HUD compares the appropriate poverty guideline with 60% of the very low-income limit and choose the greater of the two. While coverage purchased in the individual market outside the Marketplace is MEC, eligibility for this type of coverage does not prevent you from being eligible for the PTC for Marketplace coverage. Yes. You are filing a separate return from your spouse. Mike and Susan enter $850 in Form 8962, lines 12 through 18, column (b); and $400 in lines 19 through 23, column (b). Poverty However, employer-sponsored coverage is not considered affordable if, when you or a family member enrolled in a qualified health plan, you gave accurate information about the availability of employer coverage to the Marketplace, and the Marketplace determined that you were eligible for APTC for the individuals coverage in the qualified health plan. The termination is generally effective no sooner than the second month of nonpayment. Kevin and Nancy are married at the end of 2022 and have no dependents. Individuals who are not lawfully present in the United States are not eligible for coverage in a qualified health plan through a Marketplace. Part VAlternative calculation for year of marriage election. Sophia is claimed as a dependent by her grandfather, Mike. No one can claim you as a dependent for the year. Section references are to the Internal Revenue Code unless otherwise noted. Otherwise, leave column (g) blank. Need to determine applicable SLCSP premium. For purposes of the PTC, a qualified health plan is a health insurance plan or policy purchased through a Marketplace at the bronze, silver, gold, or platinum level. Under a QSEHRA, an eligible employer can reimburse eligible employees for medical expenses, including premiums for Marketplace health insurance. Our analysis uses the California Poverty Measure, whichunlike the official poverty measureaccounts for variation in the cost of living and the cash value of social safety net benefits. Poverty 974 for more information on how to determine whether the coverage you were offered was affordable and provided minimum value, including on how to use Form 1095-C. Don was eligible to enroll in his employers coverage for 2022 but instead applied for coverage in a qualified health plan through the Marketplace for coverage in 2022. Then check the Yes box on line 9 and follow the instructions for Line 9 and Part IV. Income / Threshold = $36,500 / $35,801 = 1.02. If APTC is being paid for an individual in your tax family (described later) and you have had certain changes in circumstances (see the examples later), it is important that you report them to the Marketplace where you enrolled in coverage. All the facts and circumstances are considered in determining whether an individual is abused, including the effects of alcohol or drug abuse by the victims spouse. Carols family size is two because John is not in her tax family. For individuals with household income below 100% of the federal poverty line, see Household income below 100% of the federal poverty line under Line 5, later. For purposes of the PTC, your tax family consists of the following individuals. Enter here and on Form 8962, line 2b, Enter the amount from line 3 of Form 8962, Enter the amount from line 4 of Form 8962, Follow Steps 13 below to determine which allocation rule to use in. To be eligible to make this election, you must meet either of the following conditions. Enter on lines 12 through 23, column (a), the amount of the monthly premiums reported on Form 1095-A, lines 21 through 32, column A, for the corresponding month. The workers earnings equaled about 66 percent of the poverty line for a family of four [9] and, once the workers payroll taxes and EITC were figured in, the workers income was virtually unchanged at 67 percent. 974 or, if you enrolled through the federally facilitated Marketplace, go to HealthCare.gov/Tax-Tool/. Under certain circumstances, for example, where two spouses enroll in a qualified health plan and divorce during the year, the Marketplace will provide Form 1095-A to one taxpayer, but another taxpayer will also need the information from that form to complete Form 8962. 974 under Alternative Calculation for Year of Marriage. Just the Facts: Poverty in California When completing line 11 or lines 12 through 23, complete only column (f). Note. Geography of Child Poverty in California It is not based on the amount of premiums you paid out of pocket during the year. Looking for a different state? If you or a family member isn't lawfully present in the United States and was enrolled in a qualified health plan, see Individuals Not Lawfully Present in the United States Enrolled in a Qualified Health Plan in Pub. Don is not considered eligible for employer-sponsored coverage for the months January through August of 2022 because he gave accurate information to the Marketplace about the availability of employer coverage, and the Marketplace determined that he was eligible for APTC for coverage in a qualified health plan. Otherwise, check the No box and continue to lines 12 through 23. If you have more than one Form 1095-A affecting a particular month, add the amounts together for that month and enter the total on the appropriate line on Form 8962, column (a). Our analysis of family resources includes benefits from the following safety net programs: CalFresh (Californias food stamps program, known federally as the Supplemental Nutrition Assistance Program or SNAP); CalWORKs (Californias cash assistance program, known federally as Temporary Assistance for Needy Families or TANF); General Assistance (GA); the federal Earned Income Tax Credit (EITC); the federal Child Tax Credit (CTC); Supplemental Security Income (SSI/SSP); federal housing subsidies; the Supplemental Nutrition Program for Women, Infants, and Children (WIC); and free or reduced-price school meals. It shows poverty rates by age, education, employment, family composition, immigrant status, For more information about who is treated as lawfully present for this purpose, visit HealthCare.gov. She then completes lines 28 (if it applies to her) and 29. The official poverty measure, in use since the 1960s, defines poverty by comparing pretax money income to a poverty threshold that is adjusted by family composition. Premiums another person pays on your behalf are treated as paid by you. Married individuals who file separate returns are generally not eligible to take the PTC. The plan covered John, Carol, and Mark, with an annual premium of $14,000 and APTC of $8,500, which applied to the coverage for all of the individuals. Alice is allocated 33% of the enrollment premiums, APTC, and applicable SLCSP premiums for the policy, and the remaining 67% of each is allocated to Joe. If you, your spouse, or any individual in your tax family had coverage under a qualified health plan for at least 1 month before your first full month of marriage, use the worksheets and instructions necessary to complete the alternative calculation in Pub. Poverty The enrollment premiums are the total amount of the premiums for the month, reduced by any premium amounts for that month that were refunded, for one or more qualified health plans in which any individual in your tax family enrolled. They cannot take the PTC for their own coverage and are not eligible for the repayment limitations in Table 5 for APTC paid for their own coverage. Melissa must add this amount to her APTC of $3,200 for her single coverage. The Marketplace should have entered the same SLCSP premium, which applies to all members of your coverage family, on each Form 1095-A. The credit provides financial assistance to pay the premiums for the qualified health plan offered through a Marketplace by reducing the amount of tax you owe, giving you a refund, or increasing your refund amount. Therefore, 20% of the enrollment premiums, APTC, and the applicable SLCSP premium are allocated to Alice and 80% are allocated to Joe. Changes that you should report to the Marketplace include the following. For at least 1 month of the year, all of the following were true. Form 1095-A, Health Insurance Marketplace Statement. California For examples of what documentation to keep, see Pub. The Public Policy Institute of California (PPIC) devised an updated poverty threshold that takes into account costs and standards of living on a regional level, called the California Poverty Measure (CPM). Finally, if your employer offered coverage for you but not your family, you may be able to take the PTC for your family members. Gary and Jim leave line 30, columns (f) and (g), blank. Poverty Taxpayers divorced or legally separated in 2022, earlier. To avoid making common mistakes on your Form 8962 and on your income tax return, carefully review all of the following before attaching Form 8962 to your tax return. If either of these two situations applies to you, or if you have reason to believe the Marketplace reported the wrong applicable SLCSP premium, you must determine the correct applicable SLCSP premium for every month. He has worked in both public and private schools, as well as colleges and universities. Taxpayers married at year end but filing separate returns, 50% of the $4,000 APTC ($2,000) is allocated to Melissa and 50% is allocated to Ryan. See Individuals Not Lawfully Present in the United States Enrolled in a Qualified Health Plan in Pub. See Form 1095-C, line 14, and the Instructions for Recipient included with that form, for information about whether you and other members of your tax family were offered coverage. If columns (a) and (b) of any of lines 12 through 23 are blank, leave column (c) of the corresponding line blank. 974 for guidance on determining whether an individual coverage HRA is affordable. Multiply $5,680 by 3 and add the result of $17,040 to $55,850. If you received a Form 1095-A with the VOID box checked at the top of the form, that means you previously received a Form 1095-A for the policy shown in Part I that was sent in error. Because Michael and Colleen are not applicable taxpayers and cannot take the PTC, Colleen does not complete Part IV of her Form 8962. What is the federal poverty level in California? Poverty Program Eligibility by Federal Poverty Level for 2021 Medi-Cal and Covered California have various programs with overlapping income limits. In 2021, if you are a single person earning less than $47,000 per year, you qualify for government assistance. This includes a qualified health plan purchased on HealthCare.gov or through a State Marketplace. If 100% of the policy amounts are allocated to you, check Yes on line 9 and complete Part IV by entering 100 in the appropriate box(es) for your allocation percentage. 974 for instructions on how to figure the amounts to enter in column (e). For purposes of the PTC, modified AGI is the AGI on your tax return plus certain income that is not subject to tax (foreign earned income, tax-exempt interest, and the portion of social security benefits that is not taxable). If you were married at the end of 2022 but are filing separately from your spouse, the repayment limitations shown in Table 5 apply to you and your spouse separately based on the household income reported on each return. If you or a family member could have been covered by an individual coverage HRA for 2022, but you opted out of receiving reimbursements under the individual coverage HRA, you may be allowed a PTC for your, and your family member's, Marketplace health insurance if the individual coverage HRA is considered unaffordable. For help determining which of these forms to file, see the Instructions for Form 1040 or the Instructions for Form 1040-NR. We believe in the power of good information to build a brighter future for California. If an individual in your tax family is not enrolled in a qualified health plan, or is enrolled in a qualified health plan but is eligible for MEC (other than coverage in the individual market), he or she is not part of your coverage family. However, if no APTC was paid for any individuals in your tax family, stop; do not complete Form 8962. Enter on lines 12 through 23, column (b), the amount of the monthly applicable SLCSP premium reported on Form 1095-A, lines 21 through 32, column B, for the corresponding month. If you are claimed as a dependent on another person's tax return, the person who claims you will file Form 8962 to take the PTC and, if necessary, repay excess APTC for your coverage. Cara claims Matt as a dependent on her tax return. You should round the amounts on Form 1095-A to the nearest whole dollar and enter dollars only on Form 8962. [10] Today, a full-time, minimum wage worker earns only 61 percent of the poverty line for a family of four. If you file a paper return and do not round amounts to whole dollars, be sure to enter the decimal point to separate dollars and cents. It is the amount of your household income you would be responsible for paying as your share of premiums each month if you enrolled in the, Your employer may have sent you a Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, with information about the coverage offered to you, if any. Melissa enrolled in single coverage from May through December. Do not use the information on the Form 1095-A with the VOID box checked or the previously received Form 1095-A to complete Form 8962. Generally, there are two situations where your SLCSP premium may not be accurately reflected on your Form 1095-A. See Pub. Gary and his 25-year-old nondependent son, Jim, enroll in a qualified health plan. Poverty in California According to Table 3, Henry and Cara will allocate the amounts from the policy for January through June on line 30 using the rules under Allocation Situation 1. Exception 1Certain married persons living apart or Exception 2Victim of domestic abuse or spousal abandonment. The SSN on this form should match the SSN on your tax return. Joe and Alice agree to allocate 20% of the policy amounts for the qualified health plan for Jane's coverage. You otherwise qualify as an applicable taxpayer (except for the federal poverty line percentage). Bret and Paulette must allocate the amounts from Form 1095-A for the months of January through December on their tax returns using the instructions in Table 3. Program Eligibility by Federal Poverty Level for 2023 Your financial help and whether you qualify for various Covered California or Medi-Cal programs depends on your income, based on the 2022 numbers are slightly lower, and are used to calculate savings on Marketplace insurance plans for For each policy to which (1) and (2) above apply, follow the instructions in Table 3 to determine which allocation rule applies for that qualified health plan. Enter your modified AGI on line 2a. You should round the amounts on Form 1095-A to the nearest whole dollar and enter dollars only on Form 8962. You can also visit IRS.gov and enter premium tax credit in the search box. If individuals in your coverage family enrolled in separate policies in the same state, you will receive a Form 1095-A for each policy. The facts are the same as in Example 1, except that Keith and Stephanie cannot agree on an allocation percentage. Enter the lesser of the amount in column (a) or the amount in column (d). Because Kim and Chris were eligible for CHIP, which is MEC, Tom and Nicole are not eligible for the PTC for coverage of Kim and Chris, but may be eligible for the PTC for their own coverage. Other situations where a policy is shared between two tax families. The Marketplace determination does not apply, however, for the months September through December of 2022 because Don did not provide information to the Marketplace about his new employers offer of coverage. However, if an individual in your tax family enrolled in a qualified health plan in 2022 and the enrollment was effective on the date of the individual's birth, adoption, or placement for adoption or in foster care, or on the effective date of a court order placing the individual with your family, the individual is treated as enrolled as of the first day of that month. Advance payment of the premium tax credit (APTC). For more information about eligibility for Medicaid, CHIP, and other forms of government-sponsored MEC, see Pub.
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