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Affordability Sheet


The resources on this page are meant to assist taxpayers in determining their eligibility for the affordability exemption claimed on Rhode Island’s Personal Income Tax returns. Before an individual may claim the Affordability Exemption (using Exemption Code A), the individual must use this worksheet to determine if coverage was unaffordable to them. The affordability worksheet evaluates your Household Income to determine your “Required Contribution Amount.”

The “Required Contribution Amount” is the cost of one of the following:

  • Employer based self-only coverage,
  • Employer based family coverage, or
  • Marketplace Coverage if employer-based coverage was not offered (the “Marketplace Coverage Affordability Worksheet” is provided to evaluate what the cost of coverage through HealthSource RI would have for the tax year).

The worksheet should be completed for each member of the household to determine eligibility. Please note, household income will be the same figure for each member of the household. When using age to determine monthly premium amounts for Lines 1 and 10, use the individual’s age as of 1/1/23.


The resources on this page are meant to assist taxpayers in completing the “Marketplace Coverage Affordability Worksheet” for use with Code “A” = Coverage Considered Unaffordable on Rhode Island’s Personal Income Tax returns. That worksheet is used to figure an individual’s required contribution for any month in which the individual isn’t eligible for employer-sponsored coverage. Taxpayers should complete a separate worksheet for each part of the year in which the number of people in their tax household who are neither exempt nor eligible for minimum essential coverage (other than individual market coverage) was different.

Please select the desired Line Number below to see additional information.

Definition of Household Income
Your household income is your modified adjusted gross income (MAGI) plus the MAGI of each individual in your tax household whom you claim as a dependent if that individual is required to file a tax return because his or her income meets the income tax return filing threshold.


Line 1 - Lowest Cost Bronze Level Plan
Line 7 - Applicable Table
Line 10 - Second Lowest Cost Silver Plan

HealthSource RI connects you with health and dental insurance from these companies:

Individuals & Families: 1-855-840-4774
Employers & Employees: 1-855-683-6757