OHIO I-FILE TAX RETURN
REPORT YEAR 2004
Schedule A Deduction Worksheets
Insurance and Medical Cost Worksheet
Unsubsidized Health Insurance, Long Term Care Insurance & Excess Medical Expenses 

Enter in the first field the amount you (and spouse if filing a joint return) paid in 2004 for unreimbursed medical and dental expenses including unreimbursed long term care insurance premiums and unreimbursed health insurance premiums.

Enter in the second field only that portion of the first field that pertains to the amount paid in 2004 for unreimbursed long term care insurance premiums and your unreimbursed premiums for unsubsidized health insurance for you, your spouse and your dependents.

Important Notes:

1) Examples of qualified medical expenses which can be included for the portion of expenses NOT reimbursed are:

  • insurance premiums for medical and dental care plans (including both unsubsidized and subsidized health plans, Medicare premiums and supplemental Medicare insurance),

  • long-term care insurance,

  • prescription medicine or insulin,

  • medical examinations and treatment by a certified health professional,

  • hospital costs and nursing care,

  • eyeglasses, hearing aids, braces, crutches and wheelchairs.

2) You cannot include in the first field unsubsidized  health insurance premiums and/or  long-term care insurance premiums if you qualify for social security health benefits under Medicare.

3) An unsubsidized health insurance plan is a plan where your current or former employer or your spouse's current or former employer does not pay for any part of the plan's costs and does not reimburse you or your spouse for any part of the plan's costs. Most people who receive wage or salary income from an employer participate in one or more subsidized plans and therefore are not participating in an unsubsidized health insurance plan. If you are unsure, check with your employer.

4) You must reduce from your entry for the amount of unsubsidized health insurance premiums by the "self-employed health insurance" deduction claimed on line 31 of your 2004 Federal Form 1040.

Examples to assist you:

Example 1: Mickie has a health insurance plan through her employer. She has $50.00 deducted from her paycheck each month to pay for her portion of her health insurance premium costs. Her employer contributes $450.00 each month towards the health insurance premium costs that actually total $500.00 each month. This is a subsidized health plan and Mickie may not use her $50.00 monthly payment.

Example 2: Mickie is retired and qualifies for Medicare. She pays $50.00 dollars each month for supplemental health insurance and $20.00 each month for Medicare B premiums. Mickie may not use her $50.00 or $20.00 monthly payments.