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Publication 17

Who Can Take the PTC?(p241)

You can take the PTC for 2015 if you meet all the conditions under (1) and (2) below.
  1. For at least one month of the year, all of the following were true.
    1. An individual in your tax family was enrolled in a qualified health plan offered through the Marketplace on the first day of the month.
    2. That individual was not eligible for minimum essential coverage for the month, other than coverage in the individual market. An individual is considered eligible for minimum coverage for the month only if he or she was eligible for every day of the month (see Minimum essential coverage, later).
    3. The portion of the enrollment premiums for the month for which you are responsible was paid by the due date of your tax return (not including extensions). See Enrollment premiums, later.
  2. You are an applicable taxpayer. To be an applicable taxpayer, you must meet all of the following requirements.
    1. For 2015, your household income is at least 100% but no more than 400% of the Federal poverty line for your family size (provided in Tables 1-1, 1-2, and 1-3, in the Instructions for Form 8962). See the Instructions for Form 8962 for exceptions when household income is below 100% of the Federal poverty line.
    2. No one can claim you as a dependent on a tax return for 2015.
    3. If you were married at the end of 2015, generally you must file a joint return. However, filing a separate return from your spouse will not disqualify you from being an applicable taxpayer if you meet certain requirements described under Married taxpayers in the Instructions for Form 8962.
For more information on taking the PTC and the requirements to be an applicable taxpayer, see the Instructions for Form 8962.

Terms You May Need to Know(p242)


Tax family.(p242)

For purposes of the PTC, your tax family consists of the individuals for whom you claim a personal exemption on your tax return (generally you, your spouse with whom you are filing a joint return, and your dependents). Your personal exemptions are reported on your Form 1040 or Form 1040A, line 6d. Your family size equals the number of individuals in your tax family. If no one, including you, claims a personal exemption for you and you indicated to the Marketplace when you enrolled that you would claim your own personal exemption, see Pub. 974.

Household income.(p242)

For purposes of the PTC, household income is the modified adjusted gross income (modified AGI) of you and your spouse (if filing a joint return) plus the modified AGI of each individual in your tax family whom you claim as a dependent and who is required to file a tax return because his or her income meets the income tax return filing threshold. Household income does not include the modified AGI for those individuals whom you claim as dependents and who are filing a 2015 return only to claim a refund of withheld income tax or estimated tax. See the Instructions for Form 8962 to determine your household income.
Modified AGI.(p242)
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). Use Worksheet 1-1 and Worksheet 1-2 in the Form 8962 instructions to determine your modified AGI.

Qualified health plan.(p242)

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. Catastrophic health plans, and separate dental plans purchased through the Marketplace, and all plans purchased through the Small Business Health Options Program (SHOP) are not qualified health plans for purposes of the PTC. Therefore, they do not qualify a taxpayer to take the PTC.

Minimum essential coverage.(p242)

Most individuals are required to have qualifying health coverage, qualify for a coverage exemption, or make a payment with their tax return. Health coverage that satisfies this requirement is called minimum essential coverage. An individual in your tax family who is eligible for minimum essential coverage (except coverage in the individual market) for a month is not in your coverage family for that month. Therefore, you cannot take the PTC for that individual’s coverage for the months that individual is eligible for minimum essential coverage. In addition to qualified health plans and other coverage in the individual market, types of minimum essential coverage include:
In most cases you are eligible for minimum essential coverage if the coverage is available to you whether or not you enroll in it. However, special rules apply to certain types of minimum essential coverage as explained in the Form 8962 instructions.
While coverage purchased in the individual market outside the Marketplace is minimum essential coverage, eligibility for this type of coverage does not prevent you from being eligible for the PTC for Marketplace coverage. Coverage purchased in the individual market outside the Marketplace does not qualify for the PTC.
For more details on minimum essential coverage, see Pub. 974. You can also check for future updates about types of coverage that are recognized as minimum essential coverage.

Enrollment premiums.(p242)

The enrollment premiums are the total amount of the premiums for the month for one or more qualified health plans in which any individual in your tax family enrolled. Form 1095-A, Part III, column A, reports the enrollment premiums.