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2023
Instructions for Form 8941
Department of the Treasury
Internal Revenue Service
Credit for Small Employer Health Insurance Premiums
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Partnerships, S corporations, cooperatives,
Section references are to the Internal Revenue Code
unless otherwise noted.
TIP estates, trusts, and tax-exempt eligible small
Future Developments
For the latest information about developments related to
Form 8941 and its instructions, such as legislation
enacted after they were published, go to IRS.gov/
Form8941.
Reminder
Waiver for Hawaii. Employers in Hawaii can’t claim this
credit for insurance premiums paid for health plan years
beginning after 2016. For more information, see Waiver for
Hawaii in the instructions for line A.
General Instructions
Purpose of Form
Eligible small employers (defined later) use Form 8941 to
figure the credit for small employer health insurance
premiums for tax years beginning after 2009. For tax years
beginning after 2013, the credit is only available for a
2-consecutive-tax-year credit period. The maximum credit
is generally a percentage of premiums the employer paid
during the tax year for certain health insurance coverage
the employer provided to certain employees enrolled in a
qualified health plan offered through a Small Business
Health Options Program (SHOP) Marketplace. But the
credit may be reduced by limitations based on the
employer’s full-time equivalent employees, average
annual wages, adjusted average premiums, and state
premium subsidies and tax credits.
For information about insurance plans offered
TIP through a SHOP Marketplace, go to
Healthcare.gov.
For tax-exempt eligible small employers, the
maximum credit is 35% of premiums paid, is limited to the
amount of certain payroll taxes paid, and is claimed as a
refundable credit on Form 990-T, Exempt Organization
Business Income Tax Return. A tax-exempt eligible small
employer is an eligible small employer described in
section 501(c) that is exempt from taxation under section
501(a). A tax-exempt employer not described in section
501(c) is generally not eligible to claim this credit.
However, a tax-exempt farmers’ cooperative subject to tax
under section 1381 may be able to claim the credit as a
general business credit, as discussed next.
For all other eligible small employers, the maximum
credit is 50% of premiums paid and can be taken against
both regular and alternative minimum tax. The credit is
claimed as part of the general business credit on Form
3800, General Business Credit.
Nov 8, 2023
employers must file this form to claim the credit.
All other taxpayers must not complete or file this form if
their only source for this credit is a partnership, S
corporation, cooperative, estate, or trust. Instead, they
must report this credit directly on line 4h in Part III of Form
3800, General Business Credit.
Eligible Small Employers
You’re an eligible small employer for the tax year if you
meet the following three requirements.
1. You paid premiums for employee health insurance
coverage under a qualifying arrangement. A
qualifying arrangement is generally an arrangement that
requires you to pay a uniform percentage (not less than
50%) of the premium cost for each enrolled employee’s
health insurance coverage (defined later). However, an
arrangement that requires you to pay a uniform premium
for each enrolled employee (composite billing) and offers
different tiers of coverage (for example, employee-only,
dependent, and family coverage) can be a qualifying
arrangement even if it requires you to pay a uniform
percentage that is less than 50% of the premium cost for
employees not enrolled in employee-only coverage.
In addition, an arrangement that requires you to pay a
separate premium for each employee based on age or
other factors (list billing) can be a qualifying arrangement
even if it requires you to pay a uniform percentage that is
less than 50% of the premium cost for some employees.
For details, see Employer Premiums Paid, Health
Insurance Coverage, and Qualifying Arrangement, later.
2. You had fewer than 25 full-time equivalent employees (FTEs) for the tax year. You may be able to meet
this requirement even if you had 25 or more employees.
For example, an employer with 48 employees who are
each half-time employees has 24 FTEs and can claim the
credit. For details, see Worksheets 1 and 2.
Although the term “eligible small employer” is
defined in the Internal Revenue Code to include
CAUTION employers with “no more than” 25 FTEs, the
phaseout of the credit amount operates in such a way that
an employer with exactly 25 FTEs is not, in fact, eligible for
the credit.
!
3. You paid average annual wages for the tax year of
less than $62,000 per FTE. For details, see Worksheets
1 and 3.
Cat. No. 55222U
If you had more than 10 FTEs and average annual
wages of more than $30,000, the FTE and
CAUTION average annual wage limitations (discussed later)
will separately reduce your credit. This may reduce your
credit to zero even if you had fewer than 25 FTEs and
average annual wages of less than $62,000.
State premium subsidy or tax credit. If you’re entitled
to a state tax credit or a state premium subsidy paid
directly to you for premiums you paid, don’t reduce the
amount you paid by the credit or subsidy amount. Also, if a
state pays a premium subsidy directly to your insurance
provider, treat the subsidy amount as an amount you paid
for employee health insurance coverage.
!
Employers treated as a single employer. Treat the
following employers as a single employer to figure the
credit.
• Employers who are corporations in a controlled group of
corporations.
• Employers who are members of an affiliated service
group.
• Employers who are partnerships, proprietorships, etc.,
under common control. See Regulations sections
1.414(c)-2, 1.414(c)-3, and 1.414(c)-4.
• Tax-exempt employers under common control. See
Regulations section 1.414(c)-5.
For details, see section 45R(e)(5)(A) and Regulations
section 1.45R-2(b).
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Wellness programs. A wellness program is generally an
insurance program of health promotion or disease
prevention. If you pay part or all of the cost of an
employee’s participation in a wellness program, treat the
amount you paid toward the employee’s participation as
an amount you paid for employee health insurance
coverage.
Tobacco surcharges. A tobacco surcharge is generally
an additional amount charged for insurance for a tobacco
user. If you pay part or all of an employee’s tobacco
surcharge, you can’t use the amount you paid to figure
your employer premiums paid.
Dependent coverage. Dependent coverage is generally
coverage offered separately to an individual who is or may
become eligible for coverage under the terms of a group
health plan because of a relationship to a
participant-employee, whether or not a dependent of the
participant-employee. Dependent coverage doesn’t
include coverage, such as family coverage, which
includes coverage of the participant-employee. If you pay
part or all of the cost of an employee’s dependent
coverage, use the amount you paid to figure your
employer premiums paid.
No more than one Form 8941 can be filed with a
TIP tax return, unless the exception described in
Example 2 below applies.
Example 1. You’re a sole proprietor with two separate
businesses and you file a separate Schedule C (Form
1040), Profit or Loss From Business, for each business.
You must treat both businesses as a single employer to
figure the credit. You will file one Form 8941 for both
businesses.
Example 2. You and your spouse are both sole
proprietors and file a separate Schedule C (Form 1040)
for each of your separate businesses. Neither spouse was
an employee of the other spouse or participated in the
management of the other spouse’s business at any time
during the tax year. No more than 50% of the gross
income of either business was derived from royalties,
rents, dividends, interest, and annuities and you otherwise
meet the requirements listed in Regulations section
1.414(c)-4(b)(5)(ii). Don’t treat both businesses as a
single employer to figure the credit. If you and your spouse
are both eligible small employers, you can file two Forms
8941 with a jointly filed Form 1040 or 1040-SR.
Portion of premiums paid. If you pay only a portion of
the premiums and your employees pay the rest, only the
portion you pay is taken into account. For this purpose,
any premium paid through a salary reduction arrangement
under a section 125 cafeteria plan isn’t treated as an
employer paid premium. For more information on cafeteria
plans, see section 1 of Pub. 15-B, Employer’s Tax Guide to
Fringe Benefits.
Example 3. You offer health insurance coverage to
employees under a qualifying arrangement that requires
you to pay 60% of the premium cost for employee-only
coverage for each employee enrolled in any health
insurance coverage you provide to employees. The total
premium for each employee enrolled in employee-only
coverage is $5,200 per year or $100 ($5,200 ÷ 52) for
each weekly payday. The total premium for each
employee enrolled in family coverage is $13,000 per year
or $250 ($13,000 ÷ 52) for each weekly payday.
Each payday, you contribute $60 (60% of $100) toward
the premium cost of each employee enrolled in
employee-only coverage and withhold the remaining $40
from the employee's paycheck to obtain the $100 total
weekly premium. Each payday, you contribute $60 (the
same amount you pay toward the premiums of employees
enrolled in employee-only coverage) toward the premium
cost of each employee enrolled in family coverage and
withhold the remaining $190 from the employee’s
paycheck to obtain the $250 total weekly premium.
To determine the premiums you paid during the tax
year, multiply the number of pay periods during which the
Credit Period
For tax years beginning after 2013, the credit period
during which the credit can be claimed is a
2-consecutive-tax-year period beginning with the first tax
year in which:
• An eligible small employer (or any predecessor) files an
income tax return with an attached Form 8941 with line A
checked “Yes” and a positive amount on line 12, or
• A tax-exempt eligible small employer (or any
predecessor) files Form 990-T with an attached Form
8941 with line A checked “Yes” and a positive amount on
line 12.
Employer Premiums Paid
Only premiums you paid for health insurance coverage
under a qualifying arrangement (discussed later) for
individuals considered employees are counted when
figuring your credit.
-2-
Instructions for Form 8941 (2023)
surcharge for nonparticipation). However, for purposes of
figuring the credit, the employer contributions are taken
into account, including those contributions attributable to
an employee’s participation in a wellness program.
employee was enrolled in the health insurance coverage
by $60. For example, you would’ve paid $3,120 ($60 × 52)
for an employee who was enrolled for the entire tax year.
You would’ve paid $600 ($60 × 10) for an employee who
was only enrolled for 10 pay periods. You will need an
additional set of calculations if the premium amounts
changed during the tax year.
Tobacco surcharge. Any additional amount you or your
employee pays to cover a tobacco surcharge isn’t taken
into account in figuring the uniform percentage
requirement. Amounts you or your employee pays to cover
a tobacco surcharge aren’t considered premiums paid for
health insurance coverage when figuring this credit.
Health Insurance Coverage
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For tax years beginning after 2013, health insurance
coverage generally means coverage provided to
employees enrolled in a qualified health plan offered
through a Small Business Health Options Program
(SHOP) Marketplace. For an exception that applies to
certain employers in certain counties, see the instructions
for line A, later. If this exception applies, health insurance
coverage means coverage, as defined under Health
Insurance Coverage in the 2013 Instructions for Form
8941.
Dependent coverage. Premiums you pay for dependent
coverage aren’t subject to the uniform percentage
requirement. You aren’t required to pay a uniform
percentage (not less than 50%) for dependent coverage.
Arrangements with composite billing. An arrangement
that requires you to pay a uniform premium for each
enrolled employee (composite billing) and offers different
tiers of coverage can be a qualifying arrangement even if it
requires you to pay a uniform percentage that is less than
50% of the premium cost for employees not enrolled in
employee-only coverage. It is a qualifying arrangement
(assuming employee-only coverage is the least expensive
tier of coverage) if it requires you to pay each of the
following amounts if you make the relevant tier of coverage
available.
• A uniform percentage (not less than 50%) of the
premium cost for each employee (if any) enrolled in
employee-only coverage.
• A uniform amount that is no less than the amount you
would’ve paid toward employee-only coverage for each
employee (if any) enrolled in family coverage.
• A uniform amount that is no less than the amount you
would’ve paid toward employee-only coverage for each
employee (if any) enrolled in any other tier of coverage
(figured separately for each tier).
A stand-alone dental plan offered through a SHOP
TIP exchange will be considered a qualified health
plan for purposes of the credit.
Employer premiums paid for health insurance
coverage can be counted in figuring the credit only
CAUTION if the premiums are paid under a qualifying
arrangement.
!
Qualifying Arrangement
A qualifying arrangement is generally an arrangement that
requires you to pay a uniform percentage (not less than
50%) of the premium cost for each enrolled employee's
health insurance coverage (defined earlier). An
arrangement that offers different tiers of coverage (for
example, employee-only and family coverage) is generally
a qualifying arrangement if it requires you to pay a uniform
percentage (not less than 50%) separately for each tier of
coverage you offer. However, an arrangement can be a
qualifying arrangement even if it requires you to pay a
uniform percentage that is less than 50% of the premium
cost for some employees.
Arrangements with list billing and only employee-only coverage. An arrangement that requires you to pay a
separate premium for each employee based on age or
other factors (list billing) that only provides employee-only
coverage can be a qualifying arrangement even if it
requires you to pay a uniform percentage that is less than
50% of the premium cost for some employees. It is a
qualifying arrangement if it requires you to pay either of
the following amounts.
• A uniform percentage (not less than 50%) of the
premium charged for each employee enrolled in the
employee-only coverage.
• A uniform percentage (not less than 50%) of your
employer-computed composite rate (defined later) for your
employee-only coverage for each employee enrolled in
the employee-only coverage.
For more information about the following exceptions,
see Regulations section 1.45R-4.
State or local law. You will be treated as satisfying the
uniform percentage requirement if your failure to otherwise
satisfy the requirement was solely attributable to
additional contributions you made to certain employees to
comply with state or local law.
Wellness program. If a plan of an employer provides a
wellness program, for purposes of meeting the uniform
percentage requirement, the following applies. Any
additional amount of the employer contribution attributable
to an employee’s participation in the wellness program
over the employer contribution with respect to an
employee that doesn’t participate in the wellness program
isn’t considered in calculating the uniform percentage
requirement. This is true whether the difference is due to a
discount for participation or a surcharge for
nonparticipation. The employer contribution for employees
who don’t participate in the wellness program must be at
least 50% of the premium (including any premium
Instructions for Form 8941 (2023)
Arrangements with list billing and other tiers of coverage. An arrangement that requires you to pay a
separate premium for each employee based on age or
other factors (list billing) that provides other tiers of
coverage can be a qualifying arrangement even if it
requires you to pay a uniform percentage that is less than
50% of the premium cost for some employees. It is a
qualifying arrangement (assuming employee-only
coverage is the least expensive tier of coverage) if it
-3-
Net premium payments are employer premiums paid
(discussed earlier) minus the amount of any state tax
credits you received or will receive and any state premium
subsidies paid either to you or directly to your insurance
provider for premiums for health insurance coverage you
provide under a qualifying arrangement to individuals
considered employees.
requires you to pay each of the following amounts if you
make the relevant tier of coverage available.
• A uniform percentage (not less than 50%) for each
employee enrolled in employee-only coverage, as
discussed under Arrangements with list billing and only
employee-only coverage, earlier.
• A uniform amount that is either equal to the amount you
would’ve paid toward employee-only coverage (as
discussed above), a uniform percentage (not less than
50%) of the premium charged, or a uniform percentage
(not less than 50%) of your employer-computed
composite rate (defined below) for your family coverage,
for each employee (if any) enrolled in family coverage.
• A uniform amount that is either equal to the amount you
would’ve paid toward employee-only coverage (as
discussed above), a uniform percentage (not less than
50%) of the premium charged, or a uniform percentage
(not less than 50%) of your employer-computed
composite rate (defined below) for any other tier of
coverage, for each employee (if any) enrolled in any other
tier of coverage (figured separately for each tier).
Payroll Tax Limitation for Tax-Exempt
Eligible Small Employers
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The credit for tax-exempt eligible small employers can’t
exceed the amount of certain payroll taxes. For tax years
beginning in 2023, payroll taxes, for this purpose, mean
only the following taxes.
• Federal income taxes the tax-exempt employer was
required to withhold from employees’ wages in calendar
year 2023.
• Medicare taxes the tax-exempt employer was required
to withhold from employees’ wages in calendar year 2023.
• Medicare taxes the tax-exempt employer was required
to pay for calendar year 2023.
Employer-computed composite rate. The
employer-computed composite rate for a tier of coverage
is the average rate determined by adding the premiums for
that tier of coverage for all employees eligible to
participate in the health insurance plan (whether or not
they actually receive coverage under the plan or under
that tier of coverage) and dividing by the total number of
such eligible employees.
Premium Deduction Reduced
You must reduce your deduction for the cost of providing
health insurance coverage to your employees by the
amount of any credit for small employer health insurance
premiums allowed with respect to the coverage.
More Information
For more information about this credit, see the following.
• Section 45R.
• Regulations sections 1.45R-0 through 1.45R-5.
• IRS.gov/Affordable-Care-Act/Employers/SmallBusiness-Health-Care-Tax-Credit-and-the-SHOPMarketplace.
More than one plan. Different types of health insurance
plans are generally not aggregated for purposes of
meeting the qualifying arrangement requirement. For
example, if you offer a major medical insurance plan and a
stand-alone vision plan, you generally must separately
satisfy the requirements for a qualifying arrangement with
respect to each type of coverage. For exceptions, see
Regulations section 1.45R-4(c).
Specific Instructions
State subsidies and credits. For this purpose, if you’re
entitled to a state tax credit or a state premium subsidy
paid directly to you for premiums you paid, don’t reduce
the amount you paid by the credit or subsidy amount.
Also, if a state pays a premium subsidy directly to your
insurance provider, treat the subsidy amount as an
amount you paid for employee health insurance coverage.
Partnerships, S corporations, cooperatives,
TIP estates, trusts, and tax-exempt eligible small
employers must file this form to claim the credit.
All other taxpayers must not complete or file this form if
their only source for this credit is a partnership, S
corporation, cooperative, estate, or trust. Instead, they
must report this credit directly on line 4h in Part III of Form
3800.
State Premium Subsidy and Tax
Credit Limitation
Use Worksheets 1 through 7 to figure the amounts to
report on various lines of Form 8941.
• Use Worksheets 1, 2, and 3 to figure the amounts to
report on lines 1, 2, and 3 of Form 8941.
• Use Worksheet 4 to figure the amounts to report on
lines 4, 5, and 13 of Form 8941.
• Use Worksheets 5, 6, and 7 to figure the amounts to
report on lines 8, 9, and 14 of Form 8941.
Your credit may be reduced if you’re entitled to a state tax
credit or a state premium subsidy for the cost of health
insurance coverage you provide under a qualifying
arrangement to individuals considered employees. The
state tax credit may be refundable or nonrefundable and
the state premium subsidy may be paid to you or directly
to your insurance provider.
Line A
Although a state tax credit or premium subsidy paid
directly to you doesn’t reduce the amount of your
employer premiums paid, and although a state premium
subsidy paid directly to an insurance provider is treated as
an employer premium you paid, the amount of your credit
can’t be more than your net premium payments.
Answer “Yes” if one of the following applies.
• You paid premiums for employee health insurance
coverage you provided through a SHOP Marketplace or
through a direct enrollment process, if available in your
state.
-4-
Instructions for Form 8941 (2023)
• You qualify for an exception to this requirement, as
discussed below.
Worksheet 1. Information Needed To
Complete Line 1 and Worksheets 2
and 3
If you answer “Yes” because you paid premiums for
employee health insurance coverage you provided
through a SHOP Marketplace, enter the Marketplace
identifier, if any.
If you need more rows, use a separate sheet and include
the additional amounts in the totals below.
If you answer “No,” don’t file Form 8941 unless you’re
filing it for a partnership, S corporation, cooperative,
estate, trust, or tax-exempt eligible small employer that
received from another entity a credit that must be reported
on line 15. For more information, see the instructions for
line 15.
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(a)
Individuals
Considered
Employees
(b)
Employee
Hours of
Service
(c)
Employee
Wages
Paid
1.
Waiver for Hawaii. Hawaii has received a 5-year State
Innovation Waiver under section 1332 of the Affordable
Care Act that has been extended for 5 more years.
Employers in Hawaii can’t participate in the SHOP
Marketplace or claim the credit for insurance premiums
paid for health plan years beginning after 2016. For more
information on the waiver, go to CMS.gov.
2.
3.
4.
5.
6.
Exception for eligible small employers in certain
counties. For calendar year 2023, SHOP Marketplaces
in certain counties across the United States didn’t have
qualified health plans available for employers to offer to
employees. However, relief is available, which allows
eligible small employers with a principal business address
in those counties to claim the credit for 2023 if they
properly claimed the credit under section 45R for all or
part of 2022. For details, see Notice 2018-27, 2018-20,
I.R.B. 580, available at IRS.gov/irb/
2018-20_IRB#NOT-2018-27.
7.
8.
9.
10.
11.
12.
13.
14.
To see whether a particular county has coverage
15.
TIP available through a SHOP Exchange for 2023 and
16.
beyond, go to Healthcare.gov/small-business and
enter “plans and prices” in the search box.
17.
18.
Line C
19.
Answer “Yes” if a tax return you (or any predecessor) filed
for a tax year beginning after 2013 and before 2022
included a Form 8941 with line A checked “Yes” and
line 12 showing a positive amount. For more information,
see Credit Period, earlier.
20.
21.
22.
23.
If you answer “Yes,” don’t file Form 8941 unless you’re
filing it for a partnership, S corporation, cooperative,
estate, trust, or tax-exempt eligible small employer that
received from another entity a credit that must be reported
on line 15. An entity that qualifies for this exception
shouldn’t report any amount on line 12. For more
information, see the instructions for line 15.
24.
25.
Totals:
Column (a), Individuals Considered
Employees
Enter the name or other identifying information for all
individuals considered employees for purposes of this
credit.
In general, all employees who perform services for you
during the tax year are taken into account in determining
your FTEs, average annual wages, and premiums paid.
Rules that apply to certain types of employees are
discussed below.
Instructions for Form 8941 (2023)
-5-
discussed above. A sole proprietor must include both
business and nonbusiness employees to determine FTEs,
average annual wages, and premiums paid.
Excluded employees. The following individuals aren’t
considered employees when you figure this credit. Hours
and wages of these employees and premiums paid for
them aren’t counted when you figure your credit.
• The owner of a sole proprietorship.
• A partner in a partnership.
• A shareholder who owns (after applying the section 318
constructive ownership rules) more than 2% of an S
corporation.
• A shareholder who owns (after applying the section 318
constructive ownership rules) more than 5% of the
outstanding stock or stock possessing more than 5% of
the total combined voting power of all stock of a
corporation that isn’t an S corporation.
• A person who owns more than 5% of the capital or
profits interest in any other business that isn’t a
corporation.
• Family members or a member of the household who
isn’t a family member but qualifies as a dependent on the
individual income tax return of a person listed above.
Family members include a child (or descendant of a
child), a sibling or step-sibling, a parent (or ancestor of a
parent), a step-parent, a niece or nephew, an aunt or
uncle, or a son-in-law, daughter-in-law, father-in-law,
mother-in-law, brother-in-law, or sister-in-law. A spouse of
any owner or family member listed above is also
considered a family member for this purpose.
Ministers. A minister performing services in the exercise
of the minister’s ministry is treated as self-employed for
social security and Medicare purposes. However, for
credit purposes, whether a minister is an employee or
self-employed is determined under the common law test
for determining worker status. Self-employed ministers
aren’t considered employees.
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Column (b), Employee Hours of
Service
Enter the total hours of service for the tax year for each
employee listed in column (a). Don’t enter more than
2,080 hours for any employee. But enter -0- for seasonal
employees who worked 120 or fewer days during the tax
year.
Employee hours of service. An employee’s hours of
service for a year include the following.
• Each hour for which the employee is paid, or entitled to
payment, for the performance of duties for the employer
during the employer’s tax year.
• Each hour for which an employee is paid, or entitled to
payment, by the employer on account of a period of time
during the employer’s tax year during which no duties are
performed due to vacation, holiday, illness, incapacity
(including disability), layoff, jury duty, military duty, or leave
of absence (except that no more than 160 hours of service
are required to be counted for an employee on account of
any single continuous period during which the employee
performs no duties).
To figure the total number of hours of service you must
take into account for an employee for the year, you can
use any of the following methods.
Actual-hours-worked method. Determine actual
hours of service from records of hours worked and hours
for which payment is made or due (payment is made or
due for vacation, holiday, illness, incapacity, etc., as
described above).
Days-worked equivalency method. Use a
days-worked equivalency whereby the employee is
credited with 8 hours of service for each day for which the
employee would be required to be credited with at least 1
hour of service under the rules described above.
Weeks-worked equivalency method. Use a
weeks-worked equivalency whereby the employee is
credited with 40 hours of service for each week for which
the employee would be required to be credited with at
least 1 hour of service under the rules described above.
Former employees. Premiums paid on behalf of a
former employee with no hours of service may be treated
as paid on behalf of an employee for purposes of figuring
the credit, provided that, if so treated, the former
employee is also treated as an employee for purposes of
the uniform percentage requirement.
Leased employees. Don’t use premiums paid by the
leasing organization to figure your credit. Also, a leased
employee who isn’t a common law employee is
considered an employee for credit purposes if the
employee does all the following.
• Provides services to you under an agreement between
you and a leasing organization.
• Has performed services for you (or for you and a related
person) substantially full time for at least 1 year.
• Performs services under your primary direction or
control.
But don’t use hours, wages, or premiums paid with
respect to the initial year of service on which leased
employee status is based.
Seasonal employees. Employees who perform labor or
services on a seasonal basis and perform labor or
services for you 120 or fewer days during the tax year
aren’t considered employees in determining FTEs and
average annual wages. But premiums paid on their behalf
are counted in determining the amount of the credit.
Seasonal workers include retail workers employed
exclusively during holiday seasons. Seasonal workers
also include workers employed exclusively during the
summer.
Column (c), Employee Wages Paid
!
CAUTION
Complete Worksheet 2 before you complete
column (c) of Worksheet 1. Do not complete
column (c) if Worksheet 2, line 3, is 25 or more.
Enter the total wages paid for the tax year for each
employee listed in column (a). But enter -0- for seasonal
employees who worked 120 or fewer days during the tax
year.
Household and other nonbusiness employees.
Household employees and other employees who aren’t
performing services in your trade or business are
considered employees if they otherwise qualify, as
-6-
Instructions for Form 8941 (2023)
Worksheet 4. Information Needed To
Complete Lines 4, 5, and 13 and
Worksheet 7
Wages, for this purpose, mean wages subject to social
security and Medicare tax withholding determined without
considering any wage base limit.
Worksheet 2. Information Needed To
Complete Line 2 (FTEs)
If you need more rows, use a separate sheet and include
the additional amounts in the totals below.
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Your credit is reduced if you had more than 10 FTEs for
the tax year. If you had 25 or more FTEs for the tax year,
your credit is reduced to zero.
1. Enter the total employee hours of
service from Worksheet 1, column
(b) . . . . . . . . . . . . . . . . . . . . . . . . .
1.
2. Hours of service per FTE . . . . . . . . .
2.
3. Full-time equivalent employees.
Divide line 1 by line 2. If the result isn’t a
whole number (0, 1, 2, etc.), generally
round the result down to the next
lowest whole number. For example,
round 2.99 down to 2. However, if the
result is less than one, enter 1. Report
this number on Form 8941, line 2 . . .
(a)
Enrolled
Individuals
Considered
Employees
(c)
Adjusted
Average
Premiums
(d)
Enrolled
Employee
Hours of
Service
1.
2,080
2.
3.
4.
5.
6.
7.
3.
8.
Worksheet 3. Information Needed To
Complete Line 3 (Average Annual
Wages)
9.
Your credit is reduced if you paid average annual wages of
more than $30,000 for the tax year. If you paid average
annual wages of $62,000 or more for the tax year, your
credit is reduced to zero.
13.
1. Enter the total employee wages paid
from Worksheet 1, column (c) . . . . . .
1.
2. Enter FTEs from Worksheet 2,
line 3 . . . . . . . . . . . . . . . . . . . . . . .
2.
3. Average annual wages. Divide line 1
by line 2. If the result isn’t a multiple of
$1,000 ($1,000, $2,000, $3,000, etc.),
round the result down to the next
lowest multiple of $1,000. For example,
round $2,999 down to $2,000. Report
this amount on Form 8941, line 3 . . .
(b)
Employer
Premiums
Paid
10.
11.
12.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
3.
24.
25.
Totals:
Column (a), Enrolled Individuals
Considered Employees
Enter the name or other identifying information for each
individual listed in column (a) of Worksheet 1 who was
enrolled in health insurance coverage you provided to
employees during the tax year under a qualifying
arrangement. For details, see Health Insurance Coverage
and Qualifying Arrangement, earlier.
Instructions for Form 8941 (2023)
-7-
Column (b), Employer Premiums Paid
enrolled for the entire tax year. You would’ve paid $570
($57 × 10) if the employee was only enrolled for 10 pay
periods. You’ll need an additional set of calculations if the
premium amounts changed during the tax year.
Enter the total employer premiums paid for the tax year for
each employee listed in column (a). For details, see
Employer Premiums Paid, earlier.
Column (d), Enrolled Employee Hours
of Service
Column (c), Adjusted Average
Premiums
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Your credit is reduced if the employer premiums paid are
more than the employer premiums that would’ve been
paid if individuals considered employees were enrolled in
a plan with a premium equal to the average premium for
the small group market in the rating area in which the
employee enrolls for coverage.
!
Don’t complete column (d) of Worksheet 4 if Form
8941, line 12, is zero.
CAUTION
Enter the amount from column (b) of Worksheet 1 for
each employee listed in column (a) of Worksheet 4.
Worksheet 5. Information Needed To
Complete Line 8 (If Line 2 Is More
Than 10)
The rating area in which an employee enrolls for
coverage is generally the rating area where your business
is located (based on your primary business address). You
will generally have selected a plan in your rating area that
covers all employees located within or outside your rating
area. However, if you have multiple businesses or
operations in multiple states, and have set up plans in
more than one SHOP Marketplace, the average premiums
may be different for employees enrolled in each SHOP
Marketplace.
1. Enter the amount from Form 8941,
line 7 . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter, for each employee listed in column (a), the
premiums you would’ve paid if the employee had enrolled
in a plan or plans with a total premium equal to the
average premium for the small group market in the rating
area in which the employee enrolls for coverage.
To find the average premium for the small group market
in a rating area for tax years beginning in 2023, see the
average premium tables at the end of these instructions.
Family coverage includes any coverage other than
employee-only coverage.
2. Enter the number from Form
8941, line 2 . . . . . . . . . . . .
2.
3. Subtract 10 from line 2 . . . . .
3.
4. Divide line 3 by 15. Enter the
result as a decimal (rounded to
at least 3 places) . . . . . . . .
4.
1.
5. Multiply line 1 by line 4 . . . . . . . . . . . . . .
5.
6. Subtract line 5 from line 1. Report this
amount on Form 8941, line 8 . . . . . . . . .
6.
Worksheet 6. Information Needed To
Complete Line 9 (If Line 3 Is More
Than $30,000)
Example 4. Assume the same facts that were used in
Example 3. The $60 you contribute each payday toward
employee health insurance coverage is 60% ($60 ÷ $100)
of the weekly premium for each employee enrolled in
employee-only coverage and 24% ($60 ÷ $250) of the
weekly premium for each employee enrolled in family
coverage.
In this situation, the total average premium limitation
amounts that apply are 60% of the applicable average
premium amounts for each employee enrolled in
employee-only coverage and 24% of the applicable
average premium amounts for each employee enrolled in
family coverage.
You have an employee enrolled in employee-only
coverage who enrolled for coverage in your local rating
area. The applicable employee-only average premium
amount for the rating area is $4,940 or $95 ($4,940 ÷ 52)
for each weekly payday. The amount you would’ve paid
toward this employee’s health insurance coverage based
on the average premiums is $57 (60% of $95) each
payday.
To determine the premiums you would’ve paid for this
employee during the tax year if the employee had enrolled
in an average premium plan, multiply the number of pay
periods during which your employee was enrolled in the
health insurance coverage by $57. For example, you
would’ve paid $2,964 ($57 × 52) if the employee was
1. Enter the amount from Form 8941,
line 8 . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Enter the amount from Form
8941, line 7 . . . . . . . . . . . . .
2.
3. Enter the amount from Form
8941, line 3 . . . . . . . . . . . . .
3.
4. Subtract $30,700 from line 3
4.
.
5. Divide line 4 by $30,700. Enter
the result as a decimal (rounded
to at least 3 places) . . . . . . . .
1.
5.
6. Multiply line 2 by line 5 . . . . . . . . . . . . . .
6.
7. Subtract line 6 from line 1. Report this
amount on Form 8941, line 9 . . . . . . . . .
7.
Line 10
Enter the total amount of any state premium subsidies
paid and any state tax credits available to you for
premiums included on line 4. For details, see State
Premium Subsidy and Tax Credit Limitation, earlier.
-8-
Instructions for Form 8941 (2023)
Worksheet 7. Information Needed To
Complete Line 14 (If Line 12 Is More
Than Zero)
its tax liability. Therefore, to figure the unused amount of
the credit allocated to patrons, the cooperative must first
figure its tax liability. While any excess is allocated to
patrons, any credit recapture applies as if the cooperative
had claimed the entire credit.
If the cooperative is subject to the passive activity rules,
include on line 15 any credit for small employer health
insurance premiums from passive activities disallowed for
prior years and carried forward to this year. Complete
Form 8810, Corporate Passive Activity Loss and Credit
Limitations, to determine the allowed credit that must be
allocated to patrons. For details, see the Instructions for
Form 8810.
1. Enter the total enrolled employee hours of
service from Worksheet 4, column
(d) . . . . . . . . . . . . . . . . . . . . . . . . . .
1.
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2. Hours of service per FTE . . . . . . . . . .
2.
2,080
3. Divide line 1 by line 2. If the result isn’t a
whole number (0, 1, 2, etc.), generally
round the result down to the next
lowest whole number. For example, round
2.99 down to 2. However, if the result is
less than one, enter 1. Report this
number on Form 8941, line 14 . . . . . .
3.
Estates and trusts. Allocate the credit on line 16
between the estate or trust and the beneficiaries in the
same proportion as income was allocated and enter the
beneficiaries’ share on line 17.
If the estate or trust is subject to the passive activity
rules, include on line 15 any credit for small employer
health insurance premiums from passive activities
disallowed for prior years and carried forward to this year.
Complete Form 8582-CR, Passive Activity Credit
Limitations, to determine the allowed credit that must be
allocated between the estate or trust and the
beneficiaries. For details, see the Instructions for Form
8582-CR.
Line 15
Enter any credit for small employer health insurance
premiums from:
• Schedule K-1 (Form 1065), Partner's Share of Income,
Deductions, Credits, etc., box 15 (code BA);
• Schedule K-1 (Form 1120-S), Shareholder's Share of
Income, Deductions, Credits, etc., box 13 (code BA);
• Schedule K-1 (Form 1041), Beneficiary’s Share of
Income, Deductions, Credits, etc., box 13 (code G); and
• Form 1099-PATR, Taxable Distributions Received From
Cooperatives, box 12, or other notice of credit allocation.
Line 19
Enter the total amount of certain payroll taxes. Payroll
taxes, for this purpose, mean only the following taxes.
• Federal income taxes the tax-exempt employer was
required to withhold from employees’ wages in calendar
year 2023.
• Medicare taxes the tax-exempt employer was required
to withhold from employees’ wages in calendar year 2023.
• Medicare taxes the tax-exempt employer was required
to pay for calendar year 2023.
Partnerships, S corporations, cooperatives,
TIP estates, trusts, and tax-exempt eligible small
employers report the above credits on line 15. All
other filers figuring a separate credit on earlier lines also
report the above credits on line 15. All others not using
earlier lines to figure a separate credit must report the
above credits directly on Form 3800, Part lll, line 4h.
Line 17
Cooperatives. A cooperative described in section
1381(a) must allocate to its patrons the credit in excess of
Instructions for Form 8941 (2023)
-9-
Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the
United States. You are required to give us the information. We need it to ensure that you are complying with these laws
and to allow us to figure and collect the right amount of tax.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be
retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by section 6103.
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h
The time needed to complete and file this form will vary depending on individual circumstances. The estimated burden
for individual and business taxpayers filing this form is approved under OMB control number 1545-0074 and 1545-0123
and is included in the estimates shown in the instructions for their individual and business income tax return. The
estimated burden for all other taxpayers who file this form is shown below.
Recordkeeping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Learning about the law or the form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Preparing and sending the form to the IRS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 hr., 8 min.
1 hr., 2 min.
2 hr., 5 min.
If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler,
we would be happy to hear from you. See the instructions for the tax return with which this form is filed.
-10-
Instructions for Form 8941 (2023)
Average Premiums Needed To Figure Adjusted Amounts on Worksheet 4
The following tables list the average
premiums for the small group market
in each rating area generally listed by
county for each state for tax years
beginning in 2023.
Limestone
7,262
23,301
Petersburg
11,771
31,062
Lowndes
8,391
23,453
Prince of Wales-Hyder 11,771
31,062
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Alabama
Macon
7,241
20,533
Sitka
11,771
31,062
Madison
7,262
23,301
Skagway
11,771
31,062
Marengo
7,241
20,533
Southeast Fairbanks
12,011
30,930
Marion
7,241
20,533
Valdez Cordova
11,303
29,868
7,241
20,533
Wade Hampton
12,011
30,930
Wrangell City and
Borough
11,771
31,062
Yakutat
12,011
30,930
Yukon Koyukuk
12,011
30,930
County
Employee- Dependent,
Only
Family, etc.
Marshall
Mobile
7,468
22,163
Autauga
8,391
23,453
Monroe
7,241
20,533
Baldwin
7,241
20,533
Montgomery
8,391
23,453
Barbour
7,241
20,533
Morgan
7,893
19,596
Bibb
7,061
22,250
Perry
7,241
20,533
Blount
7,061
22,250
Pickens
7,241
20,533
Bullock
7,241
20,533
Pike
7,241
20,533
Butler
7,241
20,533
Randolph
7,241
20,533
Calhoun
6,836
20,924
Russell
7,210
21,092
Chambers
7,241
20,533
Shelby
7,061
22,250
Cherokee
7,241
20,533
St. Clair
7,061
22,250
Chilton
7,061
22,250
Sumter
7,241
20,533
Choctaw
7,241
20,533
Talladega
7,241
20,533
Clarke
7,241
20,533
Tallapoosa
7,241
20,533
Clay
7,241
20,533
Tuscaloosa
7,665
21,879
Cleburne
7,241
20,533
Walker
7,061
22,250
Coffee
7,241
20,533
Washington
7,241
20,533
Colbert
8,701
22,810
Wilcox
7,241
20,533
Conecuh
7,241
20,533
Winston
7,241
20,533
Coosa
7,241
20,533
Covington
7,241
20,533
Crenshaw
7,241
20,533
Cullman
7,241
20,533
County
Employee- Dependent,
Only
Family, etc.
Dale
7,241
20,533
Aleutians East
12,011
30,930
Dallas
7,241
20,533
Aleutians West
12,011
30,930
DeKalb
7,241
20,533
Anchorage
11,303
29,868
Elmore
8,391
23,453
Bethel
11,303
29,868
Escambia
7,241
20,533
Bristol Bay
12,011
30,930
Etowah
6,539
22,226
Denali
12,011
30,930
Fayette
7,241
20,533
Dillingham
11,303
29,868
Franklin
7,241
20,533
Fairbanks North Star
12,011
30,930
Geneva
7,505
22,014
Haines
11,771
31,062
Greene
7,665
21,879
Hoonah-Angoon
11,771
31,062
Hale
7,665
21,879
Juneau
11,771
31,062
Henry
7,505
22,014
Kenai Peninsula
12,011
30,930
Houston
7,505
22,014
Ketchikan Gateway
11,771
31,062
Jackson
7,241
20,533
Kodiak Island
12,011
30,930
Jefferson
7,061
22,250
Lake and Peninsula
12,011
30,930
Lamar
7,241
20,533
Matanuska Susitna
12,011
30,930
Lauderdale
8,701
22,810
Nome
12,011
30,930
Lawrence
7,893
19,596
North Slope
12,011
30,930
Lee
6,462
19,185
Northwest Arctic
12,011
30,930
2023 Average Premium Tables
Alaska
-11-
Arizona
County
Employee- Dependent,
Only
Family, etc.
Apache
8,205
23,802
Cochise
7,758
21,771
Coconino
8,205
23,802
Gila
7,732
20,592
Graham
7,758
21,771
Greenlee
7,758
21,771
La Paz
8,893
24,548
Maricopa
7,176
22,558
Mohave
8,205
23,802
Navajo
8,205
23,802
Pima
7,513
21,227
Pinal
7,732
20,592
Santa Cruz
7,513
21,227
Yavapai
7,412
21,670
Yuma
8,893
24,548
Arkansas
County
Employee- Dependent,
Only
Family, etc.
Arkansas
7,140
17,389
Ashley
7,140
17,389
Baxter
7,244
21,429
Benton
7,244
21,429
Boone
7,244
21,429
Bradley
7,140
17,389
Calhoun
7,695
23,029
Carroll
7,244
21,429
Chicot
7,140
17,389
Clark
6,191
18,872
Clay
7,751
21,560
Cleburne
7,028
19,164
Cleveland
7,140
17,389
Columbia
7,695
23,029
Conway
7,028
19,164
Craighead
7,751
21,560
Stone
7,751
21,560
Santa Clara
9,709
28,911
Crawford
6,714
21,788
Union
7,695
23,029
Santa Cruz
9,395
26,386
Crittenden
7,751
21,560
Van Buren
7,028
19,164
Shasta
9,825
23,668
Cross
7,751
21,560
Washington
7,244
21,429
Sierra
9,825
23,668
Dallas
7,140
17,389
White
7,028
19,164
Siskiyou
9,825
23,668
Desha
7,140
17,389
Woodruff
7,751
21,560
Solano
8,407
22,859
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Drew
7,140
17,389
Faulkner
7,028
19,164
Franklin
6,714
21,788
Fulton
7,751
21,560
Garland
6,191
18,872
County
Grant
7,028
19,164
Yell
7,028
19,164
Sonoma
8,407
22,859
Stanislaus
9,008
24,693
Sutter
9,825
23,668
Employee- Dependent,
Only
Family, etc.
Tehama
9,825
23,668
Trinity
9,825
23,668
Alameda
9,991
26,876
Tulare
9,008
24,693
9,825
23,668
California
Greene
7,751
21,560
Alpine
Tuolumne
9,825
23,668
Hempstead
7,695
23,029
Amador
9,825
23,668
Ventura
8,551
25,169
Hot Spring
6,191
18,872
Butte
9,825
23,668
Yolo
8,099
24,093
9,825
23,668
Yuba
9,825
23,668
Howard
7,695
23,029
Calaveras
Independence
7,751
21,560
Colusa
9,825
23,668
Izard
7,751
21,560
Contra Costa
9,461
26,914
Jackson
7,751
21,560
Del Norte
9,825
23,668
Jefferson
7,140
17,389
El Dorado
8,099
24,093
County
Employee- Dependent,
Only
Family, etc.
Johnson
6,714
21,788
Fresno
8,250
25,788
Adams
7,411
21,656
9,825
23,668
Alamosa
8,633
23,653
Colorado
Lafayette
7,695
23,029
Glenn
Lawrence
7,751
21,560
Humboldt
9,825
23,668
Arapahoe
7,411
21,656
17,389
Imperial
8,038
22,422
Archuleta
8,143
24,827
8,038
22,422
Baca
8,633
23,653
Lee
7,140
Lincoln
7,140
17,389
Inyo
Little River
7,695
23,029
Kern
8,576
20,242
Bent
8,633
23,653
21,788
Kings
8,250
25,788
Boulder
7,775
22,089
9,825
23,668
Broomfield
7,411
21,656
Logan
6,714
Lonoke
7,028
19,164
Lake
Madison
7,244
21,429
Lassen
9,825
23,668
Chaffee
8,633
23,653
21,429
Los Angeles
8,516
24,150
Cheyenne
8,633
23,653
8,250
25,788
Clear Creek
7,411
21,656
Marion
7,244
Miller
7,695
23,029
Madera
Mississippi
7,751
21,560
Marin
8,407
22,859
Conejos
8,633
23,653
17,389
Mariposa
9,008
24,693
Costilla
8,633
23,653
9,825
23,668
Crowley
8,633
23,653
Monroe
7,140
Montgomery
6,191
18,872
Mendocino
Nevada
7,695
23,029
Merced
9,008
24,693
Custer
8,633
23,653
9,825
23,668
Delta
8,143
24,827
Newton
7,244
21,429
Modoc
Ouachita
7,695
23,029
Mono
8,038
22,422
Denver
7,411
21,656
Perry
7,028
19,164
Monterey
9,395
26,386
Dolores
8,143
24,827
8,407
22,859
Douglas
7,411
21,656
Phillips
7,140
17,389
Napa
Pike
6,191
18,872
Nevada
9,825
23,668
Eagle
7,932
24,678
Poinsett
7,751
21,560
Orange
9,098
26,021
El Paso
6,583
22,503
8,099
24,093
Elbert
7,411
21,656
Polk
6,714
21,788
Placer
Pope
7,028
19,164
Plumas
9,825
23,668
Fremont
8,633
23,653
19,164
Riverside
8,823
24,188
Garfield
7,932
24,678
8,099
24,093
Gilpin
7,411
21,656
Prairie
7,028
Pulaski
7,028
19,164
Sacramento
Randolph
7,751
21,560
San Benito
9,395
26,386
Grand
8,143
24,827
19,164
San Bernardino
8,823
24,188
Gunnison
8,143
24,827
7,936
19,698
Hinsdale
8,143
24,827
Saline
7,028
Scott
6,714
21,788
San Diego
Searcy
7,244
21,429
San Francisco
9,194
32,092
Huerfano
8,633
23,653
21,788
San Joaquin
9,008
24,693
Jackson
8,143
24,827
8,551
25,169
Jefferson
7,411
21,656
Sebastian
6,714
Sevier
7,695
23,029
San Luis Obispo
Sharp
7,751
21,560
San Mateo
10,893
30,804
Kiowa
8,633
23,653
21,560
Santa Barbara
8,551
25,169
Kit Carson
8,633
23,653
St. Francis
7,751
-12-
2023 Average Premium Tables
Florida
La Plata
8,143
24,827
Lake
8,143
24,827
Larimer
8,694
19,824
County
Las Animas
8,633
23,653
Lincoln
8,633
Logan
8,054
Pasco
7,525
22,543
Employee- Dependent,
Only
Family, etc.
Pinellas
7,371
22,139
Polk
8,801
22,081
Alachua
8,574
22,734
Putnam
7,836
23,177
23,653
Baker
7,715
22,501
Santa Rosa
7,489
20,819
23,081
Bay
7,461
21,468
Sarasota
7,521
21,644
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Mesa
8,998
21,727
Bradford
7,686
23,023
Seminole
7,715
20,590
Mineral
8,633
23,653
Brevard
8,879
23,208
St. Johns
10,257
27,879
Moffat
8,143
24,827
Broward
7,925
23,328
St. Lucie
7,591
21,601
7,789
22,571
Montezuma
8,143
24,827
Calhoun
Sumter
7,862
24,206
Montrose
8,143
24,827
Charlotte
8,533
25,787
Suwannee
7,668
22,810
Morgan
8,054
23,081
Citrus
7,757
21,534
Taylor
8,601
24,552
7,626
22,922
Otero
8,633
23,653
Clay
Union
7,932
23,505
Ouray
8,143
24,827
Collier
7,988
29,682
Volusia
8,323
20,111
Park
7,411
21,656
Columbia
8,265
24,544
Wakulla
7,548
23,347
7,735
23,403
Walton
7,767
21,234
Washington
7,947
23,329
Phillips
8,054
23,081
DeSoto
Pitkin
7,932
24,678
Dixie
7,911
21,209
Prowers
8,633
23,653
Duval
7,679
22,097
Pueblo
7,319
20,347
Escambia
7,892
21,756
Rio Blanco
8,143
24,827
Flagler
8,808
22,670
Rio Grande
8,633
23,653
Franklin
8,034
23,949
County
Employee- Dependent,
Only
Family, etc.
Routt
8,143
24,827
Gadsden
7,735
23,387
Appling
10,583
27,444
Saguache
8,633
23,653
Gilchrist
7,658
22,553
Atkinson
7,649
22,962
24,827
Glades
8,083
25,093
Bacon
7,887
23,290
8,463
25,176
San Juan
8,143
Georgia
San Miguel
8,143
24,827
Gulf
8,395
23,946
Baker
Sedgwick
8,054
23,081
Hamilton
7,602
22,503
Baldwin
8,673
24,458
24,678
Hardee
7,526
20,987
Banks
8,299
22,594
9,031
21,237
Summit
7,932
Teller
6,583
22,503
Hendry
8,388
24,714
Barrow
Washington
8,054
23,081
Hernando
8,890
23,493
Bartow
7,850
22,689
26,016
Highlands
8,138
25,498
Ben Hill
8,599
24,744
8,599
24,744
Weld
Yuma
8,306
8,054
23,081
Connecticut
Hillsborough
7,740
25,008
Berrien
Holmes
7,742
22,612
Bibb
8,545
20,662
Indian River
7,568
21,289
Bleckley
8,545
20,662
7,887
23,290
Jackson
7,381
20,719
Brantley
Jefferson
8,243
22,557
Brooks
8,599
24,744
10,583
27,444
County
Employee- Dependent,
Only
Family, etc.
Fairfield
9,528
29,578
Lafayette
7,903
21,405
Bryan
Hartford
9,002
26,680
Lake
9,585
24,889
Bulloch
10,583
27,444
Litchfield
8,527
28,343
Lee
7,667
22,838
Burke
8,071
20,462
Middlesex
8,672
27,077
Leon
9,230
28,653
Butts
7,850
22,689
New Haven
9,794
29,443
Levy
7,541
23,288
Calhoun
8,463
25,176
New London
8,729
25,787
Liberty
7,894
22,899
Camden
7,887
23,290
Tolland
8,001
22,920
Madison
8,248
23,532
Candler
10,583
27,444
Windham
8,489
31,760
Manatee
7,718
21,046
Carroll
8,130
24,070
Marion
6,342
20,829
Catoosa
7,913
23,868
7,887
23,290
Delaware
County
Employee- Dependent,
Only
Family, etc.
All
8,846
23,764
District of Columbia
County
Employee- Dependent,
Only
Family, etc.
All
9,368
28,176
2023 Average Premium Tables
Martin
8,016
24,627
Charlton
Miami-Dade
8,031
24,816
Chatham
10,583
27,444
Monroe
8,436
25,476
Chattahoochee
7,316
20,658
8,654
22,433
Nassau
8,332
20,919
Chattooga
Okaloosa
8,059
28,477
Cherokee
7,850
22,689
Okeechobee
8,465
24,963
Clarke
9,031
21,237
8,463
25,176
Orange
7,953
20,908
Clay
Osceola
8,438
24,353
Clayton
7,850
22,689
Palm Beach
8,603
28,912
Clinch
8,599
24,744
-13-
Cobb
7,850
22,689
Lanier
8,599
24,744
Towns
8,299
22,594
Coffee
7,649
22,962
Laurens
7,649
22,962
Treutlen
7,649
22,962
Colquitt
8,599
24,744
Lee
8,463
25,176
Troup
7,316
20,658
Columbia
8,071
20,462
Liberty
10,583
27,444
Turner
8,599
24,744
Cook
8,599
24,744
Lincoln
8,071
20,462
Twiggs
8,545
20,662
Coweta
7,850
22,689
Long
10,583
27,444
Union
8,299
22,594
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Crawford
8,545
20,662
Lowndes
8,599
24,744
Upson
7,316
20,658
Crisp
8,463
25,176
Lumpkin
8,299
22,594
Walker
7,913
23,868
Dade
7,913
23,868
Macon
7,316
20,658
Walton
7,850
22,689
Dawson
8,299
22,594
Madison
9,031
21,237
Ware
7,887
23,290
Decatur
8,599
24,744
Marion
7,316
20,658
Warren
8,071
20,462
DeKalb
7,850
22,689
McDuffie
8,071
20,462
Washington
8,673
24,458
Dodge
8,545
20,662
McIntosh
7,887
23,290
Wayne
7,887
23,290
Dooly
8,545
20,662
Meriwether
7,316
20,658
Webster
7,316
20,658
Dougherty
8,463
25,176
Miller
8,599
24,744
Wheeler
7,649
22,962
Douglas
7,850
22,689
Mitchell
8,463
25,176
White
8,299
22,594
Early
8,599
24,744
Monroe
8,545
20,662
Whitfield
8,050
23,245
Echols
8,599
24,744
Montgomery
7,649
22,962
Wilcox
8,545
20,662
Effingham
10,583
27,444
Morgan
9,031
21,237
Wilkes
8,071
20,462
Elbert
9,031
21,237
Murray
8,050
23,245
Wilkinson
8,673
24,458
Emanuel
8,071
20,462
Muscogee
7,316
20,658
Worth
8,463
25,176
Evans
10,583
27,444
Newton
7,850
22,689
Fannin
8,050
23,245
Oconee
9,031
21,237
Fayette
7,850
22,689
Oglethorpe
9,031
21,237
Floyd
8,654
22,433
Paulding
7,850
22,689
County
Employee- Dependent,
Only
Family, etc.
Forsyth
7,850
22,689
Peach
8,545
20,662
All
8,011
Franklin
8,299
22,594
Pickens
8,654
22,433
Fulton
7,850
22,689
Pierce
7,887
23,290
Gilmer
8,654
22,433
Pike
7,850
22,689
Glascock
8,071
20,462
Polk
8,654
22,433
Glynn
7,887
23,290
Pulaski
8,545
20,662
Gordon
8,654
22,433
Putnam
8,545
20,662
Grady
8,599
24,744
Quitman
7,316
20,658
Greene
9,031
21,237
Rabun
8,299
22,594
Gwinnett
7,850
22,689
Randolph
8,463
25,176
Habersham
8,299
22,594
Richmond
8,071
20,462
Hall
8,299
22,594
Rockdale
7,850
22,689
Hancock
8,673
24,458
Schley
8,463
25,176
Haralson
8,130
24,070
Screven
10,583
27,444
Harris
7,316
20,658
Seminole
8,599
24,744
Hart
8,299
22,594
Spalding
7,850
22,689
Heard
8,130
24,070
Stephens
8,299
22,594
Henry
7,850
22,689
Stewart
7,316
20,658
Houston
8,545
20,662
Sumter
8,463
25,176
Irwin
8,599
24,744
Talbot
7,316
20,658
Jackson
9,031
21,237
Taliaferro
8,071
20,462
Jasper
7,850
22,689
Tattnall
10,583
27,444
Jeff Davis
7,649
22,962
Taylor
7,316
20,658
Jefferson
8,071
20,462
Telfair
7,649
22,962
Jenkins
8,071
20,462
Terrell
8,463
25,176
Johnson
7,649
22,962
Thomas
8,599
24,744
Jones
8,545
20,662
Tift
8,599
24,744
Lamar
7,850
22,689
Toombs
7,649
22,962
-14-
Hawaii
21,523
Idaho
County
Employee- Dependent,
Only
Family, etc.
Ada
7,011
18,558
Adams
6,888
18,579
Bannock
8,437
18,200
Bear Lake
8,437
18,200
Benewah
7,005
16,122
Bingham
8,437
18,200
Blaine
6,476
18,948
Boise
6,888
18,579
Bonner
7,005
16,122
Bonneville
7,918
20,506
Boundary
7,005
16,122
Butte
8,437
18,200
Camas
6,476
18,948
Canyon
6,888
18,579
Caribou
8,437
18,200
Cassia
6,476
18,948
Clark
7,918
20,506
Clearwater
8,172
19,086
Custer
8,437
18,200
Elmore
6,888
18,579
Franklin
8,437
18,200
Fremont
7,918
20,506
Gem
6,888
18,579
2023 Average Premium Tables
Gooding
6,476
18,948
Fulton
8,720
23,057
Saline
9,777
25,949
Idaho
8,172
19,086
Gallatin
9,777
25,949
Sangamon
8,465
20,916
Jefferson
7,918
20,506
Greene
8,687
25,047
Schuyler
8,465
20,916
Jerome
6,476
18,948
Grundy
9,101
20,715
Scott
8,465
20,916
Kootenai
7,005
16,122
Hamilton
9,777
25,949
Shelby
8,465
20,916
Latah
7,005
16,122
Hancock
8,243
22,350
St. Clair
8,482
22,961
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Lemhi
7,918
20,506
Hardin
9,777
25,949
Stark
8,720
23,057
Lewis
8,172
19,086
Henderson
8,243
22,350
Stephenson
8,972
22,362
Lincoln
6,476
18,948
Henry
8,243
22,350
Tazewell
8,720
23,057
Madison
7,918
20,506
Iroquois
9,646
23,421
Union
9,777
25,949
Minidoka
6,476
18,948
Jackson
9,777
25,949
Vermilion
9,646
23,421
Nez Perce
8,172
19,086
Jasper
9,777
25,949
Wabash
9,777
25,949
Oneida
8,437
18,200
Jefferson
9,777
25,949
Warren
8,243
22,350
Owyhee
6,888
18,579
Jersey
8,687
25,047
Washington
8,687
25,047
Payette
6,888
18,579
Jo Daviess
8,972
22,362
Wayne
9,777
25,949
Power
8,437
18,200
Johnson
9,777
25,949
White
9,777
25,949
Shoshone
7,005
16,122
Kane
8,977
24,388
Whiteside
8,243
22,350
Teton
7,918
20,506
Kankakee
9,101
20,715
Will
9,101
20,715
Twin Falls
6,476
18,948
Kendall
9,101
20,715
Williamson
9,777
25,949
Valley
6,888
18,579
Knox
8,720
23,057
Winnebago
8,972
22,362
Washington
6,888
18,579
Lake
8,491
24,199
Woodford
8,720
23,057
LaSalle
8,720
23,057
Lawrence
9,777
25,949
Illinois
Indiana
Employee- Dependent,
Only
Family, etc.
Lee
8,972
22,362
County
Livingston
9,902
24,851
County
Employee- Dependent,
Only
Family, etc.
Adams
8,465
20,916
Logan
8,465
20,916
Adams
7,571
23,214
Alexander
9,777
25,949
20,916
Allen
8,107
24,189
Bond
8,687
25,047
Macoupin
8,687
25,047
Bartholomew
7,972
22,956
Boone
8,972
22,362
Madison
8,482
22,961
Benton
8,516
25,391
Brown
8,465
20,916
25,949
Blackford
8,548
23,755
Bureau
8,243
22,350
Marshall
8,720
23,057
Boone
8,202
25,255
Calhoun
8,687
25,047
Mason
8,465
20,916
Brown
8,081
26,469
Carroll
8,972
22,362
25,949
Carroll
8,352
26,016
8,166
21,331
Macon
Marion
Massac
8,465
9,777
9,777
Cass
8,465
20,916
McDonough
8,720
23,057
Cass
Champaign
9,646
23,421
McHenry
8,491
24,199
Clark
7,522
21,619
Christian
8,465
20,916
McLean
9,902
24,851
Clay
7,770
23,405
Clark
9,646
23,421
Menard
8,465
20,916
Clinton
8,352
26,016
Clay
9,777
25,949
Mercer
8,243
22,350
Crawford
7,522
21,619
Clinton
8,687
25,047
Monroe
8,482
22,961
Daviess
8,249
25,780
Coles
9,646
23,421
Montgomery
8,687
25,047
Dearborn
8,906
24,245
Cook
8,729
23,937
Morgan
8,465
20,916
Decatur
7,972
22,956
Crawford
9,777
25,949
Moultrie
8,465
20,916
DeKalb
7,571
23,214
Cumberland
9,646
23,421
Ogle
8,972
22,362
Delaware
8,548
23,755
DeKalb
8,972
22,362
23,057
Dubois
8,249
25,780
DeWitt
9,902
24,851
Perry
9,777
25,949
Elkhart
8,340
22,494
Douglas
9,646
23,421
Piatt
9,646
23,421
Fayette
8,158
24,148
DuPage
8,977
24,388
20,916
Floyd
7,522
21,619
Edgar
9,646
23,421
Pope
9,777
25,949
Fountain
8,352
26,016
Edwards
9,777
25,949
Pulaski
9,777
25,949
Franklin
8,906
24,245
Effingham
9,777
25,949
23,057
Fulton
8,166
21,331
9,588
24,463
Peoria
Pike
Putnam
8,720
8,465
8,720
Fayette
9,777
25,949
Randolph
8,687
25,047
Gibson
Ford
9,646
23,421
Richland
9,777
25,949
Grant
8,548
23,755
Franklin
9,777
25,949
22,350
Greene
8,249
25,780
2023 Average Premium Tables
Rock Island
8,243
-15-
Hamilton
8,202
25,255
Vanderburgh
9,588
24,463
Guthrie
8,697
21,249
Hancock
8,158
24,148
Vermillion
7,770
23,405
Hamilton
6,970
20,188
Harrison
7,522
21,619
Vigo
7,770
23,405
Hancock
7,445
21,955
Hendricks
8,202
25,255
Wabash
7,571
23,214
Hardin
6,970
20,188
Henry
8,158
24,148
Warren
8,516
25,391
Harrison
8,697
21,249
Howard
8,166
21,331
Warrick
9,588
24,463
Henry
7,311
19,465
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Huntington
7,571
23,214
Washington
7,522
21,619
Howard
7,445
21,955
Jackson
7,972
22,956
Wayne
8,158
24,148
Humboldt
7,445
21,955
Jasper
8,516
25,391
Wells
7,571
23,214
Ida
8,032
22,897
Jay
8,548
23,755
White
8,516
25,391
Iowa
7,270
21,569
Jefferson
7,522
21,619
Whitley
7,571
23,214
Jackson
7,270
21,569
Jennings
7,972
22,956
Jasper
7,095
22,233
Johnson
8,081
26,469
Jefferson
7,311
19,465
Knox
8,249
25,780
7,270
21,569
Kosciusko
8,340
22,494
County
Employee- Dependent,
Only
Family, etc.
Johnson
Jones
7,270
21,569
8,697
21,249
Iowa
LaGrange
7,571
23,214
Adair
Keokuk
7,311
19,465
Lake
8,474
22,352
Adams
8,697
21,249
Kossuth
7,445
21,955
LaPorte
8,474
22,352
Allamakee
7,445
21,955
Lee
7,311
19,465
7,311
19,465
Lawrence
8,081
26,469
Appanoose
Linn
7,270
21,569
Madison
8,158
24,148
Audubon
8,697
21,249
Louisa
7,311
19,465
Marion
8,202
25,255
Benton
7,270
21,569
Lucas
7,311
19,465
7,270
21,569
Marshall
8,340
22,494
Black Hawk
Lyon
8,032
22,897
Martin
8,249
25,780
Boone
6,970
20,188
Madison
7,095
22,233
7,445
21,955
Miami
8,166
21,331
Bremer
Mahaska
7,311
19,465
Monroe
8,081
26,469
Buchanan
7,270
21,569
Marion
7,095
22,233
Montgomery
8,352
26,016
Buena Vista
8,032
22,897
Marshall
6,970
20,188
7,445
21,955
Morgan
8,202
25,255
Butler
Mills
8,697
21,249
Newton
8,516
25,391
Calhoun
6,970
20,188
Mitchell
7,445
21,955
Noble
7,571
23,214
Carroll
6,970
20,188
Monona
8,032
22,897
8,697
21,249
Ohio
8,906
24,245
Cass
Monroe
7,311
19,465
Orange
8,249
25,780
Cedar
7,270
21,569
Montgomery
8,697
21,249
Owen
8,081
26,469
Cerro Gordo
7,445
21,955
Muscatine
7,311
19,465
8,032
22,897
Parke
7,770
23,405
Cherokee
O'Brien
8,032
22,897
Perry
8,249
25,780
Chickasaw
7,445
21,955
Osceola
8,032
22,897
Pike
8,249
25,780
Clarke
8,697
21,249
Page
8,697
21,249
8,032
22,897
Porter
8,474
22,352
Clay
Palo Alto
8,032
22,897
Posey
9,588
24,463
Clayton
7,270
21,569
Plymouth
8,032
22,897
Pulaski
8,166
21,331
Clinton
7,270
21,569
Pocahontas
8,032
22,897
8,032
22,897
Putnam
8,352
26,016
Crawford
Polk
7,095
22,233
Randolph
8,548
23,755
Dallas
7,095
22,233
Pottawattamie
8,697
21,249
Ripley
8,906
24,245
Davis
7,311
19,465
Poweshiek
6,970
20,188
8,697
21,249
Rush
7,972
22,956
Decatur
Ringgold
8,697
21,249
Scott
7,522
21,619
Delaware
7,270
21,569
Sac
8,032
22,897
7,311
19,465
Shelby
8,202
25,255
Des Moines
Scott
7,270
21,569
Spencer
8,249
25,780
Dickinson
8,032
22,897
Shelby
8,697
21,249
St. Joseph
8,340
22,494
Dubuque
7,270
21,569
Sioux
8,032
22,897
7,445
21,955
Starke
8,340
22,494
Emmet
Story
6,970
20,188
Steuben
7,571
23,214
Fayette
7,445
21,955
Tama
6,970
20,188
Sullivan
7,770
23,405
Floyd
7,445
21,955
Taylor
8,697
21,249
7,445
21,955
Switzerland
8,906
24,245
Franklin
Union
8,697
21,249
Tippecanoe
8,352
26,016
Fremont
8,697
21,249
Van Buren
7,311
19,465
Tipton
8,352
26,016
Greene
6,970
20,188
Wapello
7,311
19,465
24,148
Grundy
6,970
20,188
Warren
7,095
22,233
Union
8,158
-16-
2023 Average Premium Tables
Washington
7,311
19,465
Hodgeman
6,640
20,210
Stevens
6,640
20,210
Wayne
7,311
19,465
Jackson
7,004
19,947
Sumner
6,660
18,161
Webster
6,970
20,188
Jefferson
7,004
19,947
Thomas
7,246
21,412
Winnebago
7,445
21,955
Jewell
6,556
17,604
Trego
7,246
21,412
Winneshiek
7,445
21,955
Johnson
7,490
20,490
Wabaunsee
7,004
19,947
Woodbury
8,032
22,897
Kearny
6,640
20,210
Wallace
7,246
21,412
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Worth
7,445
21,955
Kingman
6,660
18,161
Washington
6,556
17,604
Wright
7,445
21,955
Kiowa
6,640
20,210
Wichita
7,246
21,412
Labette
7,646
19,378
Wilson
6,660
18,161
Lane
7,246
21,412
Woodson
7,646
19,378
7,490
20,490
Wyandotte
7,490
20,490
Kansas
County
Employee- Dependent,
Only
Family, etc.
Leavenworth
Lincoln
6,556
17,604
Allen
7,646
19,378
Linn
7,004
19,947
Anderson
7,004
19,947
Logan
7,246
21,412
Atchison
7,004
19,947
Lyon
7,004
19,947
County
Employee- Dependent,
Only
Family, etc.
Barber
6,640
20,210
Marion
6,660
18,161
Adair
7,995
23,900
7,995
23,900
Kentucky
Barton
7,246
21,412
Marshall
7,004
19,947
Allen
Bourbon
7,646
19,378
McPherson
6,660
18,161
Anderson
6,923
19,939
Brown
7,004
19,947
Meade
6,640
20,210
Ballard
9,237
20,839
Butler
6,660
18,161
Miami
7,490
20,490
Barren
7,995
23,900
Chase
6,660
18,161
Mitchell
6,556
17,604
Bath
7,608
22,247
Chautauqua
6,660
18,161
Montgomery
6,660
18,161
Bell
8,511
23,588
Cherokee
7,646
19,378
Morris
6,556
17,604
Boone
6,901
20,870
Cheyenne
7,246
21,412
20,210
Bourbon
6,923
19,939
Clark
6,640
20,210
Nemaha
7,004
19,947
Boyd
7,608
22,247
Clay
6,556
17,604
Neosho
7,646
19,378
Boyle
6,923
19,939
Cloud
6,556
17,604
21,412
Bracken
7,608
22,247
Coffey
7,004
19,947
Norton
7,246
21,412
Breathitt
8,511
23,588
Comanche
6,640
20,210
Osage
7,004
19,947
Breckinridge
7,219
20,556
Cowley
6,660
18,161
21,412
Bullitt
7,219
20,556
Crawford
7,646
19,378
Ottawa
6,556
17,604
Butler
7,995
23,900
Decatur
7,246
21,412
Pawnee
6,640
20,210
Caldwell
9,237
20,839
Dickinson
6,556
17,604
21,412
Calloway
9,237
20,839
6,901
20,870
Morton
Ness
Osborne
Phillips
6,640
7,246
7,246
7,246
Doniphan
7,004
19,947
Pottawatomie
7,004
19,947
Campbell
Douglas
7,004
19,947
Pratt
6,640
20,210
Carlisle
9,237
20,839
Edwards
6,640
20,210
Rawlins
7,246
21,412
Carroll
7,219
20,556
Elk
6,660
18,161
Reno
6,660
18,161
Carter
7,608
22,247
Ellis
7,246
21,412
Republic
6,556
17,604
Casey
7,995
23,900
Ellsworth
6,556
17,604
Rice
6,660
18,161
Christian
8,681
23,593
Finney
6,640
20,210
Riley
6,556
17,604
Clark
6,923
19,939
Ford
6,640
20,210
Rooks
7,246
21,412
Clay
8,511
23,588
Franklin
7,004
19,947
Rush
7,246
21,412
Clinton
7,995
23,900
Geary
6,556
17,604
Russell
7,246
21,412
Crittenden
9,237
20,839
Gove
7,246
21,412
17,604
Cumberland
7,995
23,900
Graham
7,246
21,412
Scott
7,246
21,412
Daviess
8,681
23,593
Grant
6,640
20,210
Sedgwick
6,660
18,161
Edmonson
7,995
23,900
Gray
6,640
20,210
20,210
Elliott
7,608
22,247
Greeley
7,246
21,412
Shawnee
7,004
19,947
Estill
6,923
19,939
Greenwood
6,660
18,161
Sheridan
7,246
21,412
Fayette
6,923
19,939
Hamilton
6,640
20,210
21,412
Fleming
7,608
22,247
8,511
23,588
Saline
Seward
Sherman
6,556
6,640
7,246
Harper
6,660
18,161
Smith
7,246
21,412
Floyd
Harvey
6,660
18,161
Stafford
6,640
20,210
Franklin
6,923
19,939
Haskell
6,640
20,210
20,210
Fulton
9,237
20,839
2023 Average Premium Tables
Stanton
6,640
-17-
Gallatin
6,901
20,870
Ohio
8,681
23,593
Franklin
8,275
20,521
Garrard
6,923
19,939
Oldham
7,219
20,556
Grant
8,797
22,437
Grant
6,901
20,870
Owen
6,923
19,939
Iberia
7,541
20,453
Graves
9,237
20,839
Owsley
8,511
23,588
Iberville
8,072
21,892
Grayson
7,219
20,556
Pendleton
6,901
20,870
Jackson
8,275
20,521
Green
7,995
23,900
Perry
8,511
23,588
Jefferson
7,665
21,666
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Greenup
7,608
22,247
Pike
8,511
23,588
Jefferson Davis
8,459
21,861
Hancock
8,681
23,593
Powell
6,923
19,939
Lafayette
7,541
20,453
Hardin
7,219
20,556
Pulaski
7,995
23,900
Lafourche
7,692
20,542
Harlan
8,511
23,588
Robertson
7,608
22,247
LaSalle
8,797
22,437
Harrison
6,923
19,939
Rockcastle
6,923
19,939
Lincoln
8,275
20,521
Hart
7,995
23,900
Rowan
7,608
22,247
Livingston
8,072
21,892
Henderson
8,681
23,593
Russell
7,995
23,900
Madison
8,275
20,521
Henry
7,219
20,556
Scott
6,923
19,939
Morehouse
8,275
20,521
Hickman
9,237
20,839
Shelby
7,219
20,556
Natchitoches
7,834
21,179
Hopkins
8,681
23,593
Simpson
7,995
23,900
Orleans
7,665
21,666
Jackson
6,923
19,939
Spencer
7,219
20,556
Ouachita
8,275
20,521
Jefferson
7,219
20,556
Taylor
7,995
23,900
Plaquemines
7,665
21,666
Jessamine
6,923
19,939
Todd
8,681
23,593
Pointe Coupee
8,072
21,892
Johnson
8,511
23,588
Trigg
8,681
23,593
Rapides
8,797
22,437
Kenton
6,901
20,870
Trimble
7,219
20,556
Red River
7,834
21,179
Knott
8,511
23,588
Union
8,681
23,593
Richland
8,275
20,521
Knox
8,511
23,588
Warren
7,995
23,900
Sabine
7,834
21,179
LaRue
7,219
20,556
Washington
7,219
20,556
St. Bernard
7,665
21,666
Laurel
8,511
23,588
Wayne
7,995
23,900
St. Charles
7,665
21,666
Lawrence
7,608
22,247
Webster
8,681
23,593
St. Helena
8,072
21,892
Lee
8,511
23,588
Whitley
8,511
23,588
St. James
7,665
21,666
Leslie
8,511
23,588
Wolfe
8,511
23,588
St. John Baptist
7,665
21,666
Letcher
8,511
23,588
Woodford
6,923
19,939
St. Landry
7,541
20,453
Lewis
7,608
22,247
St. Martin
7,541
20,453
Lincoln
6,923
19,939
St. Mary
7,541
20,453
Livingston
9,237
20,839
7,665
21,666
Louisiana
Employee- Dependent,
Only
Family, etc.
St. Tammany
Logan
7,995
23,900
Parish
Tangipahoa
8,072
21,892
Lyon
9,237
20,839
Acadia
7,541
20,453
Tensas
8,275
20,521
Madison
6,923
19,939
Allen
8,459
21,861
Terrebonne
7,692
20,542
8,072
21,892
Magoffin
8,511
23,588
Ascension
Union
8,275
20,521
Marion
7,219
20,556
Assumption
7,692
20,542
Vermilion
7,541
20,453
Marshall
9,237
20,839
Avoyelles
8,797
22,437
Vernon
8,797
22,437
8,459
21,861
Martin
8,511
23,588
Beauregard
Washington
8,072
21,892
Mason
7,608
22,247
Bienville
7,834
21,179
Webster
7,834
21,179
McCracken
9,237
20,839
Bossier
7,834
21,179
West Baton Rouge
8,072
21,892
7,834
21,179
McCreary
7,995
23,900
Caddo
West Carroll
8,275
20,521
McLean
8,681
23,593
Calcasieu
8,459
21,861
West Feliciana
8,072
21,892
8,275
20,521
Winn
8,797
22,437
Meade
7,219
20,556
Caldwell
Menifee
7,608
22,247
Cameron
8,459
21,861
Mercer
6,923
19,939
Catahoula
8,797
22,437
Metcalfe
7,995
23,900
Claiborne
7,834
21,179
8,797
22,437
County
Employee- Dependent,
Only
Family, etc.
Maine
Monroe
7,995
23,900
Concordia
Montgomery
6,923
19,939
DeSoto
7,834
21,179
Androscoggin
8,045
22,601
22,247
East Baton Rouge
8,072
21,892
Aroostook
9,703
24,940
8,275
20,521
Cumberland
7,735
22,574
Morgan
7,608
Muhlenberg
8,681
23,593
East Carroll
Nelson
7,219
20,556
East Feliciana
8,072
21,892
Franklin
8,045
22,601
19,939
Evangeline
7,541
20,453
Hancock
9,703
24,940
Nicholas
6,923
-18-
2023 Average Premium Tables
Kennebec
7,517
20,158
Norfolk
9,358
26,811
Lenawee
7,587
22,510
Knox
7,517
20,158
Plymouth
9,361
25,875
Livingston
7,587
22,510
Lincoln
7,517
20,158
Suffolk
9,358
26,811
Luce
9,363
22,114
Oxford
7,517
20,158
Worcester
8,989
25,350
Mackinac
8,510
22,856
Penobscot
8,045
22,601
Macomb
7,838
22,752
Piscataquis
8,045
22,601
Manistee
7,203
21,345
Michigan
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Sagadahoc
7,735
22,574
9,363
22,114
8,045
22,601
County
Employee- Dependent,
Only
Family, etc.
Marquette
Somerset
Mason
7,097
21,254
Waldo
8,045
22,601
Alcona
8,510
22,856
Mecosta
7,097
21,254
9,363
22,114
Washington
9,703
24,940
Alger
Menominee
9,363
22,114
York
7,735
22,574
Allegan
7,197
21,587
Midland
7,425
21,232
Alpena
8,510
22,856
Missaukee
7,203
21,345
Antrim
7,203
21,345
Monroe
8,584
24,261
Arenac
7,898
20,833
Montcalm
7,097
21,254
Baraga
9,363
22,114
Montmorency
8,510
22,856
Maryland
County
Employee- Dependent,
Only
Family, etc.
Allegany
8,282
24,040
Barry
7,197
21,587
Muskegon
7,097
21,254
Anne Arundel
8,273
22,894
Bay
7,898
20,833
Newaygo
7,097
21,254
Baltimore
8,273
22,894
Benzie
7,203
21,345
Oakland
7,838
22,752
Baltimore City
8,273
22,894
Berrien
8,527
24,805
Oceana
7,097
21,254
Calvert
8,337
21,174
Branch
8,488
22,633
Ogemaw
8,510
22,856
Caroline
8,337
21,174
Calhoun
8,488
22,633
Ontonagon
9,363
22,114
Carroll
8,282
24,040
Cass
8,527
24,805
Osceola
7,097
21,254
Cecil
8,337
21,174
Charlevoix
7,203
21,345
Oscoda
8,510
22,856
Charles
8,337
21,174
Cheboygan
8,510
22,856
Otsego
8,510
22,856
Dorchester
8,337
21,174
Chippewa
8,510
22,856
Ottawa
7,097
21,254
Frederick
8,282
24,040
Clare
7,425
21,232
Presque Isle
8,510
22,856
Garrett
8,282
24,040
Clinton
8,521
21,466
Roscommon
8,510
22,856
Harford
8,273
22,894
Crawford
8,510
22,856
Saginaw
7,898
20,833
Howard
8,273
22,894
Delta
9,363
22,114
Sanilac
8,709
21,559
Kent
8,337
21,174
Dickinson
9,363
22,114
Schoolcraft
9,363
22,114
Montgomery
8,718
25,697
Eaton
8,521
21,466
Shiawassee
8,060
19,416
Prince George’s
8,718
25,697
Emmet
7,203
21,345
St. Clair
7,875
22,787
Queen Anne’s
8,337
21,174
Genesee
8,060
19,416
St. Joseph
8,527
24,805
Somerset
8,337
21,174
Gladwin
7,425
21,232
Tuscola
8,709
21,559
St. Mary’s
8,337
21,174
Gogebic
9,363
22,114
Van Buren
8,527
24,805
Talbot
8,337
21,174
Grand Traverse
7,203
21,345
Washtenaw
7,587
22,510
Washington
8,282
24,040
Gratiot
7,898
20,833
Wayne
8,584
24,261
Wicomico
8,337
21,174
Hillsdale
8,521
21,466
Wexford
7,203
21,345
Worcester
8,337
21,174
Houghton
9,363
22,114
Huron
8,709
21,559
Ingham
8,521
21,466
7,097
21,254
County
Employee- Dependent,
Only
Family, etc.
County
Employee- Dependent,
Only
Family, etc.
Ionia
Iosco
8,510
22,856
Aitkin
8,499
22,222
Barnstable
11,191
27,157
Iron
9,363
22,114
Anoka
8,198
23,928
Berkshire
8,363
24,733
Isabella
7,425
21,232
Becker
8,286
23,575
Bristol
9,361
25,875
Jackson
8,521
21,466
Beltrami
8,499
22,222
Dukes
11,191
27,157
Kalamazoo
8,488
22,633
Benton
8,198
23,928
Essex
9,148
25,727
Kalkaska
7,203
21,345
Big Stone
9,311
21,521
Franklin
8,363
24,733
Kent
7,097
21,254
Blue Earth
10,352
21,766
Hampden
8,363
24,733
Keweenaw
9,363
22,114
Brown
8,725
22,580
Hampshire
8,363
24,733
Lake
7,097
21,254
Carlton
8,693
21,889
Middlesex
9,358
26,811
Lapeer
8,060
19,416
Carver
8,198
23,928
Nantucket
11,191
27,157
Leelanau
7,203
21,345
Cass
8,499
22,222
Massachusetts
2023 Average Premium Tables
-19-
Minnesota
Chippewa
9,311
21,521
Renville
9,311
21,521
Humphreys
6,958
18,688
Chisago
8,499
22,222
Rice
10,352
21,766
Issaquena
6,958
18,688
Clay
8,286
23,575
Rock
8,725
22,580
Itawamba
7,340
18,912
Clearwater
7,342
23,307
Roseau
8,499
22,222
Jackson
7,844
23,137
Cook
8,693
21,889
Scott
8,198
23,928
Jasper
6,958
18,688
Cottonwood
8,725
22,580
Sherburne
8,198
23,928
Jefferson
6,958
18,688
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Crow Wing
8,499
22,222
Sibley
9,311
21,521
Jefferson Davis
6,958
18,688
Dakota
8,198
23,928
St. Louis
8,693
21,889
Jones
7,522
17,322
Dodge
8,999
23,347
Stearns
8,198
23,928
Kemper
6,958
18,688
Douglas
8,286
23,575
Steele
8,999
23,347
Lafayette
6,958
18,688
Faribault
10,352
21,766
Stevens
8,286
23,575
Lamar
7,522
17,322
Fillmore
8,999
23,347
Swift
9,311
21,521
Lauderdale
6,958
18,688
Freeborn
8,999
23,347
Todd
8,499
22,222
Lawrence
6,958
18,688
Goodhue
8,999
23,347
Traverse
8,286
23,575
Leake
6,958
18,688
Grant
8,286
23,575
Wabasha
8,999
23,347
Lee
7,340
18,912
Hennepin
8,198
23,928
Wadena
8,499
22,222
Leflore
6,958
18,688
Houston
8,999
23,347
Waseca
10,352
21,766
Lincoln
6,958
18,688
Hubbard
8,499
22,222
Washington
8,198
23,928
Lowndes
6,958
18,688
Isanti
8,499
22,222
Watonwan
10,352
21,766
Madison
7,262
17,857
Itasca
8,693
21,889
Wilkin
8,286
23,575
Marion
6,958
18,688
Jackson
8,725
22,580
Winona
8,999
23,347
Marshall
6,877
23,091
Kanabec
8,499
22,222
Wright
8,198
23,928
Monroe
6,958
18,688
Kandiyohi
9,311
21,521
Yellow Medicine
9,311
21,521
Montgomery
6,958
18,688
Kittson
7,342
23,307
Neshoba
6,958
18,688
Koochiching
8,693
21,889
Newton
6,958
18,688
Lac qui Parle
9,311
21,521
6,958
18,688
Mississippi
Employee- Dependent,
Only
Family, etc.
Noxubee
Lake
8,693
21,889
County
Oktibbeha
6,958
18,688
Lake of the Woods
8,693
21,889
Adams
6,958
18,688
Panola
6,958
18,688
Le Sueur
10,352
21,766
Alcorn
6,958
18,688
Pearl River
7,522
17,322
6,958
18,688
Lincoln
8,725
22,580
Amite
Perry
7,522
17,322
Lyon
9,311
21,521
Attala
6,958
18,688
Pike
6,958
18,688
Mahnomen
7,342
23,307
Benton
7,340
18,912
Pontotoc
7,340
18,912
6,958
18,688
Marshall
7,342
23,307
Bolivar
Prentiss
6,958
18,688
Martin
10,352
21,766
Calhoun
6,958
18,688
Quitman
6,958
18,688
McLeod
9,311
21,521
Carroll
6,958
18,688
Rankin
7,262
17,857
6,958
18,688
Meeker
9,311
21,521
Chickasaw
Scott
6,958
18,688
Mille Lacs
8,499
22,222
Choctaw
6,958
18,688
Sharkey
6,958
18,688
Morrison
8,499
22,222
Claiborne
6,958
18,688
Simpson
7,262
17,857
6,958
18,688
Mower
8,999
23,347
Clarke
Smith
6,958
18,688
Murray
8,725
22,580
Clay
6,958
18,688
Stone
7,844
23,137
Nicollet
10,352
21,766
Coahoma
6,958
18,688
Sunflower
6,958
18,688
7,262
17,857
Nobles
8,725
22,580
Copiah
Tallahatchie
6,958
18,688
Norman
7,342
23,307
Covington
6,958
18,688
Tate
6,877
23,091
6,877
23,091
Olmsted
8,999
23,347
DeSoto
Tippah
7,340
18,912
Otter Tail
8,286
23,575
Forrest
7,522
17,322
Tishomingo
6,958
18,688
Pennington
7,342
23,307
Franklin
6,958
18,688
Tunica
6,877
23,091
7,844
23,137
Pine
8,499
22,222
George
Union
7,340
18,912
Pipestone
8,725
22,580
Greene
7,522
17,322
Walthall
6,958
18,688
Polk
7,342
23,307
Grenada
6,958
18,688
Warren
7,262
17,857
7,844
23,137
Pope
8,286
23,575
Hancock
Washington
6,958
18,688
Ramsey
8,198
23,928
Harrison
7,844
23,137
Wayne
6,958
18,688
Red Lake
7,342
23,307
Hinds
7,262
17,857
Webster
6,958
18,688
22,580
Holmes
6,958
18,688
Wilkinson
6,958
18,688
Redwood
8,725
-20-
2023 Average Premium Tables
Winston
6,958
18,688
Iron
7,282
18,701
St. Francois
7,712
20,240
Yalobusha
6,958
18,688
Jackson
8,567
22,493
St. Louis
7,712
20,240
Yazoo
6,958
18,688
Jasper
7,152
19,025
St. Louis City
7,712
20,240
Jefferson
7,712
20,240
Ste. Genevieve
7,712
20,240
Johnson
7,494
19,730
Stoddard
8,348
22,895
8,548
20,952
Stone
7,843
21,502
Missouri
County
Employee- Dependent,
Only
Family, etc.
Knox
Laclede
7,843
21,502
Sullivan
8,548
20,952
Adair
8,548
20,952
Lafayette
7,494
19,730
Taney
7,843
21,502
Andrew
10,197
19,609
Lawrence
7,843
21,502
Texas
7,282
18,701
Atchison
10,197
19,609
Lewis
8,548
20,952
Vernon
7,494
19,730
Audrain
8,472
21,174
Lincoln
7,712
20,240
Warren
7,712
20,240
Barry
7,843
21,502
Linn
8,548
20,952
Washington
7,712
20,240
Barton
7,152
19,025
Livingston
10,197
19,609
Wayne
8,348
22,895
Bates
7,494
19,730
Macon
8,548
20,952
Webster
7,843
21,502
Benton
7,494
19,730
Madison
8,348
22,895
Worth
10,197
19,609
Bollinger
8,348
22,895
Maries
8,472
21,174
Wright
7,843
21,502
Boone
8,472
21,174
Marion
8,548
20,952
Buchanan
10,197
19,609
McDonald
7,152
19,025
Butler
8,348
22,895
Mercer
10,197
19,609
Caldwell
10,197
19,609
Miller
8,472
21,174
County
Employee- Dependent,
Only
Family, etc.
Callaway
8,472
21,174
Mississippi
8,348
22,895
Beaverhead
8,693
20,347
Camden
8,472
21,174
Moniteau
8,472
21,174
Big Horn
8,693
20,347
Cape Girardeau
8,348
22,895
Monroe
8,472
21,174
Blaine
8,693
20,347
Carroll
10,197
19,609
21,174
Broadwater
7,606
22,167
Carter
7,282
18,701
Morgan
8,472
21,174
Carbon
8,123
22,023
Cass
8,567
22,493
New Madrid
8,348
22,895
Carter
8,693
20,347
Cedar
7,843
21,502
19,025
Cascade
7,606
22,167
Chariton
8,472
21,174
Nodaway
10,197
19,609
Chouteau
7,606
22,167
Christian
7,843
21,502
Oregon
7,282
18,701
Custer
8,693
20,347
Clark
8,548
20,952
21,174
Daniels
8,693
20,347
Clay
8,567
22,493
Ozark
7,843
21,502
Dawson
8,693
20,347
Clinton
10,197
19,609
Pemiscot
8,348
22,895
Deer Lodge
7,606
22,167
Cole
8,472
21,174
22,895
Fallon
8,693
20,347
8,693
20,347
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Montgomery
Newton
Osage
Perry
8,472
7,152
8,472
8,348
Montana
Cooper
8,472
21,174
Pettis
7,494
19,730
Fergus
Crawford
7,282
18,701
Phelps
7,282
18,701
Flathead
7,863
20,820
Dade
7,843
21,502
Pike
8,548
20,952
Gallatin
7,606
22,167
Dallas
7,843
21,502
Platte
8,567
22,493
Garfield
8,693
20,347
Daviess
10,197
19,609
Polk
7,843
21,502
Glacier
8,693
20,347
DeKalb
10,197
19,609
Pulaski
7,282
18,701
Golden Valley
8,693
20,347
Dent
7,282
18,701
Putnam
8,548
20,952
Granite
8,693
20,347
Douglas
7,843
21,502
Ralls
8,548
20,952
Hill
8,693
20,347
Dunklin
8,348
22,895
Randolph
8,472
21,174
Jefferson
7,606
22,167
Franklin
7,712
20,240
Ray
10,197
19,609
Judith Basin
7,606
22,167
Gasconade
8,472
21,174
18,701
Lake
7,863
20,820
Gentry
10,197
19,609
Ripley
7,282
18,701
Lewis and Clark
7,606
22,167
Greene
7,843
21,502
Saline
7,494
19,730
Liberty
8,693
20,347
Grundy
10,197
19,609
20,952
Lincoln
8,693
20,347
Harrison
10,197
19,609
Scotland
8,548
20,952
Madison
8,693
20,347
Henry
7,494
19,730
Scott
8,348
22,895
McCone
8,693
20,347
Hickory
7,843
21,502
18,701
Meagher
8,693
20,347
8,693
20,347
Reynolds
Schuyler
Shannon
7,282
8,548
7,282
Holt
10,197
19,609
Shelby
8,548
20,952
Mineral
Howard
8,472
21,174
St. Charles
7,712
20,240
Missoula
7,863
20,820
Howell
7,282
18,701
19,730
Musselshell
8,123
22,023
2023 Average Premium Tables
St. Clair
7,494
-21-
Park
8,693
20,347
Dodge
7,859
22,206
Seward
9,036
24,033
Petroleum
8,693
20,347
Douglas
7,859
22,206
Sheridan
9,129
25,388
Phillips
8,693
20,347
Dundy
9,129
25,388
Sherman
8,981
26,077
Pondera
8,693
20,347
Fillmore
9,036
24,033
Sioux
9,129
25,388
Powder River
8,693
20,347
Franklin
8,981
26,077
Stanton
8,981
26,077
Powell
8,693
20,347
Frontier
9,129
25,388
Thayer
9,036
24,033
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Prairie
8,693
20,347
Furnas
8,981
26,077
Thomas
9,129
25,388
Ravalli
8,693
20,347
Gage
9,036
24,033
Thurston
7,859
22,206
Richland
8,693
20,347
Garden
9,129
25,388
Valley
8,981
26,077
Roosevelt
8,693
20,347
Garfield
8,981
26,077
Washington
7,859
22,206
Rosebud
8,693
20,347
Gosper
8,981
26,077
Wayne
8,981
26,077
Sanders
8,693
20,347
Grant
9,129
25,388
Webster
8,981
26,077
Sheridan
8,693
20,347
Greeley
8,981
26,077
Wheeler
8,981
26,077
Silver Bow
7,606
22,167
Hall
8,981
26,077
York
9,036
24,033
Stillwater
8,123
22,023
Hamilton
8,981
26,077
Sweet Grass
8,123
22,023
Harlan
8,981
26,077
Teton
7,606
22,167
Hayes
9,129
25,388
Toole
8,693
20,347
Hitchcock
9,129
25,388
County
Employee- Dependent,
Only
Family, etc.
Treasure
8,693
20,347
Holt
8,981
26,077
Carson City
7,344
19,438
Valley
8,693
20,347
Hooker
9,129
25,388
Churchill
7,741
23,111
Wheatland
8,693
20,347
Howard
8,981
26,077
Clark
7,204
20,646
7,344
19,438
Nevada
Wibaux
8,693
20,347
Jefferson
9,036
24,033
Douglas
Yellowstone
8,123
22,023
Johnson
9,036
24,033
Elko
7,741
23,111
26,077
Esmeralda
7,741
23,111
7,741
23,111
Kearney
Nebraska
8,981
Keith
9,129
25,388
Eureka
Keya Paha
8,981
26,077
Humboldt
7,741
23,111
25,388
Lander
7,741
23,111
7,741
23,111
County
Employee- Dependent,
Only
Family, etc.
Adams
8,981
26,077
Knox
8,981
26,077
Lincoln
Antelope
8,981
26,077
Lancaster
9,036
24,033
Lyon
7,344
19,438
Arthur
9,129
25,388
25,388
Mineral
7,741
23,111
Banner
9,129
25,388
Logan
9,129
25,388
Nye
7,204
20,646
Blaine
8,981
26,077
Loup
8,981
26,077
Pershing
7,741
23,111
Boone
8,981
26,077
26,077
Storey
7,344
19,438
8,331
21,180
7,741
23,111
Kimball
Lincoln
Madison
9,129
9,129
8,981
Box Butte
9,129
25,388
McPherson
9,129
25,388
Washoe
Boyd
8,981
26,077
Merrick
8,981
26,077
White Pine
Brown
9,129
25,388
Morrill
9,129
25,388
Buffalo
8,981
26,077
Nance
8,981
26,077
Burt
7,859
22,206
Nemaha
9,036
24,033
Butler
8,981
26,077
Nuckolls
8,981
26,077
Cass
7,859
22,206
Otoe
9,036
24,033
Cedar
8,981
26,077
Pawnee
9,036
24,033
Chase
9,129
25,388
Perkins
9,129
25,388
Cherry
9,129
25,388
Phelps
8,981
26,077
Cheyenne
9,129
25,388
Pierce
8,981
26,077
Clay
8,981
26,077
Platte
8,981
26,077
Colfax
8,981
26,077
Polk
8,981
26,077
Cuming
8,981
26,077
Red Willow
9,129
25,388
Custer
8,981
26,077
Richardson
9,036
24,033
Dakota
8,981
26,077
Rock
8,981
26,077
Dawes
9,129
25,388
Saline
9,036
24,033
Dawson
8,981
26,077
Sarpy
7,859
22,206
Deuel
9,129
25,388
Saunders
7,859
22,206
Dixon
8,981
26,077
Scotts Bluff
9,129
25,388
-22-
New Hampshire
County
Employee- Dependent,
Only
Family, etc.
All
8,498
26,225
New Jersey
County
Employee- Dependent,
Only
Family, etc.
All
8,090
24,143
New Mexico
County
Employee- Dependent,
Only
Family, etc.
Bernalillo
7,758
21,368
Catron
9,379
29,015
Chaves
9,379
29,015
Cibola
9,379
29,015
2023 Average Premium Tables
Colfax
9,379
29,015
Hamilton
9,203
25,195
Bertie
7,967
22,994
Curry
9,379
29,015
Herkimer
9,203
25,195
Bladen
7,391
23,420
De Baca
9,379
29,015
Jefferson
9,203
25,195
Brunswick
7,906
21,413
Doña Ana
8,107
20,387
Kings
11,243
29,771
Buncombe
8,305
21,752
Eddy
9,379
29,015
Lewis
9,203
25,195
Burke
7,960
21,585
Grant
9,379
29,015
Livingston
8,103
20,885
Cabarrus
7,893
22,733
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Guadalupe
9,379
29,015
Madison
9,203
25,195
Caldwell
7,960
21,585
Harding
9,379
29,015
Monroe
8,103
20,885
Camden
7,967
22,994
Hidalgo
9,379
29,015
Montgomery
8,439
21,463
Carteret
9,047
21,390
Lea
9,379
29,015
Nassau
11,034
28,766
Caswell
7,851
25,284
Lincoln
9,379
29,015
New York
11,243
29,771
Catawba
7,960
21,585
Los Alamos
9,379
29,015
Niagara
8,449
20,437
Chatham
7,851
25,284
Luna
9,379
29,015
Oneida
9,203
25,195
Cherokee
8,305
21,752
McKinley
9,379
29,015
Onondaga
9,203
22,260
Chowan
7,967
22,994
Mora
9,379
29,015
Ontario
8,103
20,885
Clay
8,305
21,752
Otero
9,379
29,015
Orange
10,472
25,016
Cleveland
8,254
22,198
Quay
9,379
29,015
Orleans
8,449
20,437
Columbus
7,906
21,413
Rio Arriba
9,379
29,015
Oswego
9,203
25,195
Craven
9,047
21,390
Roosevelt
9,379
29,015
Otsego
9,203
25,195
Cumberland
7,391
23,420
San Juan
7,985
21,236
Putnam
10,472
25,016
Currituck
7,967
22,994
San Miguel
9,379
29,015
Queens
11,243
29,771
Dare
9,047
21,390
Sandoval
7,758
21,368
Rensselaer
8,439
21,463
Davidson
8,418
23,593
Santa Fe
8,139
24,010
Richmond
11,243
29,771
Davie
8,418
23,593
Sierra
9,379
29,015
Rockland
11,243
29,771
Duplin
7,906
21,413
Socorro
9,379
29,015
Saratoga
8,439
21,463
Durham
7,851
25,284
Taos
9,379
29,015
Schenectady
8,439
21,463
Edgecombe
8,970
27,984
Torrance
7,758
21,368
Schoharie
8,439
21,463
Forsyth
8,418
23,593
Union
9,379
29,015
Schuyler
9,203
22,260
Franklin
7,278
22,091
Valencia
7,758
21,368
Seneca
8,103
20,885
Gaston
8,254
22,198
St. Lawrence
9,203
25,195
Gates
7,967
22,994
Steuben
9,203
22,260
Graham
8,305
21,752
11,034
28,766
Granville
7,403
20,823
New York
County
Employee- Dependent,
Only
Family, etc.
Suffolk
Sullivan
10,472
25,016
Greene
8,970
27,984
Albany
8,439
21,463
Tioga
9,203
22,260
Guilford
7,650
21,582
Allegany
8,449
20,437
Tompkins
9,203
22,260
Halifax
7,967
22,994
Bronx
11,243
29,771
Ulster
10,472
25,016
Harnett
7,391
23,420
Broome
9,203
22,260
Warren
8,439
21,463
Haywood
8,305
21,752
Cattaraugus
8,449
20,437
Washington
8,439
21,463
Henderson
8,305
21,752
Cayuga
9,203
22,260
Wayne
8,103
20,885
Hertford
7,967
22,994
Chautauqua
8,449
20,437
Westchester
11,243
29,771
Hoke
7,391
23,420
Chemung
9,203
22,260
Wyoming
8,449
20,437
Hyde
9,047
21,390
Chenango
9,203
25,195
Yates
8,103
20,885
Iredell
7,960
21,585
Clinton
9,203
25,195
Jackson
8,305
21,752
Columbia
8,439
21,463
Cortland
9,203
22,260
Delaware
10,472
25,016
Dutchess
10,472
Erie
North Carolina
Johnston
7,278
22,091
Jones
9,047
21,390
County
Employee- Dependent,
Only
Family, etc.
Lee
7,851
25,284
25,016
Alamance
7,851
25,284
Lenoir
9,047
21,390
8,449
20,437
Alexander
7,960
21,585
Lincoln
8,254
22,198
Essex
9,203
25,195
Alleghany
8,494
23,965
Macon
8,305
21,752
Franklin
9,203
25,195
Anson
7,893
22,733
Madison
8,305
21,752
Fulton
8,439
21,463
Ashe
8,494
23,965
Martin
7,967
22,994
Genesee
8,449
20,437
Avery
8,305
21,752
McDowell
8,305
21,752
Greene
8,439
21,463
Beaufort
9,047
21,390
Mecklenburg
7,893
22,733
2023 Average Premium Tables
-23-
Mitchell
8,305
21,752
Cavalier
8,478
24,547
Auglaize
8,334
21,287
Montgomery
9,310
22,169
Dickey
8,478
24,547
Belmont
7,905
19,458
Moore
9,310
22,169
Divide
8,478
24,547
Brown
7,700
19,544
Nash
8,970
27,984
Dunn
8,478
24,547
Butler
7,872
23,435
New Hanover
7,906
21,413
Eddy
8,478
24,547
Carroll
7,693
22,733
Northampton
7,967
22,994
Emmons
8,478
24,547
Champaign
7,552
21,207
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Onslow
7,906
21,413
Foster
8,478
24,547
Clark
7,552
21,207
Orange
7,851
25,284
Golden Valley
8,478
24,547
Clermont
7,700
19,544
Pamlico
9,047
21,390
Grand Forks
7,369
23,920
Clinton
7,700
19,544
Pasquotank
7,967
22,994
Grant
8,478
24,547
Columbiana
7,575
21,064
Pender
7,906
21,413
Griggs
8,478
24,547
Coshocton
7,905
19,458
Perquimans
7,967
22,994
Hettinger
8,478
24,547
Crawford
7,799
20,711
Person
7,851
25,284
Kidder
8,478
24,547
Cuyahoga
8,331
23,234
Pitt
8,970
27,984
La Moure
8,478
24,547
Darke
7,552
21,207
Polk
8,305
21,752
Logan
8,478
24,547
Defiance
8,137
21,370
Randolph
7,650
21,582
McHenry
8,478
24,547
Delaware
7,351
22,087
Richmond
7,391
23,420
McIntosh
8,478
24,547
Erie
8,591
22,268
Robeson
7,391
23,420
McKenzie
8,478
24,547
Fairfield
7,351
22,087
Rockingham
7,650
21,582
McLean
8,478
24,547
Fayette
7,351
22,087
Rowan
7,893
22,733
Mercer
8,478
24,547
Franklin
7,351
22,087
Rutherford
8,305
21,752
Morton
8,214
23,849
Fulton
8,137
21,370
Sampson
7,391
23,420
Mountrail
8,478
24,547
Gallia
9,816
25,764
Scotland
7,391
23,420
Nelson
8,478
24,547
Geauga
8,331
23,234
Stanly
7,893
22,733
Oliver
8,478
24,547
Greene
7,552
21,207
Stokes
8,418
23,593
Pembina
8,478
24,547
Guernsey
7,905
19,458
Surry
8,418
23,593
Pierce
8,478
24,547
Hamilton
7,872
23,435
Swain
8,305
21,752
Ramsey
8,478
24,547
Hancock
8,334
21,287
Transylvania
8,305
21,752
Ransom
8,478
24,547
Hardin
8,334
21,287
Tyrrell
9,047
21,390
Renville
8,478
24,547
Harrison
7,905
19,458
Union
7,893
22,733
Richland
8,478
24,547
Henry
8,137
21,370
Vance
7,403
20,823
Rolette
8,478
24,547
Highland
7,700
19,544
Wake
7,278
22,091
Sargent
8,478
24,547
Hocking
8,183
21,428
Warren
7,403
20,823
Sheridan
8,478
24,547
Holmes
6,481
20,621
Washington
9,047
21,390
Sioux
8,478
24,547
Huron
8,591
22,268
Watauga
8,494
23,965
Slope
8,478
24,547
Jackson
9,816
25,764
Wayne
8,970
27,984
Stark
8,478
24,547
Jefferson
7,905
19,458
Wilkes
8,494
23,965
Steele
8,478
24,547
Knox
7,351
22,087
Wilson
8,970
27,984
Stutsman
8,478
24,547
Lake
8,331
23,234
Yadkin
8,418
23,593
Towner
8,478
24,547
Lawrence
9,816
25,764
Yancey
8,305
21,752
Traill
8,478
24,547
Licking
7,351
22,087
Walsh
8,478
24,547
Logan
7,351
22,087
Ward
8,478
24,547
Lorain
8,331
23,234
Wells
8,478
24,547
Lucas
8,137
21,370
Williams
8,478
24,547
Madison
7,351
22,087
Mahoning
7,575
21,064
Marion
7,861
21,747
North Dakota
County
Employee- Dependent,
Only
Family, etc.
Adams
8,478
24,547
Barnes
8,478
24,547
Benson
8,478
24,547
8,141
22,928
8,478
24,547
County
Employee- Dependent,
Only
Family, etc.
Medina
Billings
Meigs
8,183
21,428
Bottineau
8,478
24,547
Adams
7,700
19,544
Mercer
8,334
21,287
Bowman
8,478
24,547
Allen
8,334
21,287
Miami
7,552
21,207
Burke
8,478
24,547
Ashland
8,141
22,928
Monroe
7,905
19,458
Burleigh
8,214
23,849
Ashtabula
8,331
23,234
Montgomery
7,552
21,207
Cass
7,707
24,039
Athens
8,183
21,428
Morgan
7,905
19,458
Ohio
-24-
2023 Average Premium Tables
Morrow
7,861
21,747
Custer
8,126
22,340
Wagoner
8,397
22,134
Muskingum
7,905
19,458
Delaware
8,126
22,340
Washington
8,126
22,340
Noble
7,905
19,458
Dewey
8,126
22,340
Washita
8,126
22,340
Ottawa
8,591
22,268
Ellis
8,126
22,340
Woods
8,126
22,340
Paulding
8,334
21,287
Garfield
8,126
22,340
Woodward
8,126
22,340
Perry
7,905
19,458
Garvin
8,126
22,340
Oregon
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Pickaway
7,351
22,087
Grady
8,463
21,112
Pike
9,816
25,764
Grant
8,126
22,340
Portage
8,141
22,928
Greer
8,126
22,340
County
Employee- Dependent,
Only
Family, etc.
Preble
7,552
21,207
Harmon
8,126
22,340
Baker
9,689
24,154
7,925
21,095
Putnam
8,334
21,287
Harper
8,126
22,340
Benton
Richland
7,799
20,711
Haskell
8,126
22,340
Clackamas
7,421
22,379
22,340
Clatsop
9,288
23,313
9,288
23,313
Ross
9,816
25,764
Hughes
8,126
Sandusky
8,591
22,268
Jackson
8,126
22,340
Columbia
Scioto
9,816
25,764
Jefferson
8,126
22,340
Coos
9,288
23,313
22,340
Crook
9,689
24,154
9,288
23,313
Seneca
8,591
22,268
Johnston
8,126
Shelby
7,552
21,207
Kay
8,126
22,340
Curry
Stark
7,693
22,733
Kingfisher
8,126
22,340
Deschutes
8,511
23,403
8,028
22,230
Summit
8,141
22,928
Kiowa
8,126
22,340
Douglas
Trumbull
7,575
21,064
Latimer
8,126
22,340
Gilliam
9,689
24,154
Tuscarawas
7,905
19,458
Le Flore
7,472
19,440
Grant
9,689
24,154
9,689
24,154
Union
7,351
22,087
Lincoln
8,463
21,112
Harney
Van Wert
8,334
21,287
Logan
8,463
21,112
Hood River
9,689
24,154
22,340
Jackson
8,028
22,230
9,689
24,154
Vinton
9,816
25,764
Love
8,126
Warren
7,872
23,435
Major
8,126
22,340
Jefferson
Washington
8,183
21,428
Marshall
8,126
22,340
Josephine
8,028
22,230
22,340
Klamath
8,511
23,403
8,511
23,403
Wayne
6,481
20,621
Mayes
8,126
Williams
8,137
21,370
McClain
8,463
21,112
Lake
Wood
8,137
21,370
McCurtain
8,126
22,340
Lane
7,925
21,095
22,340
Lincoln
9,288
23,313
7,925
21,095
Wyandot
8,591
22,268
Oklahoma
McIntosh
8,126
Murray
8,126
22,340
Linn
Muskogee
8,126
22,340
Malheur
9,689
24,154
22,340
Marion
7,547
21,686
9,689
24,154
Noble
County
Employee- Dependent,
Only
Family, etc.
Nowata
8,126
22,340
Morrow
Adair
8,126
22,340
Okfuskee
8,126
22,340
Multnomah
7,421
22,379
Alfalfa
8,126
22,340
Oklahoma
8,463
21,112
Polk
7,547
21,686
Atoka
8,126
22,340
Okmulgee
8,397
22,134
Sherman
9,689
24,154
Beaver
8,126
22,340
Osage
8,397
22,134
Tillamook
9,288
23,313
Beckham
8,126
22,340
Ottawa
8,126
22,340
Umatilla
9,689
24,154
Blaine
8,126
22,340
Pawnee
8,397
22,134
Union
9,689
24,154
Bryan
8,126
22,340
Payne
8,126
22,340
Wallowa
9,689
24,154
Caddo
8,126
22,340
Pittsburg
8,126
22,340
Wasco
9,689
24,154
Canadian
8,463
21,112
Pontotoc
8,126
22,340
Washington
7,421
22,379
Carter
8,126
22,340
22,340
Wheeler
9,689
24,154
Cherokee
8,126
22,340
Pushmataha
8,126
22,340
Yamhill
7,421
22,379
Choctaw
8,126
22,340
Roger Mills
8,126
22,340
Cimarron
8,126
22,340
Rogers
8,397
22,134
Cleveland
8,463
21,112
Seminole
8,126
22,340
Coal
8,126
22,340
Sequoyah
7,472
19,440
Comanche
7,985
20,401
Stephens
8,126
22,340
Texas
8,126
22,340
Cotton
8,126
22,340
Pottawatomie
8,126
8,126
Craig
8,126
22,340
Tillman
8,126
22,340
Creek
8,397
22,134
Tulsa
8,397
22,134
2023 Average Premium Tables
-25-
Pennsylvania
County
Employee- Dependent,
Only
Family, etc.
Adams
8,983
24,095
Allegheny
8,022
22,027
Armstrong
8,022
22,027
Beaver
8,022
22,027
Bedford
8,469
20,575
Susquehanna
8,137
23,020
McCormick
8,590
22,973
Berks
8,983
24,095
Tioga
8,137
23,020
Newberry
8,550
22,352
Blair
8,469
20,575
Union
8,694
26,717
Oconee
9,341
25,843
Bradford
8,137
23,020
Venango
7,425
20,206
Orangeburg
8,291
23,112
Bucks
8,596
23,467
Warren
7,425
20,206
Pickens
7,983
22,026
Butler
8,022
22,027
Washington
8,022
22,027
Richland
8,074
23,003
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Cambria
8,469
20,575
Wayne
8,137
23,020
Saluda
8,422
22,368
Cameron
7,314
22,737
Westmoreland
8,022
22,027
Spartanburg
7,709
22,457
Carbon
8,137
23,020
Wyoming
8,137
23,020
Sumter
7,846
20,767
Centre
8,694
26,717
York
8,983
24,095
Union
7,512
21,717
Chester
8,596
23,467
Williamsburg
7,776
22,421
Clarion
7,425
20,206
York
7,868
22,286
Clearfield
8,469
20,575
Clinton
8,137
23,020
County
Employee- Dependent,
Only
Family, etc.
Columbia
8,694
26,717
All
8,796
Crawford
7,425
20,206
Cumberland
8,863
24,699
Dauphin
8,863
24,699
Delaware
8,596
23,467
Elk
7,314
22,737
Erie
7,425
20,206
Fayette
8,022
22,027
Forest
7,425
20,206
Franklin
8,863
24,699
Fulton
8,863
24,699
Greene
8,022
22,027
Huntingdon
8,469
20,575
Indiana
8,022
22,027
Jefferson
8,469
20,575
Juniata
8,863
24,699
Lackawanna
8,137
23,020
Lancaster
8,983
24,095
Lawrence
8,022
22,027
Lebanon
8,863
24,699
Lehigh
8,694
26,717
Luzerne
8,137
23,020
Lycoming
8,137
23,020
McKean
7,425
20,206
Mercer
7,425
20,206
Mifflin
8,694
26,717
Monroe
8,137
23,020
Montgomery
8,596
23,467
Montour
8,694
26,717
Northampton
8,694
26,717
Northumberland
8,694
26,717
Perry
8,863
24,699
Philadelphia
8,596
23,467
Pike
8,137
23,020
Potter
7,314
22,737
Schuylkill
8,694
26,717
Snyder
8,694
26,717
Somerset
8,469
20,575
Sullivan
8,137
23,020
Rhode Island
South Dakota
24,780
South Carolina
County
Employee- Dependent,
Only
Family, etc.
Aurora
8,365
24,641
Employee- Dependent,
Only
Family, etc.
Beadle
7,952
23,411
County
Bennett
7,735
21,478
Abbeville
8,099
22,442
Bon Homme
8,365
24,641
Aiken
7,627
21,404
Brookings
7,952
23,411
Allendale
7,955
22,061
Brown
7,952
23,411
Anderson
8,023
22,069
Brule
8,365
24,641
Bamberg
7,536
22,564
Buffalo
8,365
24,641
Barnwell
7,463
21,743
Butte
7,735
21,478
Beaufort
8,126
21,663
Campbell
7,952
23,411
Berkeley
8,717
21,748
Charles Mix
8,365
24,641
Calhoun
7,775
22,009
Clark
7,952
23,411
Charleston
7,808
22,902
Clay
7,477
21,356
Cherokee
7,663
22,225
Codington
7,952
23,411
Chester
8,071
21,886
Corson
7,735
21,478
Chesterfield
7,988
22,551
Custer
7,735
21,478
Clarendon
7,369
21,976
Davison
8,365
24,641
Colleton
8,068
23,075
Day
7,952
23,411
Darlington
8,319
22,772
Deuel
7,952
23,411
Dillon
8,040
21,490
Dewey
7,735
21,478
Dorchester
9,023
22,684
Douglas
8,365
24,641
Edgefield
7,449
22,065
Edmunds
7,952
23,411
Fairfield
7,982
22,308
Fall River
7,735
21,478
Florence
8,165
22,796
Faulk
7,952
23,411
Georgetown
8,100
21,834
Grant
7,952
23,411
Greenville
8,011
22,390
Gregory
7,735
21,478
Greenwood
7,464
22,222
Haakon
7,735
21,478
Hampton
8,305
22,455
Hamlin
7,952
23,411
Horry
7,496
22,581
Hand
8,365
24,641
Jasper
7,826
22,874
Hanson
8,365
24,641
Kershaw
8,349
22,207
Harding
7,735
21,478
Lancaster
8,029
21,741
Hughes
8,365
24,641
Laurens
7,684
21,804
Hutchinson
8,365
24,641
Lee
7,814
22,307
Hyde
8,365
24,641
Lexington
8,215
22,393
Jackson
7,735
21,478
Marion
8,491
23,343
Jerauld
8,365
24,641
Marlboro
8,036
22,442
Jones
7,735
21,478
-26-
2023 Average Premium Tables
Kingsbury
7,952
23,411
DeKalb
6,672
16,567
Robertson
7,695
19,360
Lake
7,477
21,356
Dickson
7,001
18,618
Rutherford
7,695
19,360
Lawrence
7,735
21,478
Dyer
7,401
20,883
Scott
6,720
17,996
Lincoln
7,477
21,356
Fayette
7,276
18,799
Sequatchie
7,379
18,618
Lyman
7,735
21,478
Fentress
6,672
16,567
Sevier
6,720
17,996
Marshall
7,952
23,411
Franklin
7,379
18,618
Shelby
7,276
18,799
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
McCook
7,477
21,356
Gibson
7,401
20,883
Smith
6,672
16,567
McPherson
7,952
23,411
Giles
7,001
18,618
Stewart
7,001
18,618
Meade
7,735
21,478
Grainger
6,720
17,996
Sullivan
7,434
18,852
Mellette
7,735
21,478
Greene
7,434
18,852
Sumner
7,695
19,360
Miner
8,365
24,641
Grundy
7,379
18,618
Tipton
7,276
18,799
Minnehaha
7,477
21,356
Hamblen
6,720
17,996
Trousdale
7,695
19,360
Moody
7,477
21,356
Hamilton
7,379
18,618
Unicoi
7,434
18,852
Pennington
7,735
21,478
Hancock
7,434
18,852
Union
6,720
17,996
Perkins
7,735
21,478
Hardeman
7,401
20,883
Van Buren
6,672
16,567
Potter
7,952
23,411
Hardin
7,401
20,883
Warren
6,672
16,567
Roberts
7,952
23,411
Hawkins
7,434
18,852
Washington
7,434
18,852
Sanborn
8,365
24,641
Haywood
7,276
18,799
Wayne
7,001
18,618
Shannon
7,735
21,478
Henderson
7,401
20,883
Weakley
7,401
20,883
Spink
7,952
23,411
Henry
7,401
20,883
White
6,672
16,567
Stanley
7,735
21,478
Hickman
7,001
18,618
Williamson
7,695
19,360
Sully
8,365
24,641
Houston
7,001
18,618
Wilson
7,695
19,360
Todd
7,735
21,478
Humphreys
7,001
18,618
Tripp
7,735
21,478
Jackson
6,672
16,567
Turner
7,477
21,356
Jefferson
6,720
17,996
Union
7,477
21,356
Johnson
7,434
18,852
County
Employee- Dependent,
Only
Family, etc.
Walworth
7,952
23,411
Knox
6,720
17,996
Anderson
7,822
20,066
7,822
20,066
Texas
Yankton
8,365
24,641
Lake
7,401
20,883
Andrews
Ziebach
7,735
21,478
Lauderdale
7,276
18,799
Angelina
7,822
20,066
18,618
Aransas
8,102
26,628
8,440
20,716
Lawrence
Tennessee
County
Employee- Dependent,
Only
Family, etc.
7,001
Lewis
7,001
18,618
Archer
Lincoln
7,001
18,618
Armstrong
10,030
23,705
17,996
Atascosa
7,665
18,955
7,250
22,662
Loudon
6,720
Anderson
6,720
17,996
Macon
6,672
16,567
Austin
Bedford
7,001
18,618
Madison
7,401
20,883
Bailey
7,822
20,066
Benton
7,401
20,883
Marion
7,379
18,618
Bandera
7,665
18,955
Bledsoe
7,379
18,618
Marshall
7,001
18,618
Bastrop
7,061
20,191
Blount
6,720
17,996
Maury
7,001
18,618
Baylor
7,822
20,066
Bradley
7,379
18,618
McMinn
7,379
18,618
Bee
7,822
20,066
Campbell
6,720
17,996
McNairy
7,401
20,883
Bell
8,124
18,547
Cannon
6,672
16,567
Meigs
7,379
18,618
Bexar
7,665
18,955
Carroll
7,401
20,883
Monroe
6,720
17,996
Blanco
7,822
20,066
Carter
7,434
18,852
Montgomery
7,695
19,360
Borden
7,822
20,066
Cheatham
7,695
19,360
18,618
Bosque
7,822
20,066
Chester
7,401
20,883
Morgan
6,720
17,996
Bowie
7,368
20,522
Claiborne
6,720
17,996
Obion
7,401
20,883
Brazoria
7,250
22,662
Clay
6,672
16,567
16,567
Brazos
7,118
20,305
Cocke
6,720
17,996
Perry
7,001
18,618
Brewster
7,822
20,066
Coffee
7,001
18,618
Pickett
6,672
16,567
Briscoe
7,822
20,066
Crockett
7,401
20,883
18,618
Brooks
7,822
20,066
7,822
20,066
Moore
Overton
Polk
7,001
6,672
7,379
Cumberland
6,672
16,567
Putnam
6,672
16,567
Brown
Davidson
7,695
19,360
Rhea
7,379
18,618
Burleson
7,118
20,305
Decatur
7,401
20,883
17,996
Burnet
7,822
20,066
2023 Average Premium Tables
Roane
6,720
-27-
Caldwell
7,061
20,191
Freestone
7,822
20,066
Kimble
7,822
20,066
Calhoun
8,198
21,897
Frio
7,822
20,066
King
7,822
20,066
Callahan
7,456
20,335
Gaines
7,822
20,066
Kinney
7,822
20,066
Cameron
6,716
18,893
Galveston
7,250
22,662
Kleberg
7,822
20,066
Camp
7,822
20,066
Garza
7,822
20,066
Knox
7,822
20,066
Carson
10,030
23,705
Gillespie
7,822
20,066
Lamar
7,822
20,066
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Cass
7,822
20,066
Glasscock
7,822
20,066
Lamb
7,822
20,066
Castro
7,822
20,066
Goliad
8,198
21,897
Lampasas
8,124
18,547
Chambers
7,250
22,662
Gonzales
7,822
20,066
LaSalle
7,822
20,066
Cherokee
7,822
20,066
Gray
7,822
20,066
Lavaca
7,822
20,066
Childress
7,822
20,066
Grayson
7,707
19,921
Lee
7,822
20,066
Clay
8,440
20,716
Gregg
6,632
22,987
Leon
7,822
20,066
Cochran
7,822
20,066
Grimes
7,822
20,066
Liberty
7,250
22,662
Coke
7,822
20,066
Guadalupe
7,665
18,955
Limestone
7,822
20,066
Coleman
7,822
20,066
Hale
7,822
20,066
Lipscomb
7,822
20,066
Collin
7,978
22,164
Hall
7,822
20,066
Live Oak
7,822
20,066
Collingsworth
7,822
20,066
Hamilton
7,822
20,066
Llano
7,822
20,066
Colorado
7,822
20,066
Hansford
7,822
20,066
Loving
7,822
20,066
Comal
7,665
18,955
Hardeman
7,822
20,066
Lubbock
7,143
21,917
Comanche
7,822
20,066
Hardin
9,052
22,480
Lynn
7,822
20,066
Concho
7,822
20,066
Harris
7,250
22,662
Madison
7,822
20,066
Cooke
7,822
20,066
Harrison
7,822
20,066
Marion
7,822
20,066
Coryell
8,124
18,547
Hartley
7,822
20,066
Martin
7,822
20,066
Cottle
7,822
20,066
Haskell
7,822
20,066
Mason
7,822
20,066
Crane
7,822
20,066
Hays
7,061
20,191
Matagorda
7,822
20,066
Crockett
7,822
20,066
Hemphill
7,822
20,066
Maverick
7,822
20,066
Crosby
7,143
21,917
Henderson
7,822
20,066
McCulloch
7,822
20,066
Culberson
7,822
20,066
Hidalgo
8,613
21,323
McLennan
5,891
17,785
Dallam
7,822
20,066
Hill
7,822
20,066
McMullen
7,822
20,066
Dallas
7,978
22,164
Hockley
7,822
20,066
Medina
7,665
18,955
Dawson
7,822
20,066
Hood
7,822
20,066
Menard
7,822
20,066
Deaf Smith
7,822
20,066
Hopkins
7,822
20,066
Midland
6,913
22,892
Delta
7,978
22,164
Houston
7,822
20,066
Milam
7,822
20,066
Denton
7,978
22,164
Howard
7,822
20,066
Mills
7,822
20,066
DeWitt
7,822
20,066
Hudspeth
7,822
20,066
Mitchell
7,822
20,066
Dickens
7,822
20,066
Hunt
7,978
22,164
Montague
7,822
20,066
Dimmit
7,822
20,066
Hutchinson
7,822
20,066
Montgomery
7,250
22,662
Donley
7,822
20,066
Irion
10,151
23,008
Moore
7,822
20,066
Duval
7,822
20,066
Jack
7,822
20,066
Morris
7,822
20,066
Eastland
7,822
20,066
Jackson
7,822
20,066
Motley
7,822
20,066
Ector
8,911
19,166
Jasper
7,822
20,066
Nacogdoches
7,822
20,066
Edwards
7,822
20,066
Jeff Davis
7,822
20,066
Navarro
7,822
20,066
El Paso
7,581
16,149
Jefferson
9,052
22,480
Newton
7,822
20,066
Ellis
7,978
22,164
Jim Hogg
7,822
20,066
Nolan
7,822
20,066
Erath
7,822
20,066
Jim Wells
7,822
20,066
Nueces
8,102
26,628
Falls
7,822
20,066
Johnson
7,978
22,164
Ochiltree
7,822
20,066
Fannin
7,822
20,066
Jones
7,456
20,335
Oldham
7,822
20,066
Fayette
7,822
20,066
Karnes
7,822
20,066
Orange
9,052
22,480
Fisher
7,822
20,066
Kaufman
7,978
22,164
Palo Pinto
7,822
20,066
Floyd
7,822
20,066
Kendall
7,665
18,955
Panola
7,822
20,066
Foard
7,822
20,066
Kenedy
7,822
20,066
Parker
7,978
22,164
Fort Bend
7,250
22,662
Kent
7,822
20,066
Parmer
7,822
20,066
Franklin
7,822
20,066
Kerr
7,822
20,066
Pecos
7,822
20,066
-28-
2023 Average Premium Tables
Virginia
Polk
7,822
20,066
Webb
8,091
21,227
Potter
10,030
23,705
Wharton
7,822
20,066
Presidio
7,822
20,066
Wheeler
7,822
20,066
County
Employee- Dependent,
Only
Family, etc.
Rains
7,822
20,066
Wichita
8,440
20,716
Accomack
7,539
20,308
Randall
10,030
23,705
Wilbarger
7,822
20,066
Albemarle
8,974
21,460
Reagan
7,822
20,066
Willacy
7,822
20,066
Alexandria City
8,021
23,327
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Real
7,822
20,066
Williamson
7,061
20,191
Alleghany
7,539
20,308
Red River
7,822
20,066
Wilson
7,665
18,955
Amelia
7,693
22,408
Reeves
7,822
20,066
Winkler
7,822
20,066
Amherst
6,642
20,171
6,642
20,171
Refugio
7,822
20,066
Wise
7,978
22,164
Appomattox
Roberts
7,822
20,066
Wood
7,822
20,066
Arlington
8,021
23,327
Robertson
7,118
20,305
Yoakum
7,822
20,066
Augusta
7,539
20,308
7,539
20,308
Rockwall
7,978
22,164
Young
7,822
20,066
Bath
Runnels
7,822
20,066
Zapata
7,822
20,066
Bedford
6,642
20,171
Rusk
6,632
22,987
Zavala
7,822
20,066
Bedford City
6,642
20,171
Bland
7,539
20,308
Botetourt
8,194
22,437
7,843
19,493
Sabine
7,822
20,066
San Augustine
7,822
20,066
San Jacinto
7,250
22,662
Utah
Employee- Dependent,
Only
Family, etc.
Bristol City
San Patricio
8,102
26,628
County
Brunswick
7,539
20,308
San Saba
7,822
20,066
Beaver
7,720
23,521
Buchanan
7,539
20,308
Schleicher
7,822
20,066
Box Elder
7,158
22,242
Buckingham
7,539
20,308
8,509
23,989
Scurry
7,822
20,066
Cache
Buena Vista City
7,539
20,308
Shackelford
7,822
20,066
Carbon
7,720
23,521
Campbell
6,642
20,171
20,066
Daggett
7,720
23,521
Caroline
7,693
22,408
7,291
22,868
Shelby
7,822
Sherman
7,822
20,066
Davis
Carroll
7,539
20,308
Smith
7,669
22,893
Duchesne
7,720
23,521
Charles City
7,693
22,408
20,066
Emery
7,720
23,521
Charlotte
7,539
20,308
7,720
23,521
Somervell
7,822
Starr
7,822
20,066
Garfield
Charlottesville City
8,974
21,460
Stephens
7,822
20,066
Grand
7,720
23,521
Chesapeake City
7,782
21,119
20,066
Iron
9,091
22,531
Chesterfield
7,693
22,408
7,720
23,521
Sterling
7,822
Stonewall
7,822
20,066
Juab
Clarke
8,021
23,327
Sutton
7,822
20,066
Kane
7,720
23,521
Colonial Heights City
7,693
22,408
20,066
Millard
7,720
23,521
Covington City
7,539
20,308
7,158
22,242
Swisher
7,822
Tarrant
7,978
22,164
Morgan
Craig
8,194
22,437
Taylor
7,456
20,335
Piute
7,720
23,521
Culpeper
7,539
20,308
8,509
23,989
Terrell
7,822
20,066
Rich
Cumberland
7,693
22,408
Terry
7,822
20,066
Salt Lake
7,291
22,868
Danville City
8,956
21,176
Throckmorton
7,822
20,066
San Juan
7,720
23,521
Dickenson
7,539
20,308
7,720
23,521
Titus
7,822
20,066
Sanpete
Dinwiddie
7,693
22,408
Tom Green
10,151
23,008
Sevier
7,720
23,521
Emporia City
7,539
20,308
Travis
7,061
20,191
Summit
7,291
22,868
Essex
7,539
20,308
7,291
22,868
Trinity
7,822
20,066
Tooele
Fairfax
8,021
23,327
Tyler
7,822
20,066
Uintah
7,720
23,521
Fairfax City
8,021
23,327
22,987
Utah
6,933
22,542
Falls Church City
8,021
23,327
7,291
22,868
Upshur
6,632
Upton
7,822
20,066
Wasatch
Fauquier
8,021
23,327
Uvalde
7,822
20,066
Washington
9,091
22,531
Floyd
7,539
20,308
20,066
Wayne
7,720
23,521
Fluvanna
8,974
21,460
Weber
7,158
22,242
Franklin
8,194
22,437
Franklin City
7,539
20,308
Frederick
8,090
21,890
Fredericksburg City
8,021
23,327
Galax City
7,539
20,308
Giles
6,887
20,744
Val Verde
7,822
Van Zandt
7,822
20,066
Victoria
8,198
21,897
Walker
7,822
20,066
Waller
7,250
22,662
Ward
7,822
20,066
Washington
7,822
20,066
2023 Average Premium Tables
Vermont
County
Employee- Dependent,
Only
Family, etc.
All
8,460
-29-
23,240
Gloucester
7,782
21,119
Radford City
6,887
20,744
Kittitas
7,672
22,822
Goochland
7,693
22,408
Rappahannock
7,539
20,308
Klickitat
7,145
20,391
Grayson
7,539
20,308
Richmond
7,539
20,308
Lewis
7,967
20,803
Greene
8,974
21,460
Richmond City
7,693
22,408
Lincoln
7,417
19,788
Greensville
7,539
20,308
Roanoke
8,194
22,437
Mason
7,967
20,803
Halifax
7,539
20,308
Roanoke City
8,194
22,437
Okanogan
7,672
22,822
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Hampton City
7,782
21,119
Rockbridge
7,539
20,308
Pacific
7,967
20,803
Hanover
7,693
22,408
Rockingham
7,253
21,742
Pend Oreille
7,417
19,788
Harrisonburg City
7,253
21,742
Russell
7,539
20,308
Pierce
7,967
20,803
Henrico
7,693
22,408
Salem City
8,194
22,437
San Juan
7,967
20,803
Henry
7,539
20,308
Scott
7,843
19,493
Skagit
7,967
20,803
Highland
7,539
20,308
Shenandoah
7,539
20,308
Skamania
7,145
20,391
Hopewell City
7,693
22,408
Smyth
7,539
20,308
Snohomish
7,967
20,803
Isle of Wight
7,782
21,119
Southampton
7,539
20,308
Spokane
7,417
19,788
James City
7,782
21,119
Spotsylvania
8,021
23,327
Stevens
7,417
19,788
King and Queen
7,693
22,408
Stafford
8,021
23,327
Thurston
7,967
20,803
King George
7,539
20,308
Staunton City
7,539
20,308
Wahkiakum
7,967
20,803
King William
7,693
22,408
Suffolk City
7,782
21,119
Walla Walla
7,672
22,822
Lancaster
7,539
20,308
Surry
7,782
21,119
Whatcom
7,967
20,803
Lee
7,539
20,308
Sussex
7,693
22,408
Whitman
7,672
22,822
Lexington City
7,539
20,308
Tazewell
7,539
20,308
Yakima
7,672
22,822
Loudoun
8,021
23,327
Virginia Beach City
7,782
21,119
Louisa
7,693
22,408
Warren
8,021
23,327
Lunenburg
7,539
20,308
Washington
7,843
19,493
Lynchburg City
6,642
20,171
Waynesboro City
7,539
20,308
County
Employee- Dependent,
Only
Family, etc.
Madison
7,539
20,308
Westmoreland
7,539
20,308
Barbour
9,242
27,010
21,119
Berkeley
8,573
24,140
8,389
26,140
Manassas City
8,021
23,327
Williamsburg City
7,782
West Virginia
Manassas Park City
8,021
23,327
Winchester City
8,090
21,890
Boone
Martinsville City
7,539
20,308
Wise
7,539
20,308
Braxton
9,567
25,392
20,308
Brooke
8,840
27,737
21,119
Cabell
8,675
25,542
Calhoun
9,567
25,392
Clay
9,567
25,392
Doddridge
9,107
24,704
Mathews
7,782
21,119
Mecklenburg
7,539
20,308
Middlesex
7,539
20,308
Montgomery
6,887
20,744
Wythe
York
7,539
7,782
Washington
Nelson
8,974
21,460
New Kent
7,693
22,408
County
Employee- Dependent,
Only
Family, etc.
Fayette
9,567
25,392
7,672
22,822
Gilmer
9,107
24,704
Newport News City
7,782
21,119
Adams
Norfolk City
7,782
21,119
Asotin
7,672
22,822
Grant
7,539
24,907
Northampton
7,539
20,308
Benton
7,672
22,822
Greenbrier
9,567
25,392
7,672
22,822
Hampshire
7,539
24,907
Northumberland
7,539
20,308
Chelan
Norton City
7,539
20,308
Clallam
7,967
20,803
Hancock
8,840
27,737
Nottoway
7,539
20,308
Clark
7,145
20,391
Hardy
7,539
24,907
7,672
22,822
Harrison
9,242
27,010
Orange
7,539
20,308
Columbia
Page
7,539
20,308
Cowlitz
7,967
20,803
Jackson
9,704
28,051
20,308
Douglas
7,672
22,822
Jefferson
8,573
24,140
7,417
19,788
Kanawha
10,466
28,870
Patrick
7,539
Petersburg City
7,693
22,408
Ferry
Pittsylvania
8,956
21,176
Franklin
7,672
22,822
Lewis
9,107
24,704
21,119
Garfield
7,672
22,822
Lincoln
8,389
26,140
7,672
22,822
Logan
8,389
26,140
Poquoson
7,782
Portsmouth City
7,782
21,119
Grant
Powhatan
7,693
22,408
Grays Harbor
7,967
20,803
Marion
9,107
24,704
20,308
Island
7,967
20,803
Marshall
8,840
27,737
7,967
20,803
Mason
8,675
25,542
Prince Edward
7,539
Prince George
7,693
22,408
Jefferson
Prince William
8,021
23,327
King
7,851
21,509
McDowell
8,389
26,140
20,744
Kitsap
7,967
20,803
Mercer
8,780
21,360
Pulaski
6,887
-30-
2023 Average Premium Tables
Mineral
7,539
24,907
Dodge
7,712
22,786
Sawyer
9,003
25,622
Mingo
8,389
26,140
Door
7,748
22,230
Shawano
7,748
22,230
Monongalia
9,107
24,704
Douglas
9,003
25,622
Sheboygan
7,712
22,786
Monroe
8,780
21,360
Dunn
8,268
24,992
St. Croix
9,799
25,801
Morgan
7,539
24,907
Eau Claire
8,268
24,992
Taylor
8,104
22,602
Nicholas
9,567
25,392
Florence
6,695
21,458
Trempealeau
7,925
22,747
TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 13, 2023
Ohio
8,840
27,737
Fond du Lac
7,712
22,786
Vernon
8,133
23,995
Pendleton
7,539
24,907
Forest
6,695
21,458
Vilas
6,695
21,458
Pleasants
9,704
28,051
Grant
8,133
23,995
Walworth
8,344
26,080
Pocahontas
9,242
27,010
Green
8,344
26,080
Washburn
9,003
25,622
Preston
9,242
27,010
Green Lake
8,246
29,125
Washington
8,177
24,978
Putnam
8,675
25,542
Iowa
8,133
23,995
Waukesha
8,177
24,978
Raleigh
8,780
21,360
Iron
6,695
21,458
Waupaca
7,712
22,786
Randolph
9,242
27,010
Jackson
7,925
22,747
Waushara
7,712
22,786
Ritchie
9,704
28,051
Jefferson
8,344
26,080
Winnebago
7,712
22,786
Roane
9,567
25,392
Juneau
8,246
29,125
Wood
9,019
25,476
Summers
8,780
21,360
Kenosha
9,382
26,795
Taylor
9,242
27,010
Kewaunee
7,748
22,230
Tucker
9,242
27,010
La Crosse
7,925
22,747
Tyler
9,704
28,051
Lafayette
8,133
23,995
County
Employee- Dependent,
Only
Family, etc.
Upshur
9,242
27,010
Langlade
6,695
21,458
Albany
8,863
24,339
8,863
24,339
Wyoming
Wayne
8,675
25,542
Lincoln
9,019
25,476
Big Horn
Webster
9,242
27,010
Manitowoc
7,748
22,230
Campbell
8,863
24,339
25,476
Carbon
8,863
24,339
8,863
24,339
Wetzel
9,107
24,704
Marathon
9,019
Wirt
9,704
28,051
Marinette
7,748
22,230
Converse
Wood
9,704
28,051
Marquette
8,246
29,125
Crook
8,863
24,339
22,230
Fremont
8,863
24,339
8,863
24,339
Wyoming
8,389
26,140
Wisconsin
Menomonee
7,748
Milwaukee
7,939
26,745
Goshen
Monroe
7,925
22,747
Hot Springs
8,863
24,339
22,230
Johnson
8,863
24,339
8,671
22,222
Employee- Dependent,
Only
Family, etc.
Oconto
County
Oneida
6,695
21,458
Laramie
Adams
8,246
29,125
Outagamie
7,712
22,786
Lincoln
8,863
24,339
Ashland
9,003
25,622
24,978
Natrona
9,630
24,281
8,863
24,339
Ozaukee
7,748
8,177
Barron
8,104
22,602
Pepin
8,268
24,992
Niobrara
Bayfield
9,003
25,622
Pierce
9,799
25,801
Park
8,863
24,339
Brown
7,748
22,230
Polk
9,799
25,801
Platte
8,863
24,339
Buffalo
7,925
22,747
Portage
9,019
25,476
Sheridan
8,863
24,339
Burnett
9,003
25,622
Price
8,104
22,602
Sublette
8,863
24,339
Calumet
7,712
22,786
Racine
9,382
26,795
Sweetwater
8,863
24,339
Chippewa
8,268
24,992
Richland
8,246
29,125
Teton
8,863
24,339
Clark
8,104
22,602
Rock
8,344
26,080
Uinta
8,863
24,339
Columbia
8,344
26,080
Rusk
8,104
22,602
Washakie
8,863
24,339
Crawford
8,133
23,995
Sauk
8,246
29,125
Weston
8,863
24,339
Dane
7,594
25,699
2023 Average Premium Tables
-31-
| File Type | application/pdf |
| File Title | 2023 Instructions for Form 8941 |
| Subject | Instructions for Form 8941, Credit for Small Employer Health Insurance Premiums |
| Author | W:CAR:MP:FP |
| File Modified | 2023-11-13 |
| File Created | 2023-11-08 |