of line 5 or line 6. Then, go termined in the immediately preceding step) until
to Step 6 next. . . . . . . . . . . . . . . . . . . . 7. . changes in both the self-employed health insurance
deduction and the total PTC between steps are less
More than one trade or business. If you have more than $1.00.
than one trade or business under which you established a If you are unable to complete Step 6 because
qualified health plan, you must complete lines 1 through 5 ! changes between steps are always $1.00 or
separately for each trade or business. Use the following CAUTION more, do not use the Iterative Calculation
instructions to complete the Step 5 Worksheet. Method. Instead, use the Simplified Calculation Method or
any computation method that satisfies the rules for the
self-employed health insurance deduction and PTC as

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long as the sum of the deduction claimed for the premi- figure the deductions/exclusions if you are not eligible for
ums and the PTC computed, taking the deduction into ac- the PTC.
count, is less than or equal to the premiums.
Step 3

Simplified Calculation Method Figure your self-employed health insurance deduction by
completing the following worksheet.
Follow the steps below to figure your self-employed health
insurance deduction and PTC under the Simplified Calcu- If you have more than one trade or business un-
lation Method. You do not have to use this method. You ! der which you established a qualified health plan,
can use the Iterative Calculation Method (discussed ear- CAUTION see More than one trade or business below be-
lier) if you can complete Step 6 of that method or you can fore you complete the Step 3 Worksheet.
use any computation method that satisfies each set of Step 3 Worksheet
rules as long as the sum of the deduction claimed for the
premiums and the PTC computed, taking the deduction 1. Enter the amount from Worksheet
into account, is less than or equal to the premiums. W, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . 1.
Caution. If the amounts on lines 12 through
23, column (e), of your Step 2 Form 8962
Step 1 are not the same for each month and you
had specified premiums for less than 12
Figure your AGI, modified AGI, and household income us- months, skip lines 2 through 5 below and
ing Worksheet X, line 31, as your self-employed health in- enter on line 6 the total of those column (e)
surance deduction. If you did not fill out Worksheet X, use amounts for the months you paid specified
the amount from Worksheet W, line 17. Use Worksheets premiums.
1-1 and 1-2 in the Form 8962 instructions to figure modi- 2. Enter the total PTC (Form 8962, line 24)
fied AGI and household income. you figured in Step 2, earlier . . . . . . . . . . . 2.
3. Enter the number of months in 2022 for
If you are claiming any of the following deductions which specified premiums were
! or exclusions, see Special Instructions for paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
CAUTION Self-Employed Individuals Who Claim Certain De-
Note. Self-employment for part of a month
ductions/Exclusions, later, before you complete Step 1. counts as a full month of self-employment.
1. Passive activity losses from rental real estate activi- 4. Enter the number of months someone in
ties and lines 1d and 3 of Form 8582 are losses. your coverage family was enrolled in the
qualified health plan . . . . . . . . . . . . . . . . . 4.
2. IRA deduction and you (or your spouse if filing a joint 5. Divide line 3 by line 4 . . . . . . . . . . . . . . . . 5.
return) were covered by a retirement plan at work or
6. Multiply line 5 by line 2 . . . . . . . . . . . . . . . 6.
through self-employment.
7. Subtract line 6 from line 1 . . . . . . . . . . . . . 7.
3. Exclusion of interest from series EE and I U.S. sav- 8. Enter the amount from Worksheet X,
ings bonds issued after 1989. line 30. If you did not complete Worksheet
4. Student loan interest deduction. X, enter the amount from Worksheet
W, line 16 . . . . . . . . . . . . . . . . . . . . . . . . 8.
9. Enter the smaller of line 7 or line 8 . . . . . . 9.
Step 2 10. Enter the amount from Worksheet
W, line 14 . . . . . . . . . . . . . . . . . . . . . . . . 10.
Figure the total PTC on Form 8962 using the AGI, modi- 11. Add lines 9 and 10. Use this amount as your
fied AGI, and household income you determined in Step self-employed health insurance deduction
1. Enter the modified AGI and household income from in Step 4 next. Also enter this amount on
line 17 of Schedule 1 (Form 1040) . . . . . . 11.
Step 1 on the Form 8962. When figuring the PTC, use all
enrollment premiums for qualified health plans in which
you or any individual in your tax family enrolled. Complete More than one trade or business. If you have more
this Form 8962 only through line 24. Do not attach this than one trade or business under which you established a
Form 8962 to your tax return. qualified health plan, you must complete lines 1 through 7
separately for each trade or business. Use the following
Cannot take the PTC. If you are not eligible to take the instructions to complete the Step 3 Worksheet.
PTC, stop here. Do not use this method. Instead, figure Line 1. Enter the amounts for the separate trade or
your self-employed health insurance deduction using the business.
Self-Employed Health Insurance Deduction Worksheet in If the Caution under line 1 applies to you, skip lines 2
the Instructions for Form 1040 or the Instructions for Form through 5. Enter on line 6 the total of the column (e)
1040-NR; or, if required, Worksheet 6-A in chapter 6 of amounts for the months you paid specified premiums that
Pub. 535. If you are following the instructions under Spe- are allocable to the specified premiums you entered on
cial Instructions for Self-Employed Individuals Who Claim line 1 for the separate trade or business. You can allocate
Certain Deductions/Exclusions, later, make this determi- the column (e) amounts using any reasonable method.
nation when you complete the final iteration of Step 2. Re-

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One reasonable method is based on enrollment premiums Read the following instructions if you are claiming one
for each plan. Under this method, multiply the total of the or more of the deductions/exclusions listed above. Read
column (e) amounts for the months you paid specified these instructions before you complete the Iterative Cal-
premiums by a fraction. The numerator of the fraction is culation Method or Simplified Calculation Method.
the amount of specified premiums you entered on line 1
1. The first time you complete the Iterative Calculation
for the separate trade or business. The denominator of the
Method or Simplified Calculation Method, you do so
fraction is the total of the column (a) amounts for the
without including any of the deductions/exclusions
months you paid specified premiums.
listed above in AGI, modified AGI, or household in-
Line 2. Enter the Step 2 PTC that is allocable to the come. If you use the Simplified Calculation Method,
specified premiums you entered on line 1 for the separate complete it only through Step 3. Enter “400” on the in-
trade or business. You can allocate the Step 2 PTC using terim Form 8962, line 5, if you answer “Yes” on Work-
any reasonable method. One reasonable method is based sheet 2, line 4, in the Form 8962 instructions.
on enrollment premiums for each plan. Under this method,
2. After you complete (1), figure the deduction/exclusion
multiply the Step 2 PTC by a fraction. The numerator of
using the appropriate form or worksheet in your tax
the fraction is the amount of specified premiums you en-
return instructions. When figuring modified AGI on the
tered on line 1 for the separate trade or business. The de-
form or worksheet (or AGI on Form 8903), use as your
nominator of the fraction is the amount on line 11, column
self-employed health insurance deduction the amount
(a), or the total of lines 12 through 23, column (a), of the
from Step 6 of the Iterative Calculation Method or
Step 2 Form 8962.
Step 3 of the Simplified Calculation Method.
Lines 3 through 6. Complete these lines for the plan
established under the separate trade or business. If you are claiming more than one deduction/exclusion
on the list, you must figure the deductions/exclusions
Line 7. After you complete this line for each trade or
in the order shown in the list. For example, if you are
business, add the amounts on line 7 for all the trades or
claiming the student loan interest deduction and the
businesses. Use the total of the line 7 amounts to com-
exclusion of interest from series EE and I U.S. savings
plete lines 8 through 11.
bonds, you must figure the exclusion of interest from
Lines 8 through 11. Complete these lines once for all series EE and I U.S. savings bonds first and complete
trades or businesses. (3) and (4) or (5) using that exclusion. Then, you fig-
ure the student loan interest deduction, as explained
Step 4 in (5) or at the end of Worksheets Y and Z.
3. Enter the deduction/exclusion you figured in (2) on
Refigure the final PTC on another Form 8962. Complete
your tax return.
this Form 8962 through line 29. Attach this Form 8962 to
your tax return. When refiguring the PTC, use all enroll- 4. If you completed Worksheet X, complete Worksheet
ment premiums for qualified health plans in which you or Y and follow the instructions under line 22 of that
any individual in your tax family enrolled. Determine AGI, worksheet. Skip (5).
modified AGI, and household income using the amount
5. If you did not complete Worksheet X, do the following.
from line 11 of the Step 3 Worksheet as your self-em-
ployed health insurance deduction. Use Worksheets 1-1 a. Repeat the Iterative Calculation Method or Simpli-
and 1-2 in the Form 8962 instructions to figure modified fied Calculation Method. Use the deduction/exclu-
AGI and household income. sion from (2) in any step that requires you to figure
AGI, modified AGI, and household income.
Special Instructions for b. If the amount from (2) is the only deduction/exclu-
Self-Employed Individuals Who Claim sion on the list you are claiming, complete either
Certain Deductions/Exclusions method through the last step and follow the step
instructions for claiming the PTC and self-em-
The instructions in this section apply to you if you claim ployed health insurance deduction on your return.
any of the following deductions or exclusions. Skip (5c).
1. Passive activity losses from rental real estate activi- c. If the amount from (2) is not the only deduction/
ties and lines 1d and 3 of Form 8582 are losses. exclusion on the list you are claiming, repeat the
Iterative Calculation Method through Step 6 or the
2. IRA deduction and you (or your spouse if filing a joint Simplified Calculation Method through Step 3. En-
return) were covered by a retirement plan at work or ter “400” on the interim Form 8962, line 5, if you
through self-employment. answered “Yes” on Worksheet 2, line 4, in the
3. Exclusion of interest from series EE and I U.S. sav- Form 8962 instructions. Then, figure the additional
ings bonds issued after 1989. deduction/exclusion using the appropriate form or
worksheet in your tax return instructions. When
4. Student loan interest deduction. figuring modified AGI on the form or worksheet (or
AGI on Form 8903), use as your self-employed

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health insurance deduction the amount from Step    (3) and (5) for each additional deduction/exclu-
6 of the Iterative Calculation Method or Step 3 of sion. Follow (5b) for your final deduction/exclu-
the Simplified Calculation Method. Then, repeat    sion.

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Worksheet Y. Refiguring Household Income and the 
Repayment Limitation When Claiming Certain Deductions 
or Exclusions                                                                               Keep for Your Records
1.  Enter the amount from Worksheet X, line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         1.   
2.  Enter the deduction or exclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .               2.   
3.  Revised household income. Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                3.   
4.  Enter the smaller of Worksheet W, line 19, or $650 ($325 if your filing status is single) . . . . . . . . . .                                              4.   
5.  Subtract line 4 from line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                      5.   
6.  Enter the amount from Worksheet X, line 17b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                          6.   
7.  Divide line 5 by line 6. If the result is not a whole percentage, do not round; instead, multiply this 
    number by 100 (to express it as a percentage) and then drop any numbers after the decimal point. 
    For example, for 0.9984, enter the result as 99; for 1.8565, enter the result as 185; and for 3.997, 
    enter the result as 399 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        7.   %
     •  If the result is less than 200, enter $650 ($325 if your filing status is single) on line 14. Skip 
        lines 8 through 13.
     •  If the result is 200 or more, go to line 8.
8.  Enter the smaller of Worksheet W, line 19, or $1,650 ($825 if your filing status is single) . . . . . . . .                                                8.   
9.  Subtract line 8 from line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                      9.   
10. Divide line 9 by line 6. If the result is not a whole percentage, do not round; instead, multiply this 
    number by 100 (to express it as a percentage) and then drop any numbers after the decimal point. 
    For example, for 0.9984, enter the result as 99; for 1.8565, enter the result as 185; and for 3.997, 
    enter the result as 399 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        10.  %
     •  If the result is less than 300, enter $1,650 ($825 if your filing status is single) on line 14. Skip 
        lines 11 through 13.
     •  If the result is 300 or more, go to line 11.
11. Enter the smaller of Worksheet W, line 19, or $2,800 ($1,400 if your filing status is single)  . . . . . .                                                 11.  
12. Subtract line 11 from line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                       12.  
13. Divide line 12 by line 6. If the result is not a whole percentage, do not round; instead, multiply this 
    number by 100 (to express it as a percentage) and then drop any numbers after the decimal point. 
    For example, for 0.9984, enter the result as 99; for 1.8565, enter the result as 185; and for 3.997, 
    enter the result as 399 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        13.  %
     •  If the result is less than 400, enter $2,800 ($1,400 if your filing status is single) on line 14.
     •  If the result is 400 or more, enter the amount from Worksheet W, line 2, on line 14.
14. Enter the amount you were instructed to enter here by line 7, 10, or 13. Also, enter this amount on 
    line 28 of the Form 8962 you attach to your tax return if you are required to complete that line and 
    you do not complete Worksheet Z. Do not enter an amount from Table 5 in the Form 8962 
    instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.  
15. Enter the amount from Worksheet X, line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        15.  
16. Add lines 14 and 15  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         16.  
17. Enter the amount from Worksheet X, line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         17.  
18. Enter the smaller of line 16 or line 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                18.  
19. Enter the amount from Worksheet X, line 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         19.  
20. Enter the smaller of line 18 or line 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                20.  
21. Enter the amount from Worksheet X, line 5  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                       21.  
22. Add lines 20 and 21. Then, see Next below for further instructions . . . . . . . . . . . . . . . . . . . . . . . . . .                                     22.  
Next. Repeat the Iterative Calculation Method or Simplified Calculation Method, whichever applies. In Step 1 of either method, use 
the amount on line 22 above as your self-employed health insurance deduction. Also, use the amount on line 2 above in any step 
that requires you to figure AGI, modified AGI, and household income. If the amount on line 2 above is the only deduction/exclusion 
on the list that you are claiming, complete either method through the last step. If you are claiming another deduction/exclusion on 
the list, do the following.
•   When you repeat either method as explained above, complete the Iterative Calculation Method through Step 6 or complete the 
    Simplified Calculation Method through Step 3. Enter “400” on the interim Form 8962, line 5, if you answer “Yes” on Worksheet 
    2, line 3, in the Form 8962 instructions.
•   Figure the other deduction/exclusion using the appropriate form or the worksheet provided in your tax return instructions. Use 
    the self-employed health insurance deduction you figured in either Step 6 of the Iterative Calculation Method or Step 3 of the 
    Simplified Calculation Method to figure modified AGI for the other deduction/exclusion.
•   Then, complete Worksheet Z for the other deduction/exclusion.

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Worksheet Z. Refiguring Household Income and the 
Repayment Limitation When Claiming Certain Deductions 
or Exclusions                                                                              Keep for Your Records
Before you begin:
•   Complete Worksheet Y before you complete Worksheet Z.
1.  Enter the amount from Worksheet Y, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                1.   
2.  Enter the deduction or exclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .       2.   
3.  Revised household income. Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        3.   
4.  Enter the smaller of Worksheet W, line 19, or $650 ($325 if your filing status is single) . . . . . . . . . .                                      4.   
5.  Subtract line 4 from line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              5.   
6.  Enter the amount from Worksheet X, line 17b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                  6.   
7.  Divide line 5 by line 6. If the result is not a whole percentage, do not round; instead, multiply this 
    number by 100 (to express it as a percentage) and then drop any numbers after the decimal 
    point. For example, for 0.9984, enter the result as 99; for 1.8565, enter the result as 185; and for 
    3.997, enter the result as 399 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     7.   %
     • If the result is less than 200, enter $650 ($325 if your filing status is single) on line 14. Skip 
       lines 8 through 13.
     • If the result is 200 or more, go to line 8.
8.  Enter the smaller of Worksheet W, line 19, or $1,650 ($825 if your filing status is single) . . . . . . . .                                        8.   
9.  Subtract line 8 from line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              9.   
10. Divide line 9 by line 6. If the result is not a whole percentage, do not round; instead, multiply this 
    number by 100 (to express it as a percentage) and then drop any numbers after the decimal 
    point. For example, for 0.9984, enter the result as 99; for 1.8565, enter the result as 185; and for 
    3.997, enter the result as 399 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     10.  %
     • If the result is less than 300, enter $1,650 ($825 if your filing status is single) on line 14. Skip 
       lines 11 through 13.
     • If the result is 300 or more, go to line 11.
11. Enter the smaller of Worksheet W, line 19, or $2,800 ($1,400 if your filing status is single) . . . . . .                                          11.  
12. Subtract line 11 from line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .               12.  
13. Divide line 12 by line 6. If the result is not a whole percentage, do not round; instead, multiply this 
    number by 100 (to express it as a percentage) and then drop any numbers after the decimal 
    point. For example, for 0.9984, enter the result as 99; for 1.8565, enter the result as 185; and for 
    3.997, enter the result as 399 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     13.  %
     • If the result is less than 400, enter $2,800 ($1,400 if your filing status is single) on line 14.
     • If the result is 400 or more, enter the amount from Worksheet W, line 2, on line 14.
14. Enter the amount you were instructed to enter here by line 7, 10, or 13. Also enter this amount on 
    line 28 of the Form 8962 you attach to your tax return if you are required to complete that line. Do 
    not enter an amount from Table 5 in the Form 8962 instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . .                             14.  
15. Enter the amount from Worksheet X, line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                15.  
16. Add lines 14 and 15  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.  
17. Enter the amount from Worksheet X, line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                 17.  
18. Enter the smaller of line 16 or line 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        18.  
19. Enter the amount from Worksheet X, line 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                 19.  
20. Enter the smaller of line 18 or line 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        20.  
21. Enter the amount from Worksheet X, line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                21.  
22. Add lines 20 and 21. Then, see Next below for further instructions . . . . . . . . . . . . . . . . . . . . . . . . . .                             22.  
Next. Repeat the Iterative Calculation Method or Simplified Calculation Method, whichever applies. In Step 1 of either method, use the amount on 
line 22 above as your self-employed health insurance deduction. Also use the amounts on line 2 of Worksheets Y and Z in any step that requires 
you to figure AGI, modified AGI, and household income. If you are not claiming any more deductions/exclusions on the list, complete either 
method through the last step and follow the step instructions for claiming the PTC and self-employed health insurance deduction on your tax 
return. If you are claiming another deduction/exclusion on the list, do the following.
•   When you repeat either method as explained above, complete the Iterative Calculation Method through Step 6 or complete the Simplified 
    Calculation Method through Step 3. Enter “400” on the interim Form 8962, line 5, if you answer “Yes” on Worksheet 2, line 3, in the Form 8962 
    instructions.
•   Figure the other deduction/exclusion using the appropriate form or the worksheet provided in your tax return instructions. Use the 
    self-employed health insurance deduction you figured in either Step 6 of the Iterative Calculation Method or Step 3 of the Simplified 
    Calculation Method to figure modified AGI for the other deduction/exclusion.
•   Then, complete another Worksheet Z for the other deduction/exclusion.

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Illustrated Example of the Simplified Carla’s Worksheet W

Calculation Method Carla begins by completing Worksheet W to determine
the limit on the self-employed health insurance deduction
The following example illustrates the Simplified Calcula-
for specified premiums.
tion Method.
In 2022, Carla Birch, her husband Jim, and their two
Carla's Worksheet X
dependent children enrolled in the applicable SLCSP
through the Marketplace. The annual premium was Because Carla had APTC during the months of self-em-
$13,000, and $4,200 in APTC was paid for Carla, her hus- ployment, she completes Worksheet X, Parts I and III. She
band, and two dependent children. All of the premiums skips Part II because neither one of her children is re-
are specified premiums. Carla operated a business as a quired to file a federal income tax return for 2022.
sole proprietorship during the entire year. Carla and Jim
are filing a joint Form 1040 (not illustrated). The income Line 1. Carla enters $114,094, which is the total income
and deductions on their Form 1040 and Schedule 1 (Form shown on line 9 of her Form 1040. Total income is the
1040), excluding Schedule 1 (Form 1040), line 17, consist sum of Jim’s salary, taxable interest, and Carla’s net
of the following. profit.

Line 4. Carla enters $4,619. This is the total of the de-
Jim's salary (Form 1040, line 1). . . . . . . . . . . $83,675
ductible part of her self-employment tax and her qualified
Taxable interest (Form 1040, line 2b) . . . . . . 419 retirement plan deduction.
Carla’s net profit from her business on
Schedule 1 (Form 1040), line 3. . . . . . . . . . . 30,000 Line 17b. Carla enters $26,500. This is the federal pov-
Total income (Form 1040, line 9). . . . . . . . . . 114,094 erty line shown in Table 1-1 in the Form 8962 instructions
Deductible part of Carla’s self-employment for a family size of four.
tax (Schedule 1 (Form 1040), line 15). . . . . . . 2,119
Carla’s qualified retirement plan deduction
(Schedule 1 (Form 1040), line 16). . . . . . . . . 2,500

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Carla's Worksheet W. Figuring the Limit on the Self-Employed Health Insurance Deduction 
for Specified Premiums

 Caution.       If you have more than one trade or business under which a qualified health plan is established, complete 
lines 4 through 13 separately for each trade or business. Add the amounts on line 13 for all the trades or businesses. 
Then, complete lines 14 through 17 once for all trades or businesses.
1.  Enter your specified premiums. See Specified Premiums under Instructions for Worksheet 
    P, earlier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   1.  13,000
2.  Enter the APTC from Form 1095-A, Part III, column C, that is attributable to the premiums on 
    line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.  4,200
3.  Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              3.  8,800
4.  Enter your net profit* and any other earned income** from the business under which the qualified 
    health plan is established. Do not include Conservation Reserve Program payments exempt from 
    self-employment tax. If the business is an S corporation, skip to line 11 . . . . . . . . . . . . . . . . . . . . . .                                          4.  30,000
5.  Enter the total of all net profits* from: Schedule C (Form 1040), line 31; Schedule F (Form 1040), 
    line 34; or box 14, code A, of Schedule K-1 (Form 1065), plus any other income allocable to the 
    profitable business. Do not include Conservation Reserve Program payments exempt from 
    self-employment tax. See the Instructions for Schedule SE (Form 1040). Do not include any net 
    losses shown on these schedules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        5.  30,000
6.  Divide line 4 by line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          6.  1.0
7.  Multiply line 15 of Schedule 1 (Form 1040) by line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                               7.  2,119
8.  Subtract line 7 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              8.  27,881
9.  Enter the amount, if any, from line 16 of Schedule 1 (Form 1040), attributable to the same 
    business for which the qualified health plan is established . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                  9.  2,500
10. Subtract line 9 from line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              10. 25,381
11. Enter your Medicare wages (box 5 of Form W-2) from an S corporation in which you are a 
    more-than-2% shareholder and in which the qualified health plan is established . . . . . . . . . . . . . . .                                                   11.  
12. Enter any amount from Form 2555, line 45, attributable to the amount entered on line 4 or line 11 
    above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    12. -0-
    Note. If you are not filing Form 2555, enter -0-.
13. Subtract line 12 from line 10 or line 11, whichever applies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                  13. 25,381
14. Enter your self-employed health insurance deduction for nonspecified premiums from Worksheet 
    P, line 3, or Worksheet 6-A, line 14, in chapter 6 of Pub. 535 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                   14.  
15. Subtract line 14 from line 13  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .               15. 25,381
16. Enter the smaller of line 3 or line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                   16. 8,800
17. Add lines 14 and 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .            17. 8,800
18. Is line 2 blank or -0-? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          18.  
       Yes. Skip line 19 and Worksheet X. Use one of the methods that follow Worksheet X to figure 
    the PTC and self-employed health insurance deduction for specified premiums.
    x No. Go to line 19.
19. Subtract line 16 from line 15. Then, go to Worksheet X          . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                          19. 16,581
* If you used either optional method to figure your net earnings from self-employment from any business, do not enter your net profit from the 
business. Instead, enter the amount attributable to that business from Schedule SE, line 4b.
 
** Earned income includes net earnings and gains from the sale, transfer, or licensing of property you created. However, it does not include 
capital gain income.
The Simplified Calculation Method for Carla                                  the Form 8962 instructions to figure her modified AGI and 
                                                                             household  income.  Her  modified  AGI  and  household  in-
Step 1.   Carla figures her AGI, modified AGI, and house-                    come are each $97,875, the same as her AGI figured in 
hold  income  using  $11,600  as  the  self-employed  health                 this Step 1.
insurance  deduction.  (She  does                   not  enter  $11,600  on 
Schedule 1 (Form 1040), line 17.) Her AGI is $97,875, fig-                   Step 2. Carla figures the total PTC on Form 8962 (not il-
ured as follows.                                                             lustrated) using the modified AGI and household income 
                                                                             figured in Step 1. She completes Form 8962 only through 
                                                                             line 24. She uses the total PTC shown on line 24 ($5,434) 
Total income from Form 1040, line 9. . . . . . .                    114,094
                                                                             to figure the self-employed health insurance deduction in 
Minus: deductible part of self-employment 
                                                                             Step 3, later. She does not attach the Form 8962 to her 
tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (2,119)
                                                                             tax return.
Minus: qualified retirement plan deduction                    . . . (2,500)
Minus: self-employed health insurance                                        Step 3. Carla completes the following worksheet to figure 
deduction from Worksheet X, line 31                 . . . . . . .   (11,600) the self-employed health insurance deduction she will en-
Equals: AGI     . . . . . . . . . . . . . . . . . . . . . . . . . . 97,875   ter on Schedule 1 (Form 1040), line 17.

 Carla uses this AGI amount on Worksheet 1-1. Taxpay-
er’s Modified AGI Worksheet—Line 2a (not illustrated) in 

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Carla's Worksheet X. Figuring Household Income and the Repayment Limitation
Complete this worksheet only if APTC was paid to your insurer on your behalf for the months you were self-employed.
Part I: Taxpayer's Modified AGI
1.  Combine the amounts from:
     •  Form 1040, 1040-SR, or 1040-NR, lines 2a and 9, and the excess, if any, of line 6a over 
        line 6b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   1.   114,094
    Note. See the instructions if you are filing Form 8582, 8814, or 8815.
2.  Enter any amounts from Form 2555, lines 45 and 50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                 2.    
3.  Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .       3.   114,094
4.  Enter the total of the amounts from:
     •  Schedule 1 (Form 1040), lines 11 through 16, 18, and 19a, plus any write-in adjustments 
        you entered on the dotted line next to Schedule 1 (Form 1040), line 26 . . . . . . . . . . . . . . . . . .                                            4.   4,619
    Note. See the instructions if you made contributions to a traditional IRA. 
5.  Enter the amount from Worksheet W, line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                            5.    
6.  Enter the amount from Worksheet W, line 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                            6.   8,800
7.  Add lines 4, 5, and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         7.   13,419
8.  Subtract line 7 from line 3. Then, go to Part II if you are claiming dependents on your tax return. If 
    you are not claiming any dependents on your tax return, skip Part II and go to Part III . . . . . . . . . .                                               8.   100,675
Part II: Dependents’ Modified AGI
 Note. Lines 9–13 of this part are omitted because Carla's dependent children are not required to file federal income tax returns.
Part III: Repayment Limitation
 
14. Household income. Add lines 8 and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        14.  100,675
15. Enter the smaller of Worksheet W, line 19, or $650 ($325 if your filing status is single) . . . . . . . . .                                               15.  650
16. Subtract line 15 from line 14. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         16.  100,025
17a. Enter the number of qualifying individuals in your tax family 
    (including yourself) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17a.                                                  4
17b. Enter the federal poverty line amount as determined by the family size on line 17a and federal 
    poverty Table 1-1, 1-2, or 1-3 for your state of residence during 2022 in the Form 8962 
    instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  17b. 26,500
18. Divide line 16 by line 17b. If the result is not a whole percentage, do not round; instead, multiply 
    this number by 100 (to express it as a percentage) and then drop any numbers after the decimal 
    point. For example, for 0.9984, enter the result as 99; for 1.8565, enter the result as 185; and for 
    3.997, enter the result as 399 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              18.  377%
     •  If the result is less than 200, enter $650 ($325 if your filing status is single) on line 25. Skip 
        lines 19 through 24.
     •  If the result is 200 or more, go to line 19.
19. Enter the smaller of Worksheet W, line 19, or $1,650 ($825 if your filing status is single) . . . . . . .                                                 19.  1,650
20. Subtract line 19 from line 14. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         20.  99,025
21. Divide line 20 by line 17b. If the result is not a whole percentage, do not round; instead, multiply 
    this number by 100 (to express it as a percentage) and then drop any numbers after the decimal 
    point. For example, for 0.9984, enter the result as 99; for 1.8565, enter the result as 185; and for 
    3.997, enter the result as 399 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              21.  374%
     •  If the result is less than 300, enter $1,650 ($825 if your filing status is single) on line 25. Skip 
        lines 22 through 24.
     •  If the result is 300 or more, go to line 22.
22. Enter the smaller of Worksheet W, line 19, or $2,800 ($1,400 if your filing status is single) . . . . .                                                   22.  2,800
23. Subtract line 22 from line 14. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         23.  97,875
24. Divide line 23 by line 17b. If the result is not a whole percentage, do not round; instead, multiply 
    this number by 100 (to express it as a percentage) and then drop any numbers after the decimal 
    point. For example, for 0.9984, enter the result as 99; for 1.8565, enter the result as 185; and for 
    3.997, enter the result as 399 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              24.  369%
     •  If the result is less than 400, enter $2,800 ($1,400 if your filing status is single) on line 25.
     •  If the result is 400 or more, enter the amount from Worksheet W, line 2, on line 25. 
25. Enter the amount you were instructed to enter here by line 18, 21, or 24. See instructions . . . . . .                                                    25.  2,800
Part IV: Maximum Self-Employed Health Insurance Deduction
26. Add lines 6 and 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        26.  11,600
27. Enter the amount from Worksheet W, line 1  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                          27.  13,000
28. Enter the smaller of line 26 or line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                 28.  11,600
29. Enter the amount from Worksheet W, line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                            29.  25,381
30. Enter the smaller of line 28 or line 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                 30.  11,600
31. Add lines 5 and 30. Then, use one of the methods that follow to figure the PTC and the 
    self-employed health insurance deduction for specified premiums . . . . . . . . . . . . . . . . . . . . . . . . .                                         31.  11,600

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Carla’s Step 3 Worksheet                                                               Carla  completes  Form  8962  (not  illustrated)  through 
                                                                                      line  26.  She  enters  the  amount  from  line  26  ($515)  on 
1.  Enter the amount from Worksheet                                                   Schedule 3 (Form 1040), line 9, and attaches Form 8962.
    W, line 1 . . . . . . . . . . . . . . . . . . . . . . . . .   1.         13,000
    Caution. If the amounts on lines 12 through 
    23, column (e), of your Step 2 Form 8962 
    are not the same for each month and you                                           How To Get Tax Help
    had specified premiums for less than 12 
    months, skip lines 2 through 5 below and                                          If you have questions about a tax issue; need help prepar-
    enter on line 6 the total of those column (e) 
    amounts for the months you paid specified                                         ing your tax return; or want to download free publications, 
    premiums.                                                                         forms, or instructions, go to IRS.gov to find resources that 
2.  Enter the total PTC (Form 8962, line 24)                                          can help you right away.
    you figured in Step 2, earlier . . . . . . . . . . .          2.         5,434
                                                                                      Preparing and filing your tax return.  After receiving all 
3.  Enter the number of months in 2022 for 
    which specified premiums were                                                     your wage and earnings statements (Forms W-2, W-2G, 
    paid . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3.         12       1099-R,  1099-MISC,  1099-NEC,  etc.);  unemployment 
    Note. Self-employment for part of a month                                         compensation statements (by mail or in a digital format) or 
    counts as a full month of self-employment.                                        other  government  payment  statements  (Form  1099-G); 
4.  Enter the number of months someone in                                             and  interest,  dividend,  and  retirement  statements  from 
    your coverage family was enrolled in the                                          banks and investment firms (Forms 1099), you have sev-
    qualified health plan . . . . . . . . . . . . . . . . .       4.         12       eral options to choose from to prepare and file your tax re-
5.  Divide line 3 by line 4 . . . . . . . . . . . . . . . .       5.         1.0      turn.  You  can  prepare  the  tax  return  yourself,  see  if  you 
6.  Multiply line 5 by line 2 . . . . . . . . . . . . . . .       6.         5,434    qualify for free tax preparation, or hire a tax professional to 
                                                                                      prepare your return.
7.  Subtract line 6 from line 1 . . . . . . . . . . . . .         7.         7,566
8.  Enter the amount from Worksheet X,                                                Free options for tax preparation.    Go to IRS.gov to see 
    line 30. If you did not complete Worksheet                                        your options for preparing and filing your return online or 
    X, enter the amount from Worksheet W,                                             in your local community, if you qualify, which include the 
    line 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.         11,600
                                                                                      following.
9.  Enter the smaller of line 7 or line 8 . . . . . .             9.         7,566
10. Enter the amount from Worksheet                                                   • Free File. This program lets you prepare and file your 
    W, line 14 . . . . . . . . . . . . . . . . . . . . . . . .    10.        -0-        federal individual income tax return for free using 
11. Add lines 9 and 10. Use this amount as                                              brand-name tax-preparation-and-filing software or 
    your self-employed health insurance                                                 Free File fillable forms. However, state tax preparation 
    deduction in Step 4 next. Also enter this                                           may not be available through Free File. Go to IRS.gov/
    amount on line 17 of Schedule 1 (Form                                               FreeFile to see if you qualify for free online federal tax 
    1040)  . . . . . . . . . . . . . . . . . . . . . . . . . . .  11.        7,566      preparation, e-filing, and direct deposit or payment op-
                                                                                        tions.
Step  4. Carla  refigures  the  final  PTC  on  another  Form                           VITA. The Volunteer Income Tax Assistance (VITA) 
                                                                                      •
8962  (not  illustrated).  Carla  figures  AGI,  modified  AGI,                         program offers free tax help to people with 
and household income using the amount from line 11 of                                   low-to-moderate incomes, persons with disabilities, 
the Step 3 Worksheet as her self-employed health insur-                                 and limited-English-speaking taxpayers who need 
ance deduction. Her AGI is $101,804, figured as follows.                                help preparing their own tax returns. Go to IRS.gov/
Carla’s Step 4 Worksheet                                                                VITA, download the free IRS2Go app, or call 
Total income from Form 1040, line 9 . . . . . . . .                          $114,094   800-906-9887 for information on free tax return prepa-
                                                                                        ration.
Minus: deductible part of self-employment 
tax  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (2,119)  • TCE. The Tax Counseling for the Elderly (TCE) pro-
Minus: qualified retirement plan                                                        gram offers free tax help for all taxpayers, particularly 
deduction  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .       (2,500)    those who are 60 years of age and older. TCE volun-
                                                                                        teers specialize in answering questions about pen-
Minus: self-employed health insurance 
                                                                                        sions and retirement-related issues unique to seniors. 
deduction from line 11 of the Step 3 
                                                                                        Go to IRS.gov/TCE, download the free IRS2Go app, 
Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        (7,566)
                                                                                        or call 888-227-7669 for information on free tax return 
Equals: AGI . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        101,909    preparation.
Carla uses this AGI amount on Worksheet 1-1. Taxpay-                                    MilTax. Members of the U.S. Armed Forces and 
                                                                                      •
er’s Modified AGI Worksheet—Line 2a (not illustrated) in                                qualified veterans may use MilTax, a free tax service 
the  Form  8962  instructions  to  refigure  her  modified  AGI                         offered by the Department of Defense through Military 
and household income. Her modified AGI and household                                    OneSource. For more information, go to 
income are each $101,909, the same as her AGI figured                                   MilitaryOneSource MilitaryOneSource.mil/MilTax (    ).
earlier.

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Also, the IRS offers Free Fillable Forms, which can more information on how to choose a tax preparer, go to
be completed online and then filed electronically re- Tips for Choosing a Tax Preparer on IRS.gov.
gardless of income.
Coronavirus. Go to IRS.gov/Coronavirus for links to in-
Using online tools to help prepare your return. Go to formation on the impact of the coronavirus, as well as tax
IRS.gov/Tools for the following. relief available for individuals and families, small and large
businesses, and tax-exempt organizations.
• The Earned Income Tax Credit Assistant IRS.gov/ (
EITCAssistant) determines if you’re eligible for the Employers can register to use Business Services On-
earned income credit (EIC). line. The Social Security Administration (SSA) offers on-
• The Online EIN Application IRS.gov/EIN ( ) helps you line service at SSA.gov/employer for fast, free, and secure
get an employer identification number (EIN) at no online W-2 filing options to CPAs, accountants, enrolled
cost. agents, and individuals who process Form W-2, Wage
and Tax Statement, and Form W-2c, Corrected Wage and
• The Tax Withholding Estimator IRS.gov/W4app ( )
Tax Statement.
makes it easier for you to estimate the federal income
tax you want your employer to withhold from your pay- IRS social media. Go to IRS.gov/SocialMedia to see the
check. This is tax withholding. See how your withhold- various social media tools the IRS uses to share the latest
ing affects your refund, take-home pay, or tax due. information on tax changes, scam alerts, initiatives, prod-
• The First-Time Homebuyer Credit Account Look-up ucts, and services. At the IRS, privacy and security are
(IRS.gov/HomeBuyer) tool provides information on our highest priority. We use these tools to share public in-
your repayments and account balance. formation with you. Don’t post your social security number
(SSN) or other confidential information on social media
• The Sales Tax Deduction Calculator IRS.gov/ ( sites. Always protect your identity when using any social
SalesTax) figures the amount you can claim if you networking site.
itemize deductions on Schedule A (Form 1040). The following IRS YouTube channels provide short, in-
Getting answers to your tax questions. On formative videos on various tax-related topics in English,
IRS.gov, you can get up-to-date information on Spanish, and ASL.
current events and changes in tax law. Youtube.com/irsvideos.
•
• IRS.gov/Help: A variety of tools to help you get an- Youtube.com/irsvideosmultilingua.
•
swers to some of the most common tax questions.
• Youtube.com/irsvideosASL.
• IRS.gov/ITA: The Interactive Tax Assistant, a tool that
will ask you questions and, based on your input, pro- Watching IRS videos. The IRS Video portal
vide answers on a number of tax law topics. (IRSVideos.gov) contains video and audio presentations
• IRS.gov/Forms: Find forms, instructions, and publica- for individuals, small businesses, and tax professionals.
tions. You will find details on the most recent tax
Online tax information in other languages. You can
changes and interactive links to help you find answers
find information on IRS.gov/MyLanguage if English isn’t
to your questions.
your native language.
• You may also be able to access tax law information in
your electronic filing software. Free Over-the-Phone Interpreter (OPI) Service. The
IRS is committed to serving our multilingual customers by
offering OPI services. The OPI Service is a federally fun-
Need someone to prepare your tax return? There are ded program and is available at Taxpayer Assistance
various types of tax return preparers, including enrolled Centers (TACs), other IRS offices, and every VITA/TCE
agents, certified public accountants (CPAs), accountants, return site. The OPI Service is accessible in more than
and many others who don’t have professional credentials. 350 languages.
If you choose to have someone prepare your tax return,
choose that preparer wisely. A paid tax preparer is: Accessibility Helpline available for taxpayers with
• Primarily responsible for the overall substantive accu- disabilities. Taxpayers who need information about ac-
racy of your return, cessibility services can call 833-690-0598. The Accessi-
bility Helpline can answer questions related to current and
• Required to sign the return, and future accessibility products and services available in al-
• Required to include their preparer tax identification ternative media formats (for example, braille, large print,
number (PTIN). audio, etc.). The Accessibility Helpline does not have ac-
cess to your IRS account. For help with tax law, refunds,
Although the tax preparer always signs the return, or account-related issues, go to IRS.gov/LetUsHelp.
you're ultimately responsible for providing all the informa-
tion required for the preparer to accurately prepare your
return. Anyone paid to prepare tax returns for others
should have a thorough understanding of tax matters. For

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Note. Form 9000, Alternative Media Preference, or 10 taxpayers use direct deposit to receive their refunds. If
Form 9000(SP) allows you to elect to receive certain types you don’t have a bank account, go to IRS.gov/
of written correspondence in the following formats. DirectDeposit for more information on where to find a
• Standard Print. bank or credit union that can open an account online.

• Large Print. Getting a transcript of your return. The quickest way
• Braille. to get a copy of your tax transcript is to go to IRS.gov/
Transcripts. Click on either “Get Transcript Online” or “Get
• Audio (MP3). Transcript by Mail” to order a free copy of your transcript.
• Plain Text File (TXT). If you prefer, you can order your transcript by calling
800-908-9946.
• Braille Ready File (BRF).
Reporting and resolving your tax-related identity
Disasters. Go to Disaster Assistance and Emergency
theft issues.
Relief for Individuals and Businesses to review the availa-
ble disaster tax relief. • Tax-related identity theft happens when someone
steals your personal information to commit tax fraud.
Getting tax forms and publications. Go to IRS.gov/ Your taxes can be affected if your SSN is used to file a
Forms to view, download, or print all the forms, instruc- fraudulent return or to claim a refund or credit.
tions, and publications you may need. Or, you can go to
IRS.gov/OrderForms to place an order. • The IRS doesn’t initiate contact with taxpayers by
email, text messages (including shortened links), tele-
Getting tax publications and instructions in eBook phone calls, or social media channels to request or
format. You can also download and view popular tax verify personal or financial information. This includes
publications and instructions (including the Instructions for requests for personal identification numbers (PINs),
Form 1040) on mobile devices as eBooks at IRS.gov/ passwords, or similar information for credit cards,
eBooks. banks, or other financial accounts.
• Go to IRS.gov/IdentityTheft, the IRS Identity Theft
Note. IRS eBooks have been tested using Apple's Central webpage, for information on identity theft and
iBooks for iPad. Our eBooks haven’t been tested on other data security protection for taxpayers, tax professio-
dedicated eBook readers, and eBook functionality may nals, and businesses. If your SSN has been lost or
not operate as intended. stolen or you suspect you’re a victim of tax-related
Access your online account (individual taxpayers identity theft, you can learn what steps you should
only). Go to IRS.gov/Account to securely access infor- take.
mation about your federal tax account. • Get an Identity Protection PIN (IP PIN). IP PINs are
• View the amount you owe and a breakdown by tax six-digit numbers assigned to taxpayers to help pre-
year. vent the misuse of their SSNs on fraudulent federal in-
come tax returns. When you have an IP PIN, it pre-
• See payment plan details or apply for a new payment vents someone else from filing a tax return with your
plan. SSN. To learn more, go to IRS.gov/IPPIN.
• Make a payment or view 5 years of payment history
and any pending or scheduled payments. Ways to check on the status of your refund.
• Access your tax records, including key data from your • Go to IRS.gov/Refunds.
most recent tax return, and transcripts. • Download the official IRS2Go app to your mobile de-
• View digital copies of select notices from the IRS. vice to check your refund status.
• Approve or reject authorization requests from tax pro- • Call the automated refund hotline at 800-829-1954.
fessionals.
Note. The IRS can’t issue refunds before mid-Febru-
• View your address on file or manage your communi- ary for returns that claimed the EIC or the additional child
cation preferences. tax credit (ACTC). This applies to the entire refund, not
just the portion associated with these credits.
Tax Pro Account. This tool lets your tax professional
submit an authorization request to access your individual Making a tax payment. Go to IRS.gov/Payments for in-
taxpayer IRS online account. For more information, go to formation on how to make a payment using any of the fol-
IRS.gov/TaxProAccount. lowing options.
Using direct deposit. The fastest way to receive a tax • IRS Direct Pay: Pay your individual tax bill or estima-
refund is to file electronically and choose direct deposit, ted tax payment directly from your checking or sav-
which securely and electronically transfers your refund di- ings account at no cost to you.
rectly into your financial account. Direct deposit also • Debit or Credit Card: Choose an approved payment
avoids the possibility that your check could be lost, stolen, processor to pay online or by phone.
destroyed, or returned undeliverable to the IRS. Eight in

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• Electronic Funds Withdrawal: Schedule a payment Contacting your local IRS office. Keep in mind, many
when filing your federal taxes using tax return prepara- questions can be answered on IRS.gov without visiting an
tion software or through a tax professional. IRS TAC. Go to IRS.gov/LetUsHelp for the topics people
ask about most. If you still need help, IRS TACs provide
• Electronic Federal Tax Payment System: Best option
tax help when a tax issue can’t be handled online or by
for businesses. Enrollment is required.
phone. All TACs now provide service by appointment, so
• Check or Money Order: Mail your payment to the ad- you’ll know in advance that you can get the service you
dress listed on the notice or instructions. need without long wait times. Before you visit, go to
• Cash: You may be able to pay your taxes with cash at IRS.gov/TACLocator to find the nearest TAC and to check
a participating retail store. hours, available services, and appointment options. Or,
on the IRS2Go app, under the Stay Connected tab,
• Same-Day Wire: You may be able to do same-day choose the Contact Us option and click on “Local Offices.”
wire from your financial institution. Contact your finan-
cial institution for availability, cost, and time frames.
The Taxpayer Advocate Service (TAS)
Note. The IRS uses the latest encryption technology to Is Here To Help You
ensure that the electronic payments you make online, by
phone, or from a mobile device using the IRS2Go app are What Is TAS?
safe and secure. Paying electronically is quick, easy, and
TAS is an independent organization within the IRS that
faster than mailing in a check or money order.
helps taxpayers and protects taxpayer rights. Their job is
What if I can’t pay now? Go to IRS.gov/Payments for to ensure that every taxpayer is treated fairly and that you
more information about your options. know and understand your rights under the Taxpayer Bill
of Rights.
• Apply for an online payment agreement IRS.gov/ (
OPA) to meet your tax obligation in monthly install-
How Can You Learn About Your Taxpayer
ments if you can’t pay your taxes in full today. Once
you complete the online process, you will receive im- Rights?

mediate notification of whether your agreement has The Taxpayer Bill of Rights describes 10 basic rights that
been approved. all taxpayers have when dealing with the IRS. Go to
• Use the Offer in Compromise Pre-Qualifier to see if TaxpayerAdvocate.IRS.gov to help you understand what
you can settle your tax debt for less than the full these rights mean to you and how they apply. These are
amount you owe. For more information on the Offer in your rights. Know them. Use them.
Compromise program, go to IRS.gov/OIC.
What Can TAS Do for You?
Filing an amended return. Go to IRS.gov/Form1040X
for information and updates. TAS can help you resolve problems that you can’t resolve
with the IRS. And their service is free. If you qualify for
Checking the status of your amended return. Go to their assistance, you will be assigned to one advocate
IRS.gov/WMAR to track the status of Form 1040-X amen- who will work with you throughout the process and will do
ded returns. everything possible to resolve your issue. TAS can help
you if:
Note. It can take up to 3 weeks from the date you filed
your amended return for it to show up in our system, and • Your problem is causing financial difficulty for you,
processing it can take up to 16 weeks. your family, or your business;
Understanding an IRS notice or letter you’ve re- • You face (or your business is facing) an immediate
ceived. Go to IRS.gov/Notices to find additional informa- threat of adverse action; or
tion about responding to an IRS notice or letter. • You’ve tried repeatedly to contact the IRS but no one
has responded, or the IRS hasn’t responded by the
Note. You can use Schedule LEP (Form 1040), Re- date promised.
quest for Change in Language Preference, to state a pref-
erence to receive notices, letters, or other written commu-
How Can You Reach TAS?
nications from the IRS in an alternative language. You
may not immediately receive written communications in TAS has offices in every state, the District of Columbia,
the requested language. The IRS’s commitment to LEP and Puerto Rico. Your local advocate’s number is in your
taxpayers is part of a multi-year timeline that is scheduled local directory and at TaxpayerAdvocate.IRS.gov/
to begin providing translations in 2023. You will continue Contact-Us. You can also call them at 877-777-4778.
to receive communications, including notices and letters,
in English until they are translated to your preferred lan-
guage.

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How Else Does TAS Help Taxpayers? to resolve tax problems with the IRS, such as audits, ap-
peals, and tax collection disputes. In addition, LITCs can
TAS works to resolve large-scale problems that affect provide information about taxpayer rights and responsibili-
many taxpayers. If you know of one of these broad issues, ties in different languages for individuals who speak Eng-
report it to them at IRS.gov/SAMS. lish as a second language. Services are offered for free or
a small fee for eligible taxpayers. To find an LITC near
TAS for Tax Professionals you, go to TaxpayerAdvocate.IRS.gov/about-us/Low-
Income-Taxpayer-Clinics-LITC or see IRS Pub. 4134, Low
TAS can provide a variety of information for tax professio- Income Taxpayer Clinic List.
nals, including tax law updates and guidance, TAS pro-
grams, and ways to let TAS know about systemic prob-
lems you’ve seen in your practice.

Low Income Taxpayer Clinics (LITCs)

LITCs are independent from the IRS. LITCs represent in-
dividuals whose income is below a certain level and need

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                   To help us develop a more useful index, please let us know if you have ideas for index entries.
Index              See “Comments and Suggestions” in the “Introduction” for the ways you can reach us.
 
A                                   H                                    Q
Abandonment  7                      Household income  4                  Qualified health plan 6
Advance payment of the premium 
 tax credit (APTC) 3                I                                    S
Allocation of policy amounts    28  Individual market plans 8            Second Lowest Cost Silver Plan 
 Divorced or legally separated  28  Individuals lawfully present   20     (SLCSP)   27
 Married but not filing a joint     Individuals not lawfully present  19 Self-employed health insurance 
  return  33                        Individuals who are incarcerated  7   deduction  47
 Two or more taxpayers  37          Iterative Calculation Method   52    Simplified calculation method                   55, 
Alternative calculation for year of                                       58
 marriage   38 44,                  M                                    SLCSP:
Alternative family size 38                                                Premium tools 27
                                    Married filing separately 8
Applicable taxpayer 6                                                    Specified premiums 49
                                    Married taxpayers 7
Assistance (See Tax help)                                                Spousal abandonment          7
                                    Minimum essential coverage     8
C                                   Modified AGI  6                      T
                                    Monthly credit amount 6
Coverage family 6                                                        Tax family 4
                                    N                                    Tax help 63
D
                                    Nonspecified premiums   48
Domestic abuse  7
                                    O
E
                                    Other coverage  19
Employer-sponsored plans        10
Expatriate health plans 8           P
G                                   Premium tax credit (PTC)  3 4, 
                                    Publications (See Tax help)
Government-sponsored 
 programs   8

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