This worksheet is a companion item to the Tax Credit Brochure. Unlike the brochure, the worksheet provides a structure that illustrates how the tax credit would reduce health insurance premiums for a specific family. It is designed for use by a navigator or broker with a consumer, particularly when paper materials are preferable to web-based materials.

As with the brochure, the worksheet information is specific to the calendar year of coverage. You can use this form to be notified of yearly updates. These companion instructions explain the use of the worksheet.