Massachusetts Tax Form Schedule HC - Health Care Information Instructions

General Instructions

Health Care Information

As a result of the health care reform law, most Massachusetts residents age 18 and over are required to have health insurance, if it is affordable for them.

More information about the health care reform law and how to purchase affordable health insurance is available at the Commonwealth Health Insurance Connector Authority’s website at www.mahealthconnector.org

Special Circumstances During 2008 

Note: Schedule HC must be completed and filed even if you fall into a “Special Circumstances” category.

Turning 18. If you turned 18 during 2008, the health care mandate applies to you beginning on the first day of the first full month following your birthday. For example, if your birthday is June 15, the mandate applies on July 1.

Part-year residents. If you moved into Massachusetts during 2008, the health care mandate applies to you beginning on the first day of the first full month following the month you became a resident of Massachusetts. For example, if you moved into Massachusetts on May 14, the mandate applies on June 1.

If you moved out of Massachusetts during 2008, the health care mandate applies to you up until the last day of the last full month you were a resident. For example, if you moved out of Massachusetts on July 10, the mandate applies up to June 30.

Deceased taxpayer. If a taxpayer dies during 2008, the health care mandate applies to the deceased taxpayer up until the last day of the last full month the taxpayer was alive. For example, if a taxpayer dies on August 4, the mandate applies up to July 30.

Lines 1a and 1b. Date of Birth

Enter your date of birth and the date of birth for your spouse (if married filing jointly).

Line 1c. Family Size

Enter your family size, including yourself, your spouse (if living in the same household at any point during the year) and any dependents as claimed on Form 1, line 2b or Form 1-NR/PY, line 4b. If married filing separately and living in the same household at any point during the year, also be sure to include in line 1c any dependents claimed on your tax return and any dependents claimed by your spouse on your spouse’s tax return.

Line 2. Federal Adjusted Gross Income

Enter your federal adjusted gross income (from U.S. Form 1040, line 37; Form 1040A, line 21; or Form 1040EZ, line 4). If married filing separately and living in the same household, each spouse must combine their income figures from their separate U.S. returns when completing this section. Also, same-sex spouses filing a Massachusetts joint return or married filing separately and living in the same household must combine their income figures from their separate U.S. returns when completing this section.

Line 3. Health Insurance

You are considered to have been enrolled in a health insurance plan if you had coverage under private health insurance, such as coverage provided by an employer or purchased on your own, or government-sponsored health insurance at any point during 2008.

Note: Receiving services through the Health Safety Net Trust Fund (previously known as the "Uncompensated Care Pool" or "Free Care Pool") is not considered health insurance.

  • If you (and your spouse if married filing jointly) answer No, go to line 6 on page 2 of Schedule HC.
  • If you (and your spouse if married filing jointly) answer Yes, follow the instructions below that apply to your situation.

Joint filers. If one spouse answers Yes and the other answers No, the spouse who answered No must go to line 6 on page 2 of Schedule HC; the spouse who answered Yes must follow the instructions below. If you and your spouse had different health insurance coverage (for example, one spouse was covered by Medicare and the other by private insurance), each should follow the instructions below that apply.

  • If you (and/or your spouse if married filing jointly) were enrolled in Medicare, Veterans Administration Program, Tri-Care or “Other government health coverage” at any point during 2008, fill in the Yes oval(s) in line 3 and then go to line 5 on page 2 of Schedule HC.

Note: Medicare includes supplemental or replacement plans that you may have purchased on your own.

“Other government health coverage” includes comprehensive government-subsidized plans such as care provided at a correctional facility. “Other” does not include the Health Safety Net Trust Fund, formerly known as the “Uncompensated Care Pool” or the “Free Care Pool” or, for purposes of this question, MassHealth or Commonwealth Care.

  • If you (and/or your spouse if married filing jointly) were enrolled only in MassHealth and/or Commonwealth Care, fill in the Yes oval(s) in line 3 and the oval(s) for the plan(s) you were enrolled in and go to line 4.
  • If you (and/or your spouse if married filing jointly) were enrolled in MassHealth and/or Commonwealth Care and private insurance during 2008, such as insurance provided by your employer, fill in the Yes oval(s) in line 3 and the oval(s) for the plan(s) you were enrolled in and complete Part A, Your Health Insurance and/or Part B, Spouse’s Health Insurance and then go to line 4.
  • If you (and/or your spouse if married filing jointly) were enrolled in MassHealth and/or Commonwealth Care and Medicare, fill in the Yes oval(s) in line 3 and then go to line 5 on page 2 of Schedule HC.
  • If you (and/or your spouse if married filing jointly) were enrolled in private health insurance, fill in the Yes oval(s) in line 3 and complete Part A (for you) and/or B (your spouse) using Form(s) MA 1099-HC. This form will be issued to you by your health insurance carrier or administrator, no later than January 31, 2009.

Note: Generally, employees or retirees of the federal, state or local governments have private health insurance and should fill in the Yes oval(s) in line 3 and complete Part A (for you) and/or Part B (your spouse) in line 3 and then go to line 4.

If you and your spouse were enrolled in the same health insurance, you must complete both Part A (for you) and Part B (your spouse) in line 3.

If you did not receive Form MA 1099-HC, enter the name of your insurance carrier or administrator and your subscriber number in Parts A and/or B. This information should be on your insurance card. If you do not know this information, contact your insurer.

Parts A and B allow you (and/or your spouse if married filing jointly) to provide information on up to two insurance carriers each, if you (and/or your spouse if married filing jointly) were covered by multiple insurers in 2008.

If you (and/or your spouse if married filing jointly) had health insurance from more than two insurance carriers, fill out Schedule HC-CS, Health Care Continuation Sheet. If you file Schedule HCCS, report your two most recent insurance carriers first on Schedule HC and use Schedule HC-CS to report the additional insurance carriers for yourself (and/or your spouse if married filing filing jointly). Schedule HC-CS is available on DOR’s website at www.mass.gov/dor.

Line 4. Full-Year Coverage

You are considered to have coverage for all of 2008 if you had coverage for each of the 12 months in 2008.

  • If you are filing a joint return, and one spouse answers Yes in line 4 and the other answers No, the spouse who answered Yes is not subject to a penalty and should skip the remainder of Schedule HC. The spouse who answered No must go to line 6.

Important Health Insurance Information HC-3

Table 1: Federal Poverty Level, Annual Income Standards

Family size*  

150% FPL  

1

$15,612

2

$21,012

3

$26,412

4

$31,812

5

$37,212

6

$42,612

7

$48,012

8

$53,412

additional

+ $ 5,400

*This Schedule reflects the Federal Poverty Level standards for 2008

  • If you (and your spouse if married filing jointly) answer No, go to line 6 on page 2 of Schedule HC.
  • If you (and your spouse if married filing jointly) answer Yes, you are not subject to a penalty. Skip the remainder of Schedule HC and continue completing your tax return. Be sure to enclose Schedule HC with your return.

Line 5. Government-Sponsored Health Insurance

If you (and/or your spouse if married filing jointly) were enrolled in Medicare, Veterans Administration Program, Tri-Care or “Other government health coverage” at any point in 2008 (see below for definition of “Other”), fill in the appropriate oval(s) for the plan(s) you were enrolled in. You are not subject to a penalty. Skip the remainder of Schedule HC and continue completing your return. Be sure to enclose Schedule HC with your return.

Note: Fill in the Medicare oval(s) even if you have a supplemental or replacement plan that you may have purchased on your own.

“Other government health coverage” includes comprehensive government-subsidized plans such as care provided at a correctional facility. “Other” does not include the Health Safety Net Trust Fund, formerly known as the “Uncompensated Care Pool” or the “Free Care Pool” or, for purposes of this question, MassHealth or Commonwealth Care.

Line 6. Federal Poverty Level

Individuals with income at or below 150% of the Federal Poverty Level (FPL) are not subject to a penalty for failure to purchase health insurance. Complete the following worksheet to determine if your income is at or below 150% of the Federal Poverty Level.

1. Enter your federal adjusted gross income from Schedule HC, line 2 .... ______

2. Enter the income amount that corresponds to your family size (as entered on Schedule HC, line 1c) from the 150% FPL column from Table 1 .... ______

If line 1 is less than or equal to line 2, your in- come in 2008 was at or below 150% of the Fed- eral Poverty Level and the penalty does not apply to you in 2008. Fill in the Yes oval in line 6, skip the remainder of Schedule HC and continue completing your tax return.

If line 1 is greater than line 2, your income in 2008 was above 150% of the Federal Poverty Level. Fill in the No oval in line 6 and go to line 7.

Line 7. Uninsured

You are considered uninsured for all of 2008 if you did not have any coverage under private health insurance (examples of which include employer- sponsored insurance, Commonwealth Choice plans or COBRA) or government-sponsored health insurance (examples of which include MassHealth or Commonwealth Care).

Note: If, during 2008, you turned 18, you were a part-year resident or a taxpayer was deceased, be sure to answer No to line 7 and go to line 8.

  • If you are filing a joint return and one spouse had health insurance for all of 2008, the spouse who had health insurance does not fill in an oval on line 7. If you are filing a joint return and one spouse answers No but the other spouse answers Yes on line 7, the spouse who answers No must go to line 8 and the spouse who answers Yes must go to line 9a.
  • If you (and/or your spouse if married filing jointly) answer No, go to line 8.
  • If you (and/or your spouse if married filing jointly) answer Yes, go to line 9a.

Line 8. Months Covered by Health Insurance

Complete this section only if you (and/or your spouse if married filing jointly) were insured for part, but not all, of 2008. You are considered to have coverage for part of 2008 if you had coverage for at least 1 but less than 12 months.

If you were enrolled in a private health insurance plan (such as coverage provided by your employer or purchased on your own) or government-sponsored health insurance (examples of which include MassHealth or Commonwealth Care), fill in the oval(s) for the months you were covered, using the information from Form(s) MA 1099-HC.

If you did not receive a Form MA 1099-HC from your insurance carrier, fill in the oval(s) for each month in which you had coverage for 15 days or more. If you had coverage in any month for 14 days or less, you must leave the oval(s) blank.

Note for MassHealth and Commonwealth Care enrollees: If you did not receive a Form MA 1099HC and you answered No to line 6, please call Mass- Health at 1-866-682-6745 or Commonwealth Care at 1-877-623-6765 for a copy. If you answered Yes to line 6, you do not need to complete this section and you do not need a Form MA 1099-HC.

  • If you have four or more consecutive months without health insurance (four or more blank ovals in a row), go to line 9a. Otherwise, you are not subject to a penalty. Skip the remainder of Schedule HC and continue completing your return. Be sure to enclose Schedule HC with your return.
  • If you are filing a joint return and one spouse has three or fewer blank ovals in a row, and the other spouse has four or more blank ovals in a row, the spouse with three or fewer blank ovals in a row is not subject to a penalty and should skip the remainder of Schedule HC. The spouse with four or more blank ovals in a row must go to line 9a.

Special Circumstances During 2008 Note: Schedule HC must be completed and filed even if you fall into a “Special Circumstances” category. Also, do not count the months that the mandate did not apply when determining if you have four or more consecutive months without health insurance.

Turning 18. If you turned 18 during 2008, the health care mandate applies to you beginning on the first day of the first full month following your birthday. For example, if your birthday is June 15, the mandate applies on July 1. In this example, do not count the months of January through June because the mandate did not apply.

Part-year residents. If you moved into Massachusetts during 2008, the health care mandate applies to you beginning on the first day of the first full month following the month you became domiciled in (a resident of) Massachusetts. For example, if you moved into Massachusetts on May 14, the mandate applies on June 1. In this example, do not count the months of January through May because the mandate did not apply.

If you moved out of Massachusetts during 2008, the health care mandate applies to you up until the last day of the last full month you were a resident. For example, if you moved out of Massachusetts on July 10, the mandate applies up to June 30. In this example, do not count the months of July through December because the mandate did not apply.

Deceased taxpayer.If a taxpayer died during 2008, the health care mandate applies to the deceased taxpayer up until the last day of the last full month the taxpayer was alive. For example, if a taxpayer died on August 4, the mandate applies up to July 30. In this example, do not count the months of August through December because the mandate did not apply.

Line 9. Religious Exemption

 Line 9a. A religious exemption is available for anyone who has a sincere religious belief that is the basis of refusal to obtain and maintain health insurance coverage. Fill in the Yes oval(s) if you are claiming a religious exemption from the requirement to purchase health insurance based on your sincerely held religious beliefs.

  • If you (and your spouse if married filing jointly) answer Yes to line 9a, go to line 9b.
  • If you (and your spouse if married filing jointly) answer No to line 9a, go to line 10.
  • If you are filing a joint return and one spouse answers No to line 9a but the other spouse answers Yes, the spouse who answered Yes must go to line 9b and the spouse who answered No must go to line 10.

Line 9b. If you are claiming a religious exemption but you received medical health care during tax year 2008, such as treatment during an emergency room visit, you may be subject to a penalty if it is determined that you could have afforded health insurance.

Medical health care excludes certain treatments such as preventative dental care, certain eye examinations and vaccinations. It also excludes a physical examination when required by a third party, such as a prospective employer. For additional information, see Department of Revenue regulation 830 CMR 111M.2.1, Health Insurance Individual Mandate; Personal Income Tax Return Requirements, available on the department’s website at www.mass.gov/dor.

  • If you (and your spouse if married filing jointly) answer Yes on line 9a and No on line 9b, the penalty does not apply to you. Skip the remainder of Schedule HC and continue completing your tax return. Be sure to enclose Schedule HC with your return.
  • If you (and your spouse if married filing jointly) answered Yes on both lines 9a and 9b, go to line 10.
  • If you are filing a joint return and one spouse answers No to line 9b but the other spouse answers Yes to line 9b, the spouse who answered No is not subject to a penalty and should skip the remainder of Schedule HC. The spouse who answered Yes must go to line 10.

Line 10. Certificate of Exemption

The Commonwealth Health Insurance Connector Authority provided certificates of exemption to qualified taxpayers who applied in 2008.

  • If you have a “Certificate of Exemption” issued by the Commonwealth Health Insurance Connector Authority for the 2008 tax year, a penalty does not apply to you. Fill in the Yes oval(s) in line 10 of Schedule HC and enter the certificate number in the space provided. If married filing jointly and both spouses have a certificate, each spouse must enter their certificate number in the space provided. Skip the remainder of Schedule HC and continue completing your tax return. Be sure to enclose Schedule HC with your return.
  • If you answered No to line 10, go to line 11.
  • If you are filing a joint return and one spouse answers Yes to line 10 but the other spouse answers No to line 10, the spouse who answered Yes must enter the certificate number and skip the remainder of Schedule HC and the spouse who answered No must go to line 11.

For more information about Certificates of Exemption, visit the Commonwealth Health Insurance Connector Authority’s website at www.mahealth connector.org.

Lines 11, 12 and 13. Affordability As Determined By State Guidelines

Taxpayers who did not have health insurance for all or part of 2008 may be subject to a penalty if they had access to affordable health insurance.

If you answered Yes in line 6 of Schedule HC indicating that your income was at or below 150% of the Federal Poverty Level, or

If you had three or fewer blank ovals in a row as shown in line 8,

you are not subject to a penalty and should skip the remainder of Schedule HC and continue completing your tax return. Be sure to enclose Schedule HC with your return.

You must complete this section if you were uninsured for all of 2008 or if you had four or more consecutive months without health insurance (four or more blank ovals in a row in the Months Covered by Health Insurance section of line 8).

The following pages contain the worksheets and tables needed to determine if you had access to affordable health insurance. To complete these worksheets, you will need to have your completed 2008 U.S. Form 1040, 1040A or 1040EZ. You also will need to know how much it would have cost you to enroll in any health insurance plan offered by an employer in 2008. An employer’s Human Resources Department should be able to provide this amount to you.

Schedule HC Worksheet for Line 11: Eligibility for Employer-Sponsored Insurance

The following worksheet will determine if you could have afforded employer-sponsored health insurance in 2008. Complete only if you (and/or your spouse if married filing jointly) were eligible for insurance offered by an employer for the entire period you were uninsured in 2008 that covered you, and your spouse and dependent children, if any. If an employer did not offer health insurance that covered you, and your spouse and dependent children, if any, or if you were not eligible for insurance offered by an employer, you were self-employed or you were unemployed, fill in the No oval(s) in line 11 and complete the Schedule HC Worksheet for Line 12.

Note: If you answered Yes in line 6 of Schedule HC indicating that your income was at or below 150% of the Federal Poverty Level or you had three or fewer blank ovals in a row on line 8 of Schedule HC, the penalty does not apply to you. Do not complete this worksheet. Skip the remainder of Schedule HC and continue completing your return. Be sure to enclose Schedule HC with your return.

If an employer offered you free health insurance coverage in 2008 (the employer’s Human Resources Department should be able to provide this information to you), you are deemed able to afford health insurance and are subject to a penalty. Fill in the Yes oval(s) in line 11 and go to the Health Care Penalty Worksheet on page HC-8.

1. Enter your federal adjusted gross income from U.S. Form 1040, line 37; Form 1040A, line21; or 1040EZ, line 4 ..... _____

If line 1 is less than or equal to:

  • $15,612 if single or married filing separately with no dependents;
  • $21,012 if married filing a joint return with no dependents; or
  • $26,412 if head of household, married filing jointly or married filing separately with one or more dependents,

you are deemed unable to afford employer- sponsored health insurance requiring an employee contribution. Fill in the No oval(s) in line 11. Skip the remainder of this worksheet and go to the Schedule HC Worksheet for Line 12 on page HC-5.

If line 1 is more than:

  • $52,500 if single or married filing separately with no dependents;
  • $82,500 if married filing a joint return with no dependents; or
  • $110,000 if head of household, married filing jointly or married filing separately with one or more dependents, you are deemed able to afford employer-spon- sored health insurance and are subject to a pen- alty. Fill in the Yes oval(s) in line 11 and go to the Health Care Penalty Worksheet on page HC-8.

If line 1 is:

  • more than $15,612 but less than or equal to $52,500 if single or married filing separately with no dependents;
  • more than $21,012 but less than or equal to $82,500 if married filing a joint return with no dependents; or
  • more than $26,412 but less than or equal to $110,000 if head of household, married filing jointly or married filing separately with one or more dependents,

go to line 2.

2. Enter the monthly premium that corresponds with your income range (from line 1 of work- sheet) and filing status from Table 3: Affordability on page HC-7. To find this amount, look at the row for your income range in col. a of the appropriate table based on your filing status and go to col. b to find the monthly premium amount...... _______

3. Enter the lowest monthly premium cost of health insurance that would cover you, and your spouse and dependent children, if any, offered to you during your uninsured period in 2008 through an employer. The employer’s Human Resources Department should be able to provide this amount to you ...... ________

Note: If you declined employer-sponsored health insurance, the monthly premium amount may be found on the Health Insurance Responsibility Disclosure Form (HIRD) you should have received from your employer.

If line 3 is less than or equal to line 2:

  • you are deemed able to afford employer- sponsored health insurance during your unin- sured period(s), which you did not obtain, and
  • you are subject to a penalty. Fill in the Yes oval(s) in line 11, and
  • go to the Health Care Penalty Worksheet on page HC-8.

If line 3 is greater than line 2:

  • you could not afford health insurance offered to you by your employer,
  • fill in the No oval(s) in line 11, and
  • complete the following Schedule HC Work- sheet for Line 12.

Schedule HC Worksheet for Line 12: Eligibility for Government-Subsidized Health Insurance

The following worksheet will determine if you were eligible for government-subsidized health insurance in 2008. Complete the following work- sheet only if an employer did not offer you affordable health insurance, as determined in the Schedule HC Worksheet for Line 11.

Note: If you answered Yes in line 6 of Schedule HC indicating that your income was at or below 150% of the Federal Poverty Level or you had three or fewer blank ovals in a row on line 8 of Schedule HC, the penalty does not apply to you. Do not complete this worksheet. Skip the re- mainder of Schedule HC and continue complet- ing your return. Be sure to enclose Schedule HC with your return.

If married filing separately and living in the same household, each spouse must combine their income figures from their separate U.S. returns when completing this worksheet. Also, same-sex spouses filing a Massachusetts joint return or married filing separately and living in the same household must combine their income figures from their separate U.S. returns when completing this worksheet.

  1. Enter your income before adjustments (from U.S. Form 1040, line 22, Form 1040A, line 15 or Form 1040EZ, line 4) ..... ________
  2. Enter the amount from the Income column, based on your family size (do not include de- pendent children age 19 or older in your family size), from Table 2 ..... ________

If line 1 is greater than line 2:

you were ineligible for government-subsidized health insurance in 2008 and must

  • fill in the No oval(s) in line 12, and
  • go to Schedule HC Worksheet for Line 13 to determine if you were deemed able to afford private health insurance.

If line 1 is less than or equal to line 2, and at any point during the period when you were uninsured:

  • you were not a citizen or an alien legally resid- ing in the U.S., or
  • an employer offered to pay more than 20% of a family plan or 33% of an individual plan (the em- ployer’s Human Resources Department should be able to provide this information to you), or
  • you applied for MassHealth or Commonwealth Care and were denied,

you are deemed ineligible for government- subsidized health insurance in 2008 and must

  • fill in the No oval(s) in line 12, and
  • go to Schedule HC Worksheet for Line 13 to determine if you were able to afford private health insurance.

If line 1 is less than or equal to line 2, and none of the above conditions apply, then

  • you would have been deemed eligible for gov- ernment-subsidized health insurance in 2008, which you did not obtain and you are subject to a penalty. You must
  • fill in the Yes oval(s) in line 12 and go to the Health Care Penalty Worksheet on page HC-8.

If line 1 is less than or equal to line 2, but you believe that, during the period when you were uninsured, your income was actually too high to qualify for government-subsidized insurance, you may have grounds to appeal the penalty. Fill in the Yes oval(s) in line 12 and go to the in- structions for the Appeals section on page HC-9.

Table 2: Income at 300% of the Federal Poverty Level

Family size*  

Income  

01

$031,212

02

$042,012

03

$052,812

04

$063,612

05

$074,412

06

$085,212

07

$096,012

08

$106,812

09

$117,612

10

$128,412

11

$139,212

12

$150,012

13

$160,812

*Include only yourself, your spouse (if married filing a joint return) and any dependent children age 18 or younger in your family size. For family size over 13, add $10,800 for each additional family member.

Schedule HC Worksheet for Line 13: Ability to Afford Private Health Insurance

The following worksheet will determine if you could have afforded private health insurance in 2008. Complete the following worksheet only if you (and/or your spouse if married filing jointly) were deemed ineligible for government- subsidized health insurance, as determined in the Schedule HC Worksheet for line 12.

Note: If you answered Yes in line 6 of Schedule HC indicating that your income was at or below 150% of the Federal Poverty Level or you had three or fewer blank ovals in a row in line 8 of Schedule HC, the penalty does not apply to you. Do not complete this worksheet. Skip the remainder of Schedule HC and continue completing your return. Be sure to enclose Schedule HC with your return.

1. Enter your federal adjusted gross income from U.S. Form 1040, line 37; Form 1040A, line21; or 1040EZ, line 4 ..... ________

2. Enter the monthly premium that corresponds with your county of residency (see page HC-10 in the Schedule HC instructions if you do not know what county you live in), age (if married filing a joint return, use the age of the older spouse) and filing status from Table 4: Premiums on page HC-7 ..... ________

Go to the table that corresponds to your county of residency and go to the row for your age range and then go to the column based on your filing status to find the monthly premium amount.

3. Enter the monthly premium that corresponds with your income range (from line 1 of worksheet) and filing status from Table 3: Affordability on page HC-7. To find this amount, look at the row for your income range in col. a of the appropriate table based on your filing status and go to col. b to find the monthly premium amount ..... ________

If line 2 is less than or equal to line 3:

  • you are deemed able to afford private health insurance, which you did not obtain;
  • you are subject to a penalty and you must
  • fill in the Yes oval(s) in line 13 and go to the Health Care Penalty Worksheet on page HC-8.

If line 2 is greater than line 3:

  • you are deemed unable to afford health insurance and not subject to a penalty, and you must
  • fill in the No oval(s) in line 13 and
  • skip the remainder of Schedule HC and continue completing your tax return. Be sure to enclose Schedule HC with your return.

Table 3: Affordability

Individual or Married Filing Separately (no dependents)  

a. Federal adjusted gross income  

b. Monthly premium  

From  

To  

 

$ 0

$15,612

$ 0

$15,613

$20,808

$ 39

$20,809

$26,016

$ 77

$26,017

$31,212

$116

$31,213

$37,500

$165

$37,501

$42,500

$220

$42,501

$52,500

$330

$52,501

Any individual with an annual income over $52,500 is deemed to be able to afford health insurance.

 

Married Filing Jointly (no dependents)  

a. Federal adjusted gross income  

b. Monthly premium  

From  

To  

 

$ 0

$21,012

$ 0

$21,013

$28,008

$ 78

$28,009

$35,016

$154

$35,017

$42,012

$232

$42,013

$52,500

$297

$52,501

$62,500

$396

$62,501

$82,500

$550

$82,501

Any couple with an annual income over $82,500 is deemed to be able to afford health insurance.

 

Head of Household, Married Filing Jointly or Married Filing Separately (1 or more dependents)  

a. Federal adjusted gross income  

b. Monthly premium  

From  

To  

 

$ 0

$ 26,412

$ 0

$26,413

$ 35,208

$ 78

$35,209

$ 44,016

$154

$44,017

$ 52,812

$232

$52,813

$ 70,000

$352

$70,001

$ 90,000

$550

$90,001

$110,000

$792

$110,001

Any family with an annual income over $110,000 is deemed to be able to afford health insurance.

 

Table 4: Premiums

Region 1. Berkshire, Franklin and Hampshire Counties

Age  

*Individual*  

Married couple (no dependents)

**Family**  

00–26

$120

$240

$0,710

27–29

$210

$420

$0,710

30–34

$210

$420

$0,740

35–39

$220

$440

$0,770

40–44

$240

$480

$0,780

45–49

$275

$550

$0,820

50–54

$360

$720

$0,950

55–59

$400

$800

$1,060

60+

$400

$800

$1,140

 

Region 2. Bristol, Essex, Hampden, Middlesex, Norfolk, Suffolk and Worcester Counties  

Age  

*Individual*  

Married couple (no dependents)

**Family**  

00–26

$140

$280

$0,600

27–29

$195

$390

$0,600

30–34

$195

$390

$0,740

35–39

$195

$390

$0,760

40–44

$250

$500

$0,760

45–49

$250

$500

$0,810

50–54

$290

$580

$0,890

55–59

$390

$780

$1,040

60+

$390

$780

$1,190

 

Region 3. Barnstable, Dukes, Nantucket and Plymouth Counties  

Age  

*Individual*  

Married couple (no dependents)

**Family**  

00–26

$130

$260

$0,680

27–29

$210

$420

$0,680

30–34

$230

$460

$0,720

35–39

$270

$540

$0,750

40–44

$320

$640

$0,760

45–49

$370

$740

$0,800

50–54

$420

$840

$0,920

55–59

$420

$840

$1,120

60+

$420

$840

$1,280

**Includes married filing separately (no dependents).

**Head of household or married couple with dependent(s).

Health Care Penalty Worksheet

Complete the following worksheet to calculate the penalty. If married filing a joint return and both you and your spouse are subject to a penalty, separate worksheets must be filled out to calculate the separate penalty amounts for you and your spouse, using your married filing jointly income. Each separate penalty amount must then be entered on Form 1, line 34a and line 34b or Form 1-NR/PY, line 39a and line 39b.

Note: If you answered Yes in line 6 of Schedule HC indicating that your income was at or below 150% of the Federal Poverty Level, the penalty does not apply to you. Do not complete this worksheet. Skip the remainder of Schedule HC and continue completing your tax return.

1. Enter your federal adjusted gross income from Schedule HC, line 2 ..... ________

2. Look at Table 5, Annual Income Standards, and enter col. A, B, C or D, based on your family size (from line 1c of Schedule HC) and income (from line 1 above) ..... ________

3. Based on the column entered in line 2, go to Table 6, Penalties for 2008, to determine the monthly penalty amount. Enter that amount here. If you entered col. D, enter the penalty amount that corresponds to your age ..... ________

Note: See examples at right when completing lines 4 and 5.

4. Enter the number of gap(s) in coverage of four or more consecutive months in which you were uninsured, as shown in Sched. HC, line 8*. If you were uninsured for all of 2008, enter “0” ..... ________

5. Enter the total number of months for the gap(s) in coverage in which you were uninsured from line 4. If you were uninsured for all of 2008, enter “12” ..... ________

6. Multiply line 4 by “3” ..... ________

7. Subtract line 6 from line 5 ..... ________

8. Multiply line 3 by line 7. This is your penalty amount ..... ________

Note: See page 9 of the Form 1 instructions for information regarding the whole-dollar method.

If you are subject to a penalty because you are deemed able to afford insurance in 2008 but did not obtain it, you may appeal the application of the penalty to you. Go to the Filing an Appeal section on Schedule HC and in the instructions on page HC-9. If you are filing an appeal, do not enter a penalty amount on Form 1, line 34a or line 34b or Form 1-NR/PY, line 39a or line 39b. If you are not appealing the penalty, enter the pen- alty amount from line 8 on Form 1, line 34a or line 34b or Form 1-NR/PY, line 39a or line 39b.

*Turning 18, Part-Year Residents or a Taxpayer Was Deceased. When completing line 4, do not include the number of unfilled ovals for months that the mandate did not apply, as determined in Schedule HC, line 8.

Table 5: Annual Income Standards

Family size

Col. A  

Col. B  

Col. C  

Col. D  

From -To  

From - To  

From - To  

Above  

1

$15,613 – 20,808

$20,809 – $26,016

$26,017 – $31,212

$31,212

2

21,013 – 8,008

28,009 – 35,016

35,017 – 42,012

42,012

3

26,413 – 5,208

35,209 – 44,016

44,017 – 52,812

52,812

4

31,813 – 2,408

42,409 – 53,016

53,017 – 63,612

63,612

5

37,213 – 49,608

49,609 – 62,016

62,017 – 74,412

74,412

6

42,613 – 56,808

56,809 – 71,016

71,017 – 85,212

85,212

7

48,013 – 64,008

64,009 – 80,016

80,017 – 96,012

96,012

8

53,413 – 71,208

71,209 – 89,016

89,017 – 106,812

106,812

Additional

+ $ 5,400 + $ 7,200

+ $ 7,200 + $ 9,000

+ $ 9,000 + $10,800

+ $10,800

Table 6: Penalties for 2008

Col.  

Monthly penalty amount  

A  

$17.50

B  

$35.00

C  

$52.50

*D-1 (age 18–26)*

$56.00

*D-2 (age 27+)*

$76.00

Filing an Appeal

If you are subject to a penalty for not obtaining health insurance in 2008, you have the right to appeal. The appeal will be heard by the Commonwealth Health Insurance Connector Authority, an independent state body.

In your appeal, you may claim that the penalty should not apply to you. You may claim that you could not afford insurance in 2008 because you experienced a hardship. To establish a hardship, you must be able to show that, during 2008:

(a) You were homeless, more than 30 days in arrears in rent or mortgage payments, or received an eviction or foreclosure notice;

(b) You received a shut-off notice, were shut off, or were refused the delivery of essential utilities (gas, electric, oil, water, or telephone);

(c) You had non-cosmetic medical and/or dental out-of-pocket expenses (exclusive of premium payments), totaling more than 7.5% of your household’s adjusted gross income that were not subject to payment by a third-party;

(d) You incurred a significant, unexpected increase in essential expenses resulting directly from the consequences of: (i) domestic violence; (ii) the death of a spouse, family member, or partner with primary responsibility for child care, where that spouse, family member, or partner shared household expenses with you; (iii) the sudden responsibility for providing full care for yourself, an aging parent or other family member, including a major, extended illness of a child that required a working parent to hire a full-time caretaker for the child; or (iv) a fire, flood, natural disaster, or other unexpected natural or human-caused event causing substantial household or personal damage for the individual filing the appeal.

(e) Your financial circumstances were such that the expense of purchasing health insurance would have caused you to experience a serious deprivation of food, shelter, clothing or other necessities.

(f) Your family size was so large that reliance on the affordability schedule (on page HC-7) to determine how much you could afford to pay for health insurance is inequitable.

You may also base your appeal on other circumstances, such as the application of the affordability tables in Schedule HC to you is inequitable (for example, due to fluctuation in income during the year), you were unable to obtain government- subsidized insurance despite your income, or other circumstances that made you unable to purchase insurance despite your income.

If you file an appeal, you will be required to state your grounds for appealing, and provide further information and supporting documentation. Any statements and claims you make will be under pains and penalties of perjury.

How to Appeal

To appeal, you must fill in the oval for you (and your spouse, if applicable) on Schedule HC, Appeals Section that authorizes DOR to share information in your tax return, including Schedule HC, with the Commonwealth Health Insurance Connector Authority, the independent state body that will hear the appeal. No penalty will be assessed by DOR pending the outcome of your appeal.

If you (and your spouse) fill in that oval on your return, you will receive a follow-up letter from the Connector Authority asking you to state your grounds for appeal in writing, and submit supporting documentation. Failure to respond to that form within the time specified will lead to dismissal of your appeal. The Connector Authority will then review the information you provided. You may be required to attend a hearing on your case. You will be required to state your claims under pains and penalties of perjury.

Note: Do not include any hardship documentation with your original return. You will be required to submit substantiating hardship documentation at a later date during the appeal process.

 

Massachusetts Tax Help Links