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Massachusetts Free Printable  for 2021 Massachusetts Health Care Information

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Health Care Information
Schedule HC

Full-year residents and certain part-year residents must complete and enclose Schedule HC with return. TAXPAYER’S FIRST NAME M.I. LAST NAME TAXPAYER’S SOCIAL SECURITY NUMBER Schedule HC Health Care Information. You must enclose this schedule with Form 1 or Form 1-NR/PY. 2020 1 a. Date of birth  M M D D Y Y Y Y   b. Spouse’s date of birth  MM D D Y Y Y Y  c. Family size. See instructions  2 Federal adjusted gross income (required information; from U.S. Form 1040, line 11). If married filing 0 0 separately, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Indicate the time period that you were enrolled in a Minimum Creditable Coverage (MCC) health insurance plan(s). See Form MA 1099-HC from your insurer or ­Schedule HC instructions. You must fill in an oval. a. You   Full-year MCC   Part-year MCC   No MCC/None b. Spouse   Full-year MCC   Part-year MCC   No MCC/None If you filled in “Full-year MCC” or “Part-year MCC,” go to line 4. If you filled in “No MCC/None,” go to line 6. 4 Indicate the health insurance plan(s) that met the Minimum Creditable Coverage (MCC) requirements in which you were enrolled in 2020. See Form MA 1099-HC from your insurer or ­Schedule HC instructions. Check all that apply. a. Private insurance, including ConnectorCare. Complete lines 4f and/or 4g below . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. MassHealth. Fill in oval(s) and go to line 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c. Medicare (including a replacement or supplemental plan). Fill in oval(s) and go to line 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. U.S. military (including Veteran’s Administration and Tri-Care). Fill in oval(s) and go to line 5. . . . . . . . . . . . . . . . . . . . . . . . . e. Other program. Enter program name(s) only in lines 4f and/or 4g below (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . 4f YOUR HEALTH INSURANCE. Complete if you answered line(s) 4a or 4e and go to line 5.  4a  4b  4c  4d  4e            You  You  You  You  You            Spouse Spouse Spouse Spouse Spouse   Fill in if you were not issued Form MA 1099-HC. 1. NAME OF PRIVATE INSURANCE COMPANY, ADMINISTRATOR OR OTHER GOVERNMENT PROGRAM (from box 1 of Form MA 1099-HC) FEDERAL IDENTIFICATION NUMBER OF INSURANCE CO. (from box 2 of Form MA 1099-HC) SUBSCRIBER NUMBER (from Form MA 1099-HC) 2. NAME OF SECOND PRIVATE INSURANCE COMPANY, ADMINISTRATOR OR OTHER GOVERNMENT PROGRAM IF NECESSARY (from box 1 of Form MA 1099-HC) FEDERAL IDENTIFICATION NUMBER OF INSURANCE CO. (from box 2 of Form MA 1099-HC) SUBSCRIBER NUMBER (from Form MA 1099-HC) 4g SPOUSE’S HEALTH INSURANCE. Complete if you answered line(s) 4a or 4e and go to line 5.    Fill in if you were not issued Form MA 1099-HC. 1. NAME OF PRIVATE INSURANCE COMPANY, ADMINISTRATOR OR OTHER GOVERNMENT PROGRAM FOR SPOUSE (from box 1 of Form MA 1099-HC) FEDERAL IDENTIFICATION NUMBER OF INSURANCE CO. (from box 2 of Form MA 1099-HC) SUBSCRIBER NUMBER (from Form MA 1099-HC) 2. NAME OF SECOND PRIVATE INSURANCE COMPANY, ADMINISTRATOR OR OTHER GOVERNMENT PROGRAM IF NECESSARY FOR SPOUSE (from box 1 of Form MA 1099-HC) FEDERAL IDENTIFICATION NUMBER OF INSURANCE CO. (from box 2 of Form MA 1099-HC) SUBSCRIBER NUMBER (from Form MA 1099-HC) 5 Skip the remainder of this schedule and continue completing your return if you had health insurance that met MCC requirements for the full year, including private insurance, MassHealth or ConnectorCare; or if, at any point during 2020, you had Medicare (including supplement or replacement plan), U.S. Military (including Veterans Administration and Tri-Care), or other government insurance. You are not subject to a penalty. You must complete and enclose this Schedule HC with your return. IF YOU HAD HEALTH INSURANCE INS URANCE THAT MET MCC R EQUIREMENTS FOR THE FULL YEAR, INCLUDING PRIVATE INSURANCE, MASSHEALTH OR MAS SHEALTH OR CONNECTORCARE, CONNECTORC ARE, OR IF YOU HAD MEDICARE, MED ICARE, U.S.MILITARY O R OTHER GOVERNMENT INSURANCE IN SURANCE AT ANY POINT D URING 20 URING 2020 20,, YOU ARE NOT SUBJECT TO A PENALTY. PENALTY. SKIP THE  REMAINDER OF SCHEDULE OF  SCHEDULE HC AND CONTINUE COMPLETING CONTI NUE COMPLETING YOUR TAX  RETURN. 2020 SCHEDULE HC, PAGE 2 TAXPAYER’S FIRST NAME M.I. LAST NAME TAXPAYER’S SOCIAL SECURITY NUMBER Schedule HC Uninsured for All or Part of 2020. Do not complete if you are not subject to a penalty. 6 Was your income in 2020 at or below 150% of the federal poverty level? (See worksheet). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6    Yes    No If you answer Yes, you are not subject to a penalty in 2020. Skip the remainder of this schedule and complete your tax return. If you answer No and you were enrolled in a health insurance plan that met the Minimum Creditable Coverage (MCC) requirements for part, but not all, of 2020, go to line 7. If you answer No and you had no insurance or you were enrolled in a plan that did not meet the MCC requirements during the period that the mandate applied, go to line 8a. 7 Complete this section only if you, and/or your spouse if married filing jointly, were enrolled in a health insurance plan(s) that met the Minimum Creditable Coverage (MCC) requirements for part, but not all of 2020. Fill in the ovals below for the months that met the MCC requirements, as shown on Form MA 1099-HC. If you did not receive this form, fill in the ovals for the months you were covered by a plan that met the MCC requirements at least 15 days or more. If, during 2020, you turned 18, you were a part-year resident or a taxpayer was deceased, fill in the oval(s) below for the month(s) that met the MCC requirements during the period that the mandate applied. See instructions. You may only fill in the oval(s) for the month(s) you had health insurance that met MCC requirements. If you had health insurance, but it did not meet MCC requirements, you must skip this section and go to line 8a. MONTHS COVERED BY HEALTH INSURANCE THAT MET MINIMUM CREDITABLE COVERAGE JAN FEB MARCH APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC You: Spouse: If you had four or more consecutive months either with no insurance or insurance that did not meet the MCC requirements (four or more blank ovals in a row), go to line 8a. Otherwise, a penalty does not apply to you in 2020. You are not subject to a penalty in 2020. Skip the remainder of this schedule and complete your tax return. Schedule HC Religious Exemption and Certificate of Exemption Do not complete if you are not subject to a penalty. 8 a. Religious exemption. Are you claiming an exemption from the requirement to purchase health insurance based on your sincerely-held religious beliefs that cause you to object to substantially all forms of treatment covered by health insurance? 8a. You    Yes    No Spouse    Yes    No If you answer Yes, go to line 8b. If you answer No, go to line 9. If you are filing a joint return and one spouse answers Yes but the other spouse answers No, see instructions. b. If you are claiming a religious exemption in line 8a, did you receive medical health care during the 2020 tax year? 8b. You    Yes    No Spouse    Yes    No If you answer No to line 8b, you are not subject to a penalty in 2020. Skip the remainder of this schedule and continue completing your tax return. If you answer Yes to line 8b, go to line 9. If you are filing a joint return and one spouse answers Yes but the other spouse answers No, see instructions. 9 Certificate of exemption. Have you obtained a Certificate of Exemption issued by the Massachusetts Health Connector for the 2020 tax year? 9. You    Yes    No Spouse    Yes    No Note: If you received a Certificate of Exemption from the Federal shared responsibility requirement in 2020, issued by the Federal Health Insurance Marketplace, do not enter that information in line 9. If you answer Yes, enter the certificate number below, you are not subject to a penalty in 2020. Skip the remainder of this schedule and continue completing your tax return. If you an­­swer No to line 9, go to line 10. If you are filing a joint return and one spouse answers Yes but the other spouse answers No, see instructions. YOUR MASSACHUSETTS CERTIFICATE NUMBER SPOUSE’S MASSACHUSETTS CERTIFICATE NUMBER BE SURE TO ENCLOSE SCHEDULE HC WITH YOUR RETURN. 2020 SCHEDULE HC, PAGE 3 TAXPAYER’S FIRST NAME M.I. LAST NAME TAXPAYER’S SOCIAL SECURITY NUMBER Schedule HC Affordability as Determined By State Guidelines Do not complete if you are not subject to a penalty. Note: This section will require the use of worksheets and tables. You must complete the worksheet(s) to determine if health i­nsurance was affordable to you during the 2020 tax year. 10 Did your employer offer affordable health insurance that met the minimum creditable coverage requirements as determined by completing the Schedule HC Worksheet for Line 10? 10. You    Yes    No Spouse    Yes    No If your employer did not offer health insurance that met the minimum creditable coverage requirements, you were not eligible for health insurance offered by your employer, you were self-employed or you were unemployed, fill in the No oval. If you answer No, go to line 11. If you answer Yes, go to the Health Care Penalty Worksheet to calculate your penalty amount. 11 Were you eligible for government-subsidized health insurance as determined by completing the Schedule HC Worksheet for Line 11? 11. You  Spouse  If you answer No, go to line 12. If you answer Yes, go to the Health Care Penalty Worksheet to calculate your penalty amount.   Yes    Yes    No   No 12 Were you able to purchase affordable private health insurance that met the minimum creditable coverage requirements as determined by completing the Schedule HC Worksheet for Line 12? 12. You    Yes    No Spouse    Yes    No If you answer No, you are not subject to a penalty. Continue completing your tax return. If you answer Yes, go to the Health Care Penalty Work­sheet to calculate your penalty amount. Schedule HC Complete Only If You Are Filing an Appeal You must complete the Health Care Penalty Worksheet to determine your penalty amount before completing this section. You may have grounds to appeal if you were unable to obtain affordable insurance that met the minimum creditable coverage requirements in 2020 due to a hardship or other circumstances. The grounds for appeal are explained in more detail in the instructions. If you believe you have grounds for appealing the penalty, fill in the oval(s) below. The appeal will be heard by the Massachusetts Health Connector. By filling in the oval below, you (or your spouse if married filing jointly) are authorizing DOR to share information from your tax return, including this schedule, with the Massachusetts Health Connector for purposes of deciding your appeal. Important information if you are filing an appeal: You will receive a follow-up letter asking you to state your grounds for appeal in writing, and submit supporting documentation. Failure to respond to that letter within the time specified in the letter will lead to dismissal of your appeal and will result in a future assessment of a penalty. Once your documentation is received, it will be reviewed by the Massachusetts Health Connector and you may be re­quired to attend a hearing on your case. You will be required to file your claims under the pains and penalties of perjury. Note: If you are filing an appeal, make sure you have calculated the penalty amount that you are appealing, but do not assess yourself or enter a penalty amount on your Form 1 or Form 1-NR/PY. Also, do not include any hardship documentation with this return. You will be required to submit substantiating hardship documentation at a later date during the appeal process. You:   I wish to appeal the penalty. I authorize DOR to share this tax return including this schedule with the Massachusetts Health Connector for ­purposes of deciding this appeal. Spouse:   I wish to appeal the penalty. I authorize DOR to share this tax return including this schedule with the Massachusetts Health Connector for ­purposes of deciding this appeal. BE SURE TO ENCLOSE SCHEDULE HC WITH YOUR RETURN.
Extracted from PDF file 2020-massachusetts-schedule-hc.pdf, last modified September 2020

More about the Massachusetts Schedule HC Individual Income Tax TY 2020

The Massachusetts health care reform law requires most residents 18 and over with access to affordable health insurance to obtain it. 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 mahealthconnector.org. You must enclose this schedule with Form 1 or Form 1-NR/PY. You must indicate the health insurance plan(s) that met the Minimum Creditable Coverage (MCC) requirements in which you were enrolled in, or face a penalty for being uninsured.

We last updated the Health Care Information in February 2021, so this is the latest version of Schedule HC, fully updated for tax year 2020. You can download or print current or past-year PDFs of Schedule HC directly from TaxFormFinder. You can print other Massachusetts tax forms here.


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Related Massachusetts Individual Income Tax Forms:

TaxFormFinder has an additional 126 Massachusetts income tax forms that you may need, plus all federal income tax forms. These related forms may also be needed with the Massachusetts Schedule HC.

Form Code Form Name
Schedule HC-CS Health Care Information Continuation Sheet

Download all MA tax forms View all 127 Massachusetts Income Tax Forms


Form Sources:

Massachusetts usually releases forms for the current tax year between January and April. We last updated Massachusetts Schedule HC from the Department of Revenue in February 2021.

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About the Individual Income Tax

The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.

Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!

Historical Past-Year Versions of Massachusetts Schedule HC

We have a total of nine past-year versions of Schedule HC in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:



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