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IRS.gov Website
Publication 17
taxmap/pub17/p17-188.htm#en_us_publink1000174964

Who Can Take the PTC?(p246)

rule
You can take the PTC for 2016 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). However, if you became eligible for APTC because of a successful eligibility appeal, see Enrollment premiums, later, for the date by which your portion of the enrollment premiums must be paid.
  2. You are an applicable taxpayer for 2016. To be an applicable taxpayer, you must meet all of the following requirements.
    1. Your household income for 2016 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 2016.
    3. If you were married at the end of 2016, 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.
taxmap/pub17/p17-188.htm#en_us_publink100017056

Terms You May Need to Know(p247)

rule
taxmap/pub17/p17-188.htm#en_us_publink100022977

Tax family.(p247)

rule
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.
taxmap/pub17/p17-188.htm#en_us_publink100022978

Household income.(p247)

rule
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 2016 return only to claim a refund of withheld income tax or estimated tax. See the Instructions for Form 8962 to determine your household income.
taxmap/pub17/p17-188.htm#en_us_publink100041409
Modified AGI.(p247)
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.
taxmap/pub17/p17-188.htm#en_us_publink100022979

Qualified health plan.(p247)

rule
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 stand-alone 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.
taxmap/pub17/p17-188.htm#en_us_publink100022980

Minimum essential coverage.(p247)

rule
A separate tax provision requires most individuals 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, minimum essential coverage includes:
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 IRS.gov/uac/Individual-Shared-Responsibility-Provision for future updates about types of coverage that are recognized as minimum essential coverage.
taxmap/pub17/p17-188.htm#en_us_publink100037542

Enrollment premiums.(p247)

rule
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.
You are generally not allowed a monthly credit amount for the month if any part of the enrollment premiums for which you are responsible that month has not been paid by the due date of your tax return (not including extensions). However, if you became eligible for APTC because of a successful eligibility appeal and you retroactively enrolled in the plan, the portion of the enrollment premium for which you are responsible must be paid on or before the 120th day following the date of the appeals decision. Premiums another person pays on your behalf are treated as paid by you.