Line 5 Limitation Chart and Worksheet. Summary: This flowchart is used to determine the amount of deductible limitation for each month. After calculating the amount
for each month
in 2006, enter the amount on the line for that month in the worksheet, add them all together and divide by 12 to receive the
limitation amount to be
entered on Form 8853, line 5.Start. This is the starting of the flowchart.Decision (1). Were you enrolled in Medicare benefits for the month?
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IF Yes Continue To Process (a)
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IF No Continue To Decision (2)
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Process (a). Enter 0 on the line below for the month.
Decision (2). Were you an eligible individual (see page 1 of the instructions) on the first day of the month?
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IF Yes Continue To Decision (3)
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IF No Continue To Process (a)
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Decision (3). What type of coverage did your High Deductible Health Plan provide on the first day of the month? If you had more than one
High Deductible
Health Plan, see instructions that begin on page 2.
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IF Self-only coverage Continue To Process (b)
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IF Family coverage Continue To Process (d)
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Process (b). Enter annual deductible (must be at least $1,800 but not more than $2,700)
Process (c). Enter 65% (.65) of the annual deductible on the line below for the month.
Process (d). Enter annual deductible (must be at least $3,650 but not more than $5,450)
Process (e). Enter 75% (.75) of the annual deductible on the line below for the month. If married filing separately, see instructions on
this
page.
End. This is the ending of the flowchart.
