Fillable Form 8962 (2019)

What is Form 8962?

Form 8962, officially the Premium Tax Credit (PTC), is an Internal Revenue Service (IRS) form used to calculate the amount of premium tax credit you’re eligible to claim if you paid premiums for health insurance purchased through the Health Insurance Marketplace.

This calculation is important because it determines whether or not you owe money to the IRS. If the amount of advanced premium tax credit received exceeds the amount of the premium tax credit you’re eligible to claim, you owe money back to the IRS. On the other hand, if the advanced premium tax credit received is less than the premium tax credit you’re eligible to receive, then the IRS owes you.

You are only eligible to file Form 8962 if:

• You want to claim the premium tax credit, or advanced premium tax credits were paid for you or a family member covered by your plan and
• You have a Form 1095-A (Health Insurance Marketplace Statement) which was issued by the Marketplace. If you haven’t received one, view your form by logging into your Marketplace account online.

How to Fill Out the Form 8962?

Form 8962 consists of five parts.?You will need Form 1095-A to complete each section of the form, as well as your Form 1040 showing your modified adjusted gross income.
At the top of the form, provide your full legal name and Social Security Number.

Part I

Annual and monthly contribution amount

Line 1
Enter the number of exemptions from Form 1040 or Form 1040A.
Lines 2a & 2b
Enter the amounts related to modified Annual Gross Income (AGI).
Line 3
Input the household income by adding the amounts on lines 2a and 2b.
Line 4
Select the appropriate choice and enter the value.
Line 5
Enter Household income as a percentage of the federal poverty line.
Line 6
If you entered 401% on line 5, then proceed to line 7. If not, then select yes.
Line 7
Input the applicable figure.
Line 8a
Provide the annual contribution amount by following the method shown.
Line 8b
Provide the monthly contribution amount by following the method shown.

Part II

Premium Tax Credit Claim and Reconciliation of Advance Payment of Premium Tax Credit

Line 9
Mark Yes and skip to Part IV or Part V if the below-mentioned conditions apply to you. If not, Mark No and continue to Line 10.

1. The policy covered at least one individual in your tax family and at least one individual in another tax family, and
2. Either:

i. You received a Form 1095-A for the policy that does not accurately represent the members of your tax family who were enrolled in the policy, or
ii. The other tax family received a Form 1095-A for the policy that includes a member of your tax family.

Line 10
Select the appropriate choice by referring to Form 1095-A.
If you were enrolled in a qualified health plan for fewer than 12 months during 2019, check the "No" box and continue to lines 12 through 23.
Check the "Yes" box and continue to line 11 if all of the following apply for each qualified health plan you or a member of your tax family was enrolled in for 2019.

• You were enrolled in the qualified health plan for all 12 months during 2019.
• Your enrollment premium was the same for every month of 2019.
• Your SLCSP premium is the same for every month of 2019.

Otherwise, check the "No" box and continue to lines 12 through 23.
Line 11
Fill the annual totals for the empty fields under each column.
Lines 12 to 23
Provide the monthly amounts under each column.
Line 24
Input the total premium tax credit.
Line 25
Input the Advance payment of PTC by following the method shown.
Line 26
Input the Net premium tax credit by following the method shown.

Part III

Repayment of Excess Advance Payment of the Premium Tax Credit

Line 27
Input the Excess advance payment of PTC.
Line 28
Enter the Repayment limitation based on certain conditions. If the amount on Form 8962 Line 5 is:

• less than 200, then enter on Line 28 $300 for a filing status of Single and $600 for any other filing status; or
• at least 200 but less than 300, then enter $800 for a filing status of Single and $1,600 for any other filing status; or
• at least 300 but less than 400, then enter $1,32500 for a filing status of Single and $2,650 for any other filing status; or
• 400 or 401, leave Line 28 blank.

Line 29
Enter the Excess advance premium tax credit repayment.

Part IV

Allocation of Policy Amounts

Lines 30 to 33
a. Provide all the shared policy allocations.
b. Enter the marketplace assigned Policy Number.
c. Enter the Social Security Number of the other taxpayer with whom you are allocating policy amounts.
d. Enter the first month you are allocating policy amounts.
e. Enter the last month you are allocating policy amounts.
f. Enter the Premium Percentage as a decimal rounded to two places.

You will only input in this column if:

• You allocated the policy amounts under Allocation Situation 1. Taxpayers divorced or legally separated in 2019, earlier.
• You allocated the policy amounts under Allocation Situation 4. Other situations where a policy is shared between two tax families, earlier.

In all other situations, leave this column blank because you do not allocate the applicable SLCSP premium reported in those situations

g. Enter the SLCSP Percentage as a decimal rounded to two places.

Input on this column, if your allocation situation requires you to allocate the APTC on Form 1095-A, lines 21 through 32, column C. Otherwise, leave it blank.

h. Enter the Advance Payment of the PTC Percentage.

Line 34
Select the appropriate choice that applies to your allocation situation.
Refer to your Forms 1095-A, if you have completed your required allocations of policy amounts shown on using lines 30 through 33, check the "Yes" box. If you must make more than four allocations of policy amounts, check the "No" box and attach a statement providing the information shown on lines 30 through 33, columns (a) through (g) for each additional allocation.

Part V

Alternative Calculation for Year of Marriage

This portion is optional, but this may reduce the amount of excess APTC you must repay. To be eligible to make this election, you must meet either of the following conditions.

• You checked the "Yes" box on line 6, and you answered " Yes " to all 5 questions in Table 4.
• You checked the "No" box on line 6, and the "Yes" box on line 14 of Worksheet 3.

Line 35
Enter all the Alternative entries for your SSN on the respective fields: (a) alternative family size, (b)alternative monthly contribution amount, (c) alternative start month, and (d)alternative stop month.
Line 36
Enter all the Alternative entries for your spouse's SSN on the respective fields: (a) alternative family size, (b)alternative monthly contribution amount, (c) alternative start month, and (d)alternative stop month.

Submission

Mail the Form 8962 along with your Form 1040 to the IRS regional office that covers your state of residence, if you’re filling out a paper tax return.

If you’re filing your taxes online, you should be able to complete Form 8962 through the tax filing software program you’re using.