NJ Health Insurance Mandate
Income-Related Exemption Tester *BETA*


Basic Information

Please provide some basic information about the whole NJ Tax Family. Include all people even if you are only seeking an Exemption for some people. Note: include dependents who could have been claimed as well as those who were actually claimed.


Filing Status: * Dependents:

Note: You are exempt from the NJ Health Insurance Mandate if your NJ-1040, line 29 is less than

Check if you can be claimed as a dependent on someone else's return
STOP! If you can be claimed as a dependent on someone else's return - stop now.
You do not need to provide Insurance information on your return. (Insurance issues will be dealt with on the return of whoever can claim you as a dependent.)

Family Size:   Federal Poverty Level (FPL): 12,345

Info from NJ return

First we'll determine if you are eligible for the Poverty Exemption. You must include income for dependents here even if a dependent was not required to file a NJ return. If you do not have information from a dependent's return, you should estimate their income.

Tax Household Total NJ Income: • 138% of FPL: • NJ Percent of FPL: %

STOP! You qualify for the Poverty Exemption You do NOT qualify for the Poverty Exemption

NJ Poverty Line Worksheet

This is a replica of the form NJ will ask you to fill in to apply for the Poverty Line Exemption

Description Amount
Household Income
Number of Household Family Members:
Qualification Status: Qualified Not Qualified

Info from federal return

To calculate the applicable subsidy, we need information from your federal return. Include information from dependent's returns also. (You only need to include information for a dependent if they were required to file a return.)

(convenience shortcut)

Tax Household Total US Income:

Info for Health Plan Costs

To calculate the applicable subsidy, we need to calculate the applicable LCBP (and SLCSP) amounts. For this we need birthdays for everyone in the NJ Tax Family.

LCBP Base Monthly Rate: • SLCSP Base Monthly Rate:

Total Monthly LCBP: • Total Annual LCBP:

Total Monthly SLCSP: • Total Annual SLCSP:

Info on Employer Offers

Health Insurance offered by employer(s)


Form 8962 (Premium Tax Credit)

Form 8962 is used to calculate the PTC (subsidy) applicable for your situation. (It only shows up if Show Detail is checked.)

If filing status is MfS, then PTC is not allowed unless an exception applies. (see Form 8962 Instructions for details.)
Check if MFS exception applies

1 Tax family size
2b Dependent's MAGI
3 Household income
4 Federal poverty line
5 Household income as a percentage of federal poverty line %
6 Is Household income outside PTC range (100% - 400%)
7 Applicable Figure
8a Annual contribution amount
8b Monthly contribution amount
Annual Calculation (a) LCBP (b) SLCSP (c)=8a (d)=(b)-(c) (e) PTC
Annual Totals
24 Total premium tax credit

Total premium tax credit (Monthly): • LCBP (subsidized) (Monthly):

NJ Marketplace Affordability Worksheet

This is a replica of the form NJ will ask you to fill in to apply for the Marketplace Affordability Exemption

Line Description Amount
01 Household Income
02 8.05% of NJ Household Income
03 Lowest Monthly Cost Bronze-Level plan (subsidized)
04 Annual Cost
05 Qualify? (Is Line 04 > Line 02) Qualified Not Qualified

If you want to apply for a Job-Based Affordability Exemption, your Job-based insurance will need to cost more than 8.05% of your household income ( per month).

Click Here to apply for NJ Health Insurance Mandate Coverage Exemptions.

Please print a copy of this page for the TP to keep with their records.

You must still go to the NJ Health Insurance Mandate Exemption application page to officially apply for your exemption. You will receive an Exemption Number which you can then use on Schedule NJ-HCC.

Show Detail?

This site is NOT authorized or associated with the NJ Division of Taxation. Although we work hard to insure correctlness, results are not guaranteed to be correct.
© 2011-2021 / Al Hershey
v2020.09 01-27-2021 • Comments to: