8941 Instructions for Form 8941

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2024

Instructions for Form 8941
Credit for Small Employer Health Insurance Premiums

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Section references are to the Internal Revenue Code
unless otherwise noted.

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 20, 2024

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, 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 $65,000 per FTE. For details, see Worksheets
1 and 3.

Instructions for Form 8941 (2024) Catalog Number 55222U
Department of the Treasury Internal Revenue Service www.irs.gov

If you had more than 10 FTEs and average annual
wages of more than $32,000, 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 $65,000.

!

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).

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.

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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.

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

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.

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

Instructions for Form 8941 (2024)

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.

Health Insurance Coverage

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.
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.

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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.

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.
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 (2024)

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).
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.
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

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).

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.

Payroll Tax Limitation for Tax-Exempt
Eligible Small Employers

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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.

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).

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.

State Premium Subsidy and Tax
Credit Limitation

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.
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.
4

The credit for tax-exempt eligible small employers can’t
exceed the amount of certain payroll taxes. For tax years
beginning in 2024, 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 2024.
• Medicare taxes the tax-exempt employer was required
to withhold from employees’ wages in calendar year 2024.
• Medicare taxes the tax-exempt employer was required
to pay for calendar year 2024.

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.

Specific Instructions
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.
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.

Line A

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.
Instructions for Form 8941 (2024)

• You qualify for an exception to this requirement, as
discussed below.
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 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.

Worksheet 1. Information Needed To
Complete Line 1 and Worksheets 2
and 3
If you need more rows, use a separate sheet and include
the additional amounts in the totals below.

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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.

Exception for eligible small employers in certain
counties. For calendar year 2024, 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 2024 if they
properly claimed the credit under section 45R for all or
part of 2023. For details, see Notice 2018-27, 2018-20,
I.R.B. 580, available at IRS.gov/irb/
2018-20_IRB#NOT-2018-27.
To see whether a particular county has coverage

TIP available through a SHOP Exchange for 2024 and

beyond, go to Healthcare.gov/small-business and
enter “plans and prices” in the search box.

Line C

Answer “Yes” if a tax return you (or any predecessor) filed
for a tax year beginning after 2013 and before 2023
included a Form 8941 with line A checked “Yes” and
line 12 showing a positive amount. For more information,
see Credit Period, earlier.
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.

(a)
Individuals
Considered
Employees

(b)
Employee
Hours of
Service

(c)
Employee
Wages
Paid

 1.
 2.
 3.
 4.
 5.
 6.
 7.
 8.
 9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
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 (2024)

5

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.

discussed above. A sole proprietor must include both
business and nonbusiness employees to determine FTEs,
average annual wages, and premiums paid.
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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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.
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

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.

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.

Instructions for Form 8941 (2024)

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)

Worksheet 4. Information Needed To
Complete Lines 4, 5, and 13 and
Worksheet 7
If you need more rows, use a separate sheet and include
the additional amounts in the totals below.

TREASURY/IRS
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November 21, 2024
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 . . .

2,080

(a)
Enrolled
Individuals
Considered
Employees

(c)
Adjusted
Average
Premiums

(d)
Enrolled
Employee
Hours of
Service

 1.
 2.
 3.
 4.
 5.
 6.

3.

 7.
 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 $32,000 for the tax year. If you paid average
annual wages of $65,000 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 (2024)

7

Column (b), Employer Premiums Paid

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 (c), Adjusted Average
Premiums

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.

Column (d), Enrolled Employee Hours
of Service

TREASURY/IRS
AND OMB USE
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November 21, 2024
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.

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.
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 2024, see the
average premium tables at the end of these instructions.
Family coverage includes any coverage other than
employee-only coverage.

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
8

!

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)
1. Enter the amount from Form 8941,
line 7 . . . . . . . . . . . . . . . . . . . . . . . . . .
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 $32,000)
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 $32,400 from line 3

4.

.

5. Divide line 4 by $32,400. 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.

Instructions for Form 8941 (2024)

Worksheet 7. Information Needed To
Complete Line 14 (If Line 12 Is More
Than Zero)
1. Enter the total enrolled employee hours of
service from Worksheet 4, column
(d) . . . . . . . . . . . . . . . . . . . . . . . . . .
1.

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.

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
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.

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.
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

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 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 2024.
• Medicare taxes the tax-exempt employer was required
to withhold from employees’ wages in calendar year 2024.
• Medicare taxes the tax-exempt employer was required
to pay for calendar year 2024.

Cooperatives. A cooperative described in section
1381(a) must allocate to its patrons the credit in excess of

Instructions for Form 8941 (2024)

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.

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
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 (2024)

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 2024.

Limestone

8,306

23,301

Petersburg

12,288

35,134

Lowndes

8,741

23,453

Prince of Wales-Hyder 12,288

35,134

TREASURY/IRS
AND OMB USE
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November 21, 2024
Alabama

Macon

8,328

20,937

Sitka

12,288

35,134

Madison

8,306

23,301

Skagway

12,288

35,134

Marengo

8,328

20,937

Southeast Fairbanks

12,563

33,209

Marion

8,328

20,937

Valdez Cordova

11,682

31,718

8,328

20,937

Wade Hampton

12,563

33,209

Wrangell City and
Borough

12,288

35,134

Yakutat

12,563

33,209

Yukon Koyukuk

12,563

33,209

County

Employee- Dependent,
Only
Family, etc.

Marshall
Mobile

8,215

22,163

Autauga

8,741

23,453

Monroe

8,328

20,937

Baldwin

8,328

20,937

Montgomery

8,741

23,453

Barbour

8,328

20,937

Morgan

8,446

21,495

Bibb

8,073

22,250

Perry

8,328

20,937

Blount

8,073

22,250

Pickens

8,328

20,937

Bullock

8,328

20,937

Pike

8,328

20,937

Butler

8,328

20,937

Randolph

8,328

20,937

Calhoun

7,635

20,924

Russell

8,401

21,352

Chambers

8,328

20,937

Shelby

8,073

22,250

Cherokee

8,328

20,937

St. Clair

8,073

22,250

Chilton

8,073

22,250

Sumter

8,328

20,937

Choctaw

8,328

20,937

Talladega

8,328

20,937

Clarke

8,328

20,937

Tallapoosa

8,328

20,937

Clay

8,328

20,937

Tuscaloosa

8,200

21,879

Cleburne

8,328

20,937

Walker

8,073

22,250

Coffee

8,328

20,937

Washington

8,328

20,937

Colbert

8,710

22,810

Wilcox

8,328

20,937

Conecuh

8,328

20,937

Winston

8,328

20,937

Coosa

8,328

20,937

Covington

8,328

20,937

Crenshaw

8,328

20,937

Cullman

8,328

20,937

County

Employee- Dependent,
Only
Family, etc.

Dale

8,328

20,937

Aleutians East

12,563

33,209

Dallas

8,328

20,937

Aleutians West

12,563

33,209

DeKalb

8,328

20,937

Anchorage

11,682

31,718

Elmore

8,741

23,453

Bethel

11,682

31,718

Escambia

8,328

20,937

Bristol Bay

12,563

33,209

Etowah

7,572

22,226

Denali

12,563

33,209

Fayette

8,328

20,937

Dillingham

11,682

31,718

Franklin

8,328

20,937

Fairbanks North Star

12,563

33,209

Geneva

8,057

22,014

Haines

12,288

35,134

Greene

8,200

21,879

Hoonah-Angoon

12,288

35,134

Hale

8,200

21,879

Juneau

12,288

35,134

Henry

8,057

22,014

Kenai Peninsula

12,563

33,209

Houston

8,057

22,014

Ketchikan Gateway

12,288

35,134

Jackson

8,328

20,937

Kodiak Island

12,563

33,209

Jefferson

8,073

22,250

Lake and Peninsula

12,563

33,209

Lamar

8,328

20,937

Matanuska Susitna

12,563

33,209

Lauderdale

8,710

22,810

Nome

12,563

33,209

Lawrence

8,446

21,495

North Slope

12,563

33,209

Lee

7,726

20,656

Northwest Arctic

12,563

33,209

2024 Average Premium Tables

Alaska

Arizona
County

Employee- Dependent,
Only
Family, etc.

Apache

8,205

23,802

Cochise

7,861

21,771

Coconino

8,205

23,802

Gila

7,803

20,592

Graham

7,861

21,771

Greenlee

7,861

21,771

La Paz

8,893

24,548

Maricopa

7,510

22,558

Mohave

8,205

23,802

Navajo

8,205

23,802

Pima

7,513

21,227

Pinal

7,803

20,592

Santa Cruz

7,513

21,227

Yavapai

8,154

21,670

Yuma

8,893

24,548

Arkansas
County

Employee- Dependent,
Only
Family, etc.

Arkansas

7,140

18,250

Ashley

7,140

18,250

Baxter

7,244

21,429

Benton

7,244

21,429

Boone

7,244

21,429

Bradley

7,140

18,250

Calhoun

7,695

23,029

Carroll

7,244

21,429

Chicot

7,140

18,250

Clark

7,180

21,558

Clay

7,751

21,560

Cleburne

7,231

19,797

Cleveland

7,140

18,250

Columbia

7,695

23,029

Conway

7,231

19,797

11

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

7,231

19,797

Shasta

9,825

23,668

Cross

7,751

21,560

Washington

7,244

21,429

Sierra

9,825

23,668

Dallas

7,140

18,250

White

7,231

19,797

Siskiyou

9,825

23,668

Desha

7,140

18,250

Woodruff

7,751

21,560

Solano

8,673

24,682

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Drew

7,140

18,250

Faulkner

7,231

19,797

Franklin

6,714

21,788

Fulton

7,751

21,560

Garland

7,180

21,558

County

Grant

7,231

19,797

Yell

7,231

19,797

Sonoma

8,673

24,682

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

7,180

21,558

Butte

9,825

23,668

Yolo

8,406

24,340

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

18,250

El Dorado

8,406

24,340

County

Employee- Dependent,
Only
Family, etc.

Johnson

6,714

21,788

Fresno

8,250

25,788

Adams

8,504

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

8,504

21,656

18,250

Imperial

8,038

22,422

Archuleta

8,569

24,827

8,038

22,422

Baca

8,633

23,653

7,140

Lee

Lincoln

7,140

18,250

Inyo

Little River

7,695

23,029

Kern

8,576

20,941

Bent

8,633

23,653

21,788

Kings

8,250

25,788

Boulder

8,665

22,089

9,825

23,668

Broomfield

8,504

21,656

6,714

Logan

Lonoke

7,231

19,797

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

8,504

21,656

Marion

7,244

Miller

7,695

23,029

Madera

Mississippi

7,751

21,560

Marin

8,673

24,682

Conejos

8,633

23,653

18,250

Mariposa

9,008

24,693

Costilla

8,633

23,653

9,825

23,668

Crowley

8,633

23,653

Monroe

7,140

Montgomery

7,180

21,558

Mendocino

Nevada

7,695

23,029

Merced

9,008

24,693

Custer

8,633

23,653

9,825

23,668

Delta

8,569

24,827

Newton

7,244

21,429

Modoc

Ouachita

7,695

23,029

Mono

8,038

22,422

Denver

8,504

21,656

Perry

7,231

19,797

Monterey

9,395

26,386

Dolores

8,569

24,827

8,673

24,682

Douglas

8,504

21,656

Phillips

7,140

18,250

Napa

Pike

7,180

21,558

Nevada

9,825

23,668

Eagle

7,932

24,678

Poinsett

7,751

21,560

Orange

9,098

26,021

El Paso

7,425

22,503

8,406

24,340

Elbert

8,504

21,656

Polk

6,714

21,788

Placer

Pope

7,231

19,797

Plumas

9,825

23,668

Fremont

8,633

23,653

19,797

Riverside

8,823

24,188

Garfield

7,932

24,678

8,406

24,340

Gilpin

8,504

21,656

Prairie

7,231

Pulaski

7,231

19,797

Sacramento

Randolph

7,751

21,560

San Benito

9,395

26,386

Grand

8,569

24,827

19,797

San Bernardino

8,823

24,188

Gunnison

8,569

24,827

8,224

22,479

Hinsdale

8,569

24,827

Saline

7,231

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

8,569

24,827

8,551

25,169

Jefferson

8,504

21,656

6,714

Sebastian
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

7,751

St. Francis

12

2024 Average Premium Tables

Florida

La Plata

8,569

24,827

Lake

8,569

24,827

Larimer

8,694

20,373

County

Las Animas

8,633

23,653

Lincoln

8,633

Logan

9,459

Pasco

7,525

23,362

Employee- Dependent,
Only
Family, etc.

Pinellas

8,194

23,018

Polk

9,577

24,469

Alachua

8,574

22,734

Putnam

8,213

24,383

23,653

Baker

7,973

24,191

Santa Rosa

7,980

23,369

25,901

Bay

8,052

21,468

Sarasota

7,958

24,513

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Mesa

9,910

22,125

Bradford

8,111

24,389

Seminole

7,715

20,895

Mineral

8,633

23,653

Brevard

9,160

26,969

St. Johns

10,257

27,879

Moffat

8,569

24,827

Broward

8,175

23,328

St. Lucie

7,591

21,601

8,179

24,235

Montezuma

8,569

24,827

Calhoun

Sumter

8,329

24,392

Montrose

8,569

24,827

Charlotte

8,533

25,787

Suwannee

8,117

24,652

Morgan

9,459

25,901

Citrus

8,060

24,117

Taylor

8,601

24,732

7,995

23,813

Otero

8,633

23,653

Clay

Union

8,069

24,395

Ouray

8,569

24,827

Collier

7,988

29,682

Volusia

8,915

22,545

Park

8,504

21,656

Columbia

8,606

25,617

Wakulla

8,092

24,704

8,161

25,090

Walton

8,033

23,143

Washington

8,243

24,709

Phillips

9,459

25,901

DeSoto

Pitkin

7,932

24,678

Dixie

8,049

23,261

Prowers

8,633

23,653

Duval

8,681

26,581

Pueblo

8,421

21,282

Escambia

8,119

24,945

Rio Blanco

8,569

24,827

Flagler

8,811

24,301

Rio Grande

8,633

23,653

Franklin

8,293

25,489

County

Employee- Dependent,
Only
Family, etc.

Routt

8,569

24,827

Gadsden

8,215

24,406

Appling

10,583

27,444

Saguache

8,633

23,653

Gilchrist

8,214

24,798

Atkinson

8,296

26,061

24,827

Glades

8,262

25,093

Bacon

8,995

24,100

9,035

25,176

San Juan

8,569

Georgia

San Miguel

8,569

24,827

Gulf

8,395

24,880

Baker

Sedgwick

9,459

25,901

Hamilton

8,080

24,470

Baldwin

9,240

24,458

24,678

Hardee

7,947

23,424

Banks

8,493

22,594

9,031

21,237

Summit

7,932

Teller

7,425

22,503

Hendry

8,408

25,031

Barrow

Washington

9,459

25,901

Hernando

8,893

23,963

Bartow

8,799

22,877

26,016

Highlands

8,547

25,569

Ben Hill

8,599

24,744

8,599

24,744

Weld
Yuma

8,816
9,459

25,901

Connecticut

Hillsborough

7,958

25,175

Berrien

Holmes

8,083

23,872

Bibb

8,882

20,662

Indian River

8,085

24,108

Bleckley

8,882

20,662

8,995

24,100

Jackson

7,785

22,810

Brantley

Jefferson

8,349

23,916

Brooks

8,599

24,744

10,583

27,444

County

Employee- Dependent,
Only
Family, etc.

Fairfield

9,847

29,578

Lafayette

8,166

23,429

Bryan

Hartford

9,002

26,680

Lake

9,660

24,889

Bulloch

10,583

27,444

Litchfield

8,793

28,343

Lee

8,269

25,057

Burke

8,370

20,462

Middlesex

9,071

27,136

Leon

9,847

28,653

Butts

8,799

22,877

New Haven

9,794

29,443

Levy

7,897

24,443

Calhoun

9,035

25,176

New London

10,375

25,787

Liberty

8,032

23,563

Camden

8,995

24,100

Tolland

9,085

25,131

Madison

8,249

24,855

Candler

10,583

27,444

Windham

9,637

31,760

Manatee

7,718

21,046

Carroll

9,728

28,180

Marion

7,167

20,829

Catoosa

9,171

24,214

8,995

24,100

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

2024 Average Premium Tables

Martin

8,016

24,627

Charlton

Miami-Dade

8,264

24,940

Chatham

10,583

27,444

Monroe

8,436

25,476

Chattahoochee

8,306

21,721

8,654

22,433

Nassau

8,332

23,044

Chattooga

Okaloosa

8,059

28,477

Cherokee

8,799

22,877

Okeechobee

8,534

25,640

Clarke

9,031

21,237

9,035

25,176

Orange

7,953

22,301

Clay

Osceola

8,438

24,353

Clayton

8,799

22,877

Palm Beach

8,603

28,912

Clinch

8,599

24,744

13

Cobb

8,799

22,877

Lanier

8,599

24,744

Towns

8,493

22,594

Coffee

8,296

26,061

Laurens

8,296

26,061

Treutlen

8,296

26,061

Colquitt

8,599

24,744

Lee

9,035

25,176

Troup

8,306

21,721

Columbia

8,370

20,462

Liberty

10,583

27,444

Turner

8,599

24,744

Cook

8,599

24,744

Lincoln

8,370

20,462

Twiggs

8,882

20,662

Coweta

8,799

22,877

Long

10,583

27,444

Union

8,493

22,594

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Crawford

8,882

20,662

Lowndes

8,599

24,744

Upson

8,306

21,721

Crisp

9,035

25,176

Lumpkin

8,493

22,594

Walker

9,171

24,214

Dade

9,171

24,214

Macon

8,306

21,721

Walton

8,799

22,877

Dawson

8,493

22,594

Madison

9,031

21,237

Ware

8,995

24,100

Decatur

8,599

24,744

Marion

8,306

21,721

Warren

8,370

20,462

DeKalb

8,799

22,877

McDuffie

8,370

20,462

Washington

9,240

24,458

Dodge

8,882

20,662

McIntosh

8,995

24,100

Wayne

8,995

24,100

Dooly

8,882

20,662

Meriwether

8,306

21,721

Webster

8,306

21,721

Dougherty

9,035

25,176

Miller

8,599

24,744

Wheeler

8,296

26,061

Douglas

8,799

22,877

Mitchell

9,035

25,176

White

8,493

22,594

Early

8,599

24,744

Monroe

8,882

20,662

Whitfield

8,899

23,245

Echols

8,599

24,744

Montgomery

8,296

26,061

Wilcox

8,882

20,662

Effingham

10,583

27,444

Morgan

9,031

21,237

Wilkes

8,370

20,462

Elbert

9,031

21,237

Murray

8,899

23,245

Wilkinson

9,240

24,458

Emanuel

8,370

20,462

Muscogee

8,306

21,721

Worth

9,035

25,176

Evans

10,583

27,444

Newton

8,799

22,877

Fannin

8,899

23,245

Oconee

9,031

21,237

Fayette

8,799

22,877

Oglethorpe

9,031

21,237

Floyd

8,654

22,433

Paulding

8,799

22,877

County

Employee- Dependent,
Only
Family, etc.

Forsyth

8,799

22,877

Peach

8,882

20,662

All

8,011

Franklin

8,493

22,594

Pickens

8,654

22,433

Fulton

8,799

22,877

Pierce

8,995

24,100

Gilmer

8,654

22,433

Pike

8,799

22,877

Glascock

8,370

20,462

Polk

8,654

22,433

Glynn

8,995

24,100

Pulaski

8,882

20,662

Gordon

8,654

22,433

Putnam

8,882

20,662

Grady

8,599

24,744

Quitman

8,306

21,721

Greene

9,031

21,237

Rabun

8,493

22,594

Gwinnett

8,799

22,877

Randolph

9,035

25,176

Habersham

8,493

22,594

Richmond

8,370

20,462

Hall

8,493

22,594

Rockdale

8,799

22,877

Hancock

9,240

24,458

Schley

9,035

25,176

Haralson

9,728

28,180

Screven

10,583

27,444

Harris

8,306

21,721

Seminole

8,599

24,744

Hart

8,493

22,594

Spalding

8,799

22,877

Heard

9,728

28,180

Stephens

8,493

22,594

Henry

8,799

22,877

Stewart

8,306

21,721

Houston

8,882

20,662

Sumter

9,035

25,176

Irwin

8,599

24,744

Talbot

8,306

21,721

Jackson

9,031

21,237

Taliaferro

8,370

20,462

Jasper

8,799

22,877

Tattnall

10,583

27,444

Jeff Davis

8,296

26,061

Taylor

8,306

21,721

Jefferson

8,370

20,462

Telfair

8,296

26,061

Jenkins

8,370

20,462

Terrell

9,035

25,176

Johnson

8,296

26,061

Thomas

8,599

24,744

Jones

8,882

20,662

Tift

8,599

24,744

Lamar

8,799

22,877

Toombs

8,296

26,061

14

Hawaii

22,871

Idaho

County

Employee- Dependent,
Only
Family, etc.

Ada

7,370

18,558

Adams

7,815

19,674

Bannock

8,437

18,200

Bear Lake

8,437

18,200

Benewah

7,039

16,122

Bingham

8,437

18,200

Blaine

6,966

18,948

Boise

7,815

19,674

Bonner

7,039

16,122

Bonneville

7,965

20,506

Boundary

7,039

16,122

Butte

8,437

18,200

Camas

6,966

18,948

Canyon

7,815

19,674

Caribou

8,437

18,200

Cassia

6,966

18,948

Clark

7,965

20,506

Clearwater

8,172

19,086

Custer

8,437

18,200

Elmore

7,815

19,674

Franklin

8,437

18,200

Fremont

7,965

20,506

Gem

7,815

19,674

2024 Average Premium Tables

Gooding

6,966

18,948

Fulton

8,744

25,140

Saline

9,777

25,949

Idaho

8,172

19,086

Gallatin

9,777

25,949

Sangamon

8,465

23,011

Jefferson

7,965

20,506

Greene

8,687

25,047

Schuyler

8,465

23,011

Jerome

6,966

18,948

Grundy

9,101

21,765

Scott

8,465

23,011

Kootenai

7,039

16,122

Hamilton

9,777

25,949

Shelby

8,465

23,011

Latah

7,039

16,122

Hancock

8,243

25,623

St. Clair

8,984

26,654

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Lemhi

7,965

20,506

Hardin

9,777

25,949

Stark

8,744

25,140

Lewis

8,172

19,086

Henderson

8,243

25,623

Stephenson

8,972

22,362

Lincoln

6,966

18,948

Henry

8,243

25,623

Tazewell

8,744

25,140

Madison

7,965

20,506

Iroquois

9,646

25,054

Union

9,777

25,949

Minidoka

6,966

18,948

Jackson

9,777

25,949

Vermilion

9,646

25,054

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

25,623

Owyhee

7,815

19,674

Jersey

8,687

25,047

Washington

8,687

25,047

Payette

7,815

19,674

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

7,039

16,122

Kane

8,977

25,172

Whiteside

8,243

25,623

Teton

7,965

20,506

Kankakee

9,101

21,765

Will

9,101

21,765

Twin Falls

6,966

18,948

Kendall

9,101

21,765

Williamson

9,777

25,949

Valley

7,815

19,674

Knox

8,744

25,140

Winnebago

8,972

22,362

Washington

7,815

19,674

Lake

8,536

25,135

Woodford

8,744

25,140

LaSalle

8,744

25,140

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

23,011

Logan

8,465

23,011

Adams

8,481

23,214

Alexander

9,777

25,949

23,011

Allen

8,709

24,189

Bond

8,687

25,047

Macoupin

8,687

25,047

Bartholomew

7,972

23,203

Boone

8,972

22,362

Madison

8,984

26,654

Benton

8,516

25,391

Brown

8,465

23,011

25,949

Blackford

8,548

25,410

Bureau

8,243

25,623

Marshall

8,744

25,140

Boone

8,559

25,255

Calhoun

8,687

25,047

Mason

8,465

23,011

Brown

8,560

27,709

Carroll

8,972

22,362

25,949

Carroll

9,016

26,016

9,034

21,897

Macon

Marion

Massac

8,465

9,777

9,777

Cass

8,465

23,011

McDonough

8,744

25,140

Cass

Champaign

9,646

25,054

McHenry

8,536

25,135

Clark

7,522

22,444

Christian

8,465

23,011

McLean

9,902

24,851

Clay

8,780

24,472

Clark

9,646

25,054

Menard

8,465

23,011

Clinton

9,016

26,016

Clay

9,777

25,949

Mercer

8,243

25,623

Crawford

7,522

22,444

Clinton

8,687

25,047

Monroe

8,984

26,654

Daviess

8,271

25,780

Coles

9,646

25,054

Montgomery

8,687

25,047

Dearborn

9,246

24,245

Cook

8,729

24,808

Morgan

8,465

23,011

Decatur

7,972

23,203

Crawford

9,777

25,949

Moultrie

8,465

23,011

DeKalb

8,481

23,214

Cumberland

9,646

25,054

Ogle

8,972

22,362

Delaware

8,548

25,410

DeKalb

8,972

22,362

25,140

Dubois

8,271

25,780

DeWitt

9,902

24,851

Perry

9,777

25,949

Elkhart

8,456

22,896

Douglas

9,646

25,054

Piatt

9,646

25,054

Fayette

8,795

26,531

DuPage

8,977

25,172

23,011

Floyd

7,522

22,444

Edgar

9,646

25,054

Pope

9,777

25,949

Fountain

9,016

26,016

Edwards

9,777

25,949

Pulaski

9,777

25,949

Franklin

9,246

24,245

Effingham

9,777

25,949

25,140

Fulton

9,034

21,897

9,588

24,463

Peoria

Pike

Putnam

8,744

8,465

8,744

Fayette

9,777

25,949

Randolph

8,687

25,047

Gibson

Ford

9,646

25,054

Richland

9,777

25,949

Grant

8,548

25,410

Franklin

9,777

25,949

25,623

Greene

8,271

25,780

2024 Average Premium Tables

Rock Island

8,243

15

Hamilton

8,559

25,255

Vanderburgh

9,588

24,463

Guthrie

8,697

21,249

Hancock

8,795

26,531

Vermillion

8,780

24,472

Hamilton

7,966

23,547

Harrison

7,522

22,444

Vigo

8,780

24,472

Hancock

8,404

23,443

Hendricks

8,559

25,255

Wabash

8,481

23,214

Hardin

7,966

23,547

Henry

8,795

26,531

Warren

8,516

25,391

Harrison

8,697

21,249

Howard

9,034

21,897

Warrick

9,588

24,463

Henry

8,218

20,576

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Huntington

8,481

23,214

Washington

7,522

22,444

Howard

8,404

23,443

Jackson

7,972

23,203

Wayne

8,795

26,531

Humboldt

8,404

23,443

Jasper

8,516

25,391

Wells

8,481

23,214

Ida

8,772

22,897

Jay

8,548

25,410

White

8,516

25,391

Iowa

8,640

23,258

Jefferson

7,522

22,444

Whitley

8,481

23,214

Jackson

8,640

23,258

Jennings

7,972

23,203

Jasper

8,281

23,344

Johnson

8,560

27,709

Jefferson

8,218

20,576

Knox

8,271

25,780

8,640

23,258

Kosciusko

8,456

22,896

County

Employee- Dependent,
Only
Family, etc.

Johnson
Jones

8,640

23,258

8,697

21,249

Iowa

LaGrange

8,481

23,214

Adair

Keokuk

8,218

20,576

Lake

8,474

23,469

Adams

8,697

21,249

Kossuth

8,404

23,443

LaPorte

8,474

23,469

Allamakee

8,404

23,443

Lee

8,218

20,576

8,218

20,576

Lawrence

8,560

27,709

Appanoose

Linn

8,640

23,258

Madison

8,795

26,531

Audubon

8,697

21,249

Louisa

8,218

20,576

Marion

8,559

25,255

Benton

8,640

23,258

Lucas

8,218

20,576

8,640

23,258

Marshall

8,456

22,896

Black Hawk

Lyon

8,772

22,897

Martin

8,271

25,780

Boone

7,966

23,547

Madison

8,281

23,344

8,404

23,443

Miami

9,034

21,897

Bremer

Mahaska

8,218

20,576

Monroe

8,560

27,709

Buchanan

8,640

23,258

Marion

8,281

23,344

Montgomery

9,016

26,016

Buena Vista

8,772

22,897

Marshall

7,966

23,547

8,404

23,443

Morgan

8,559

25,255

Butler

Mills

8,697

21,249

Newton

8,516

25,391

Calhoun

7,966

23,547

Mitchell

8,404

23,443

Noble

8,481

23,214

Carroll

7,966

23,547

Monona

8,772

22,897

8,697

21,249

Ohio

9,246

24,245

Cass

Monroe

8,218

20,576

Orange

8,271

25,780

Cedar

8,640

23,258

Montgomery

8,697

21,249

Owen

8,560

27,709

Cerro Gordo

8,404

23,443

Muscatine

8,218

20,576

8,772

22,897

Parke

8,780

24,472

Cherokee

O'Brien

8,772

22,897

Perry

8,271

25,780

Chickasaw

8,404

23,443

Osceola

8,772

22,897

Pike

8,271

25,780

Clarke

8,697

21,249

Page

8,697

21,249

8,772

22,897

Porter

8,474

23,469

Clay

Palo Alto

8,772

22,897

Posey

9,588

24,463

Clayton

8,640

23,258

Plymouth

8,772

22,897

Pulaski

9,034

21,897

Clinton

8,640

23,258

Pocahontas

8,772

22,897

8,772

22,897

Putnam

9,016

26,016

Crawford

Polk

8,281

23,344

Randolph

8,548

25,410

Dallas

8,281

23,344

Pottawattamie

8,697

21,249

Ripley

9,246

24,245

Davis

8,218

20,576

Poweshiek

7,966

23,547

8,697

21,249

Rush

7,972

23,203

Decatur

Ringgold

8,697

21,249

Scott

7,522

22,444

Delaware

8,640

23,258

Sac

8,772

22,897

8,218

20,576

Shelby

8,559

25,255

Des Moines

Scott

8,640

23,258

Spencer

8,271

25,780

Dickinson

8,772

22,897

Shelby

8,697

21,249

St. Joseph

8,456

22,896

Dubuque

8,640

23,258

Sioux

8,772

22,897

8,404

23,443

Starke

8,456

22,896

Emmet

Story

7,966

23,547

Steuben

8,481

23,214

Fayette

8,404

23,443

Tama

7,966

23,547

Sullivan

8,780

24,472

Floyd

8,404

23,443

Taylor

8,697

21,249

8,404

23,443

Switzerland

9,246

24,245

Franklin

Union

8,697

21,249

Tippecanoe

9,016

26,016

Fremont

8,697

21,249

Van Buren

8,218

20,576

Tipton

9,016

26,016

Greene

7,966

23,547

Wapello

8,218

20,576

26,531

Grundy

7,966

23,547

Warren

8,281

23,344

8,795

Union

16

2024 Average Premium Tables

Washington

8,218

20,576

Hodgeman

6,640

20,210

Stevens

6,640

20,210

Wayne

8,218

20,576

Jackson

7,618

19,947

Sumner

7,303

20,982

Webster

7,966

23,547

Jefferson

7,618

19,947

Thomas

7,246

21,412

Winnebago

8,404

23,443

Jewell

6,958

19,361

Trego

7,246

21,412

Winneshiek

8,404

23,443

Johnson

8,105

20,832

Wabaunsee

7,618

19,947

Woodbury

8,772

22,897

Kearny

6,640

20,210

Wallace

7,246

21,412

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Worth

8,404

23,443

Kingman

7,303

20,982

Washington

6,958

19,361

Wright

8,404

23,443

Kiowa

6,640

20,210

Wichita

7,246

21,412

Labette

7,646

19,378

Wilson

7,303

20,982

Lane

7,246

21,412

Woodson

7,646

19,378

8,105

20,832

Wyandotte

8,105

20,832

Kansas
County

Employee- Dependent,
Only
Family, etc.

Leavenworth
Lincoln

6,958

19,361

Allen

7,646

19,378

Linn

7,618

19,947

Anderson

7,618

19,947

Logan

7,246

21,412

Atchison

7,618

19,947

Lyon

7,618

19,947

County

Employee- Dependent,
Only
Family, etc.

Barber

6,640

20,210

Marion

7,303

20,982

Adair

7,995

23,900

7,995

23,900

Kentucky

Barton

7,246

21,412

Marshall

7,618

19,947

Allen

Bourbon

7,646

19,378

McPherson

7,303

20,982

Anderson

7,342

21,758

Brown

7,618

19,947

Meade

6,640

20,210

Ballard

9,237

20,839

Butler

7,303

20,982

Miami

8,105

20,832

Barren

7,995

23,900

Chase

7,303

20,982

Mitchell

6,958

19,361

Bath

7,628

23,016

Chautauqua

7,303

20,982

Montgomery

7,303

20,982

Bell

8,511

27,031

Cherokee

7,646

19,378

Morris

6,958

19,361

Boone

7,287

22,920

Cheyenne

7,246

21,412

20,210

Bourbon

7,342

21,758

Clark

6,640

20,210

Nemaha

7,618

19,947

Boyd

7,628

23,016

Clay

6,958

19,361

Neosho

7,646

19,378

Boyle

7,342

21,758

Cloud

6,958

19,361

21,412

Bracken

7,628

23,016

Coffey

7,618

19,947

Norton

7,246

21,412

Breathitt

8,511

27,031

Comanche

6,640

20,210

Osage

7,618

19,947

Breckinridge

7,433

23,472

Cowley

7,303

20,982

21,412

Bullitt

7,433

23,472

Crawford

7,646

19,378

Ottawa

6,958

19,361

Butler

7,995

23,900

Decatur

7,246

21,412

Pawnee

6,640

20,210

Caldwell

9,237

20,839

Dickinson

6,958

19,361

21,412

Calloway

9,237

20,839

7,287

22,920

Morton

Ness

Osborne

Phillips

6,640

7,246

7,246

7,246

Doniphan

7,618

19,947

Pottawatomie

7,618

19,947

Campbell

Douglas

7,618

19,947

Pratt

6,640

20,210

Carlisle

9,237

20,839

Edwards

6,640

20,210

Rawlins

7,246

21,412

Carroll

7,433

23,472

Elk

7,303

20,982

Reno

7,303

20,982

Carter

7,628

23,016

Ellis

7,246

21,412

Republic

6,958

19,361

Casey

7,995

23,900

Ellsworth

6,958

19,361

Rice

7,303

20,982

Christian

8,681

26,611

Finney

6,640

20,210

Riley

6,958

19,361

Clark

7,342

21,758

Ford

6,640

20,210

Rooks

7,246

21,412

Clay

8,511

27,031

Franklin

7,618

19,947

Rush

7,246

21,412

Clinton

7,995

23,900

Geary

6,958

19,361

Russell

7,246

21,412

Crittenden

9,237

20,839

Gove

7,246

21,412

19,361

Cumberland

7,995

23,900

Graham

7,246

21,412

Scott

7,246

21,412

Daviess

8,681

26,611

Grant

6,640

20,210

Sedgwick

7,303

20,982

Edmonson

7,995

23,900

Gray

6,640

20,210

20,210

Elliott

7,628

23,016

Greeley

7,246

21,412

Shawnee

7,618

19,947

Estill

7,342

21,758

Greenwood

7,303

20,982

Sheridan

7,246

21,412

Fayette

7,342

21,758

Hamilton

6,640

20,210

21,412

Fleming

7,628

23,016

8,511

27,031

Saline

Seward

Sherman

6,958

6,640

7,246

Harper

7,303

20,982

Smith

7,246

21,412

Floyd

Harvey

7,303

20,982

Stafford

6,640

20,210

Franklin

7,342

21,758

Haskell

6,640

20,210

20,210

Fulton

9,237

20,839

2024 Average Premium Tables

Stanton

6,640

17

Gallatin

7,287

22,920

Ohio

8,681

26,611

Franklin

9,664

20,521

Garrard

7,342

21,758

Oldham

7,433

23,472

Grant

9,380

24,782

Grant

7,287

22,920

Owen

7,342

21,758

Iberia

7,992

20,866

Graves

9,237

20,839

Owsley

8,511

27,031

Iberville

8,791

22,141

Grayson

7,433

23,472

Pendleton

7,287

22,920

Jackson

9,664

20,521

Green

7,995

23,900

Perry

8,511

27,031

Jefferson

8,750

22,499

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Greenup

7,628

23,016

Pike

8,511

27,031

Jefferson Davis

9,547

21,861

Hancock

8,681

26,611

Powell

7,342

21,758

Lafayette

7,992

20,866

Hardin

7,433

23,472

Pulaski

7,995

23,900

Lafourche

8,784

20,542

Harlan

8,511

27,031

Robertson

7,628

23,016

LaSalle

9,380

24,782

Harrison

7,342

21,758

Rockcastle

7,342

21,758

Lincoln

9,664

20,521

Hart

7,995

23,900

Rowan

7,628

23,016

Livingston

8,791

22,141

Henderson

8,681

26,611

Russell

7,995

23,900

Madison

9,664

20,521

Henry

7,433

23,472

Scott

7,342

21,758

Morehouse

9,664

20,521

Hickman

9,237

20,839

Shelby

7,433

23,472

Natchitoches

8,188

21,752

Hopkins

8,681

26,611

Simpson

7,995

23,900

Orleans

8,750

22,499

Jackson

7,342

21,758

Spencer

7,433

23,472

Ouachita

9,664

20,521

Jefferson

7,433

23,472

Taylor

7,995

23,900

Plaquemines

8,750

22,499

Jessamine

7,342

21,758

Todd

8,681

26,611

Pointe Coupee

8,791

22,141

Johnson

8,511

27,031

Trigg

8,681

26,611

Rapides

9,380

24,782

Kenton

7,287

22,920

Trimble

7,433

23,472

Red River

8,188

21,752

Knott

8,511

27,031

Union

8,681

26,611

Richland

9,664

20,521

Knox

8,511

27,031

Warren

7,995

23,900

Sabine

8,188

21,752

LaRue

7,433

23,472

Washington

7,433

23,472

St. Bernard

8,750

22,499

Laurel

8,511

27,031

Wayne

7,995

23,900

St. Charles

8,750

22,499

Lawrence

7,628

23,016

Webster

8,681

26,611

St. Helena

8,791

22,141

Lee

8,511

27,031

Whitley

8,511

27,031

St. James

8,750

22,499

Leslie

8,511

27,031

Wolfe

8,511

27,031

St. John Baptist

8,750

22,499

Letcher

8,511

27,031

Woodford

7,342

21,758

St. Landry

7,992

20,866

Lewis

7,628

23,016

St. Martin

7,992

20,866

Lincoln

7,342

21,758

St. Mary

7,992

20,866

Livingston

9,237

20,839

8,750

22,499

Louisiana
Employee- Dependent,
Only
Family, etc.

St. Tammany

Logan

7,995

23,900

Parish

Tangipahoa

8,791

22,141

Lyon

9,237

20,839

Acadia

7,992

20,866

Tensas

9,664

20,521

Madison

7,342

21,758

Allen

9,547

21,861

Terrebonne

8,784

20,542

8,791

22,141

Magoffin

8,511

27,031

Ascension

Union

9,664

20,521

Marion

7,433

23,472

Assumption

8,784

20,542

Vermilion

7,992

20,866

Marshall

9,237

20,839

Avoyelles

9,380

24,782

Vernon

9,380

24,782

9,547

21,861

Martin

8,511

27,031

Beauregard

Washington

8,791

22,141

Mason

7,628

23,016

Bienville

8,188

21,752

Webster

8,188

21,752

McCracken

9,237

20,839

Bossier

8,188

21,752

West Baton Rouge

8,791

22,141

8,188

21,752

McCreary

7,995

23,900

Caddo

West Carroll

9,664

20,521

McLean

8,681

26,611

Calcasieu

9,547

21,861

West Feliciana

8,791

22,141

9,664

20,521

Winn

9,380

24,782

Meade

7,433

23,472

Caldwell

Menifee

7,628

23,016

Cameron

9,547

21,861

Mercer

7,342

21,758

Catahoula

9,380

24,782

Metcalfe

7,995

23,900

Claiborne

8,188

21,752

9,380

24,782

County

Employee- Dependent,
Only
Family, etc.

Maine

Monroe

7,995

23,900

Concordia

Montgomery

7,342

21,758

DeSoto

8,188

21,752

Androscoggin

8,563

23,088

23,016

East Baton Rouge

8,791

22,141

Aroostook

9,703

24,940

9,664

20,521

Cumberland

8,290

23,123

7,628

Morgan
Muhlenberg

8,681

26,611

East Carroll

Nelson

7,433

23,472

East Feliciana

8,791

22,141

Franklin

8,563

23,088

21,758

Evangeline

7,992

20,866

Hancock

9,703

24,940

7,342

Nicholas

18

2024 Average Premium Tables

Kennebec

8,238

22,625

Norfolk

10,326

30,660

Lenawee

8,673

25,644

Knox

8,238

22,625

Plymouth

9,830

29,195

Livingston

8,673

25,644

Lincoln

8,238

22,625

Suffolk

10,326

30,660

Luce

10,018

23,163

Oxford

8,238

22,625

Worcester

9,664

28,933

Mackinac

8,510

22,856

Penobscot

8,563

23,088

Macomb

8,234

22,845

Piscataquis

8,563

23,088

Manistee

7,203

21,345

Michigan

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Sagadahoc

8,290

23,123

10,018

23,163

8,563

23,088

County

Employee- Dependent,
Only
Family, etc.

Marquette

Somerset

Mason

7,127

21,445

Waldo

8,563

23,088

Alcona

8,510

22,856

Mecosta

7,127

21,445

10,018

23,163

Washington

9,703

24,940

Alger

Menominee

10,018

23,163

York

8,290

23,123

Allegan

8,008

23,533

Midland

8,542

21,522

Alpena

8,510

22,856

Missaukee

7,203

21,345

Antrim

7,203

21,345

Monroe

9,002

24,547

Arenac

8,524

24,111

Montcalm

7,127

21,445

Baraga

10,018

23,163

Montmorency

8,510

22,856

Maryland
County

Employee- Dependent,
Only
Family, etc.

Allegany

8,282

25,727

Barry

8,008

23,533

Muskegon

7,127

21,445

Anne Arundel

8,273

24,972

Bay

8,524

24,111

Newaygo

7,127

21,445

Baltimore

8,273

24,972

Benzie

7,203

21,345

Oakland

8,234

22,845

Baltimore City

8,273

24,972

Berrien

8,627

24,892

Oceana

7,127

21,445

Calvert

8,337

21,363

Branch

9,298

25,097

Ogemaw

8,510

22,856

Caroline

8,337

21,363

Calhoun

9,298

25,097

Ontonagon

10,018

23,163

Carroll

8,282

25,727

Cass

8,627

24,892

Osceola

7,127

21,445

Cecil

8,337

21,363

Charlevoix

7,203

21,345

Oscoda

8,510

22,856

Charles

8,337

21,363

Cheboygan

8,510

22,856

Otsego

8,510

22,856

Dorchester

8,337

21,363

Chippewa

8,510

22,856

Ottawa

7,127

21,445

Frederick

8,282

25,727

Clare

8,542

21,522

Presque Isle

8,510

22,856

Garrett

8,282

25,727

Clinton

8,521

22,881

Roscommon

8,510

22,856

Harford

8,273

24,972

Crawford

8,510

22,856

Saginaw

8,524

24,111

Howard

8,273

24,972

Delta

10,018

23,163

Sanilac

8,709

21,559

Kent

8,337

21,363

Dickinson

10,018

23,163

Schoolcraft

10,018

23,163

Montgomery

8,718

25,697

Eaton

8,521

22,881

Shiawassee

8,060

21,150

Prince George’s

8,718

25,697

Emmet

7,203

21,345

St. Clair

7,875

23,377

Queen Anne’s

8,337

21,363

Genesee

8,060

21,150

St. Joseph

8,627

24,892

Somerset

8,337

21,363

Gladwin

8,542

21,522

Tuscola

8,709

21,559

St. Mary’s

8,337

21,363

Gogebic

10,018

23,163

Van Buren

8,627

24,892

Talbot

8,337

21,363

Grand Traverse

7,203

21,345

Washtenaw

8,673

25,644

Washington

8,282

25,727

Gratiot

8,524

24,111

Wayne

9,002

24,547

Wicomico

8,337

21,363

Hillsdale

8,521

22,881

Wexford

7,203

21,345

Worcester

8,337

21,363

Houghton

10,018

23,163

Huron

8,709

21,559

Ingham

8,521

22,881

7,127

21,445

County

Employee- Dependent,
Only
Family, etc.

County

Employee- Dependent,
Only
Family, etc.

Ionia
Iosco

8,510

22,856

Aitkin

8,631

22,222

Barnstable

11,896

30,964

Iron

10,018

23,163

Anoka

8,348

23,928

Berkshire

8,966

27,598

Isabella

8,542

21,522

Becker

8,643

23,575

Bristol

9,830

29,195

Jackson

8,521

22,881

Beltrami

8,631

22,222

Dukes

11,896

30,964

Kalamazoo

9,298

25,097

Benton

8,348

23,928

Essex

10,000

29,332

Kalkaska

7,203

21,345

Big Stone

9,311

21,521

Franklin

8,966

27,598

Kent

7,127

21,445

Blue Earth

10,352

22,188

Hampden

8,966

27,598

Keweenaw

10,018

23,163

Brown

9,117

22,580

Hampshire

8,966

27,598

Lake

7,127

21,445

Carlton

10,107

22,968

Middlesex

10,326

30,660

Lapeer

8,060

21,150

Carver

8,348

23,928

Nantucket

11,896

30,964

Leelanau

7,203

21,345

Cass

8,631

22,222

Massachusetts

2024 Average Premium Tables

Minnesota

19

Chippewa

9,311

21,521

Renville

9,311

21,521

Humphreys

7,206

18,688

Chisago

8,631

22,222

Rice

10,352

22,188

Issaquena

7,206

18,688

Clay

8,643

23,575

Rock

9,117

22,580

Itawamba

7,416

18,912

Clearwater

8,842

24,327

Roseau

8,631

22,222

Jackson

7,844

23,137

Cook

10,107

22,968

Scott

8,348

23,928

Jasper

7,206

18,688

Cottonwood

9,117

22,580

Sherburne

8,348

23,928

Jefferson

7,206

18,688

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Crow Wing

8,631

22,222

Sibley

9,311

21,521

Jefferson Davis

7,206

18,688

Dakota

8,348

23,928

St. Louis

10,107

22,968

Jones

7,593

18,156

Dodge

8,999

23,347

Stearns

8,348

23,928

Kemper

7,206

18,688

Douglas

8,643

23,575

Steele

8,999

23,347

Lafayette

7,206

18,688

Faribault

10,352

22,188

Stevens

8,643

23,575

Lamar

7,593

18,156

Fillmore

8,999

23,347

Swift

9,311

21,521

Lauderdale

7,206

18,688

Freeborn

8,999

23,347

Todd

8,631

22,222

Lawrence

7,206

18,688

Goodhue

8,999

23,347

Traverse

8,643

23,575

Leake

7,206

18,688

Grant

8,643

23,575

Wabasha

8,999

23,347

Lee

7,416

18,912

Hennepin

8,348

23,928

Wadena

8,631

22,222

Leflore

7,206

18,688

Houston

8,999

23,347

Waseca

10,352

22,188

Lincoln

7,206

18,688

Hubbard

8,631

22,222

Washington

8,348

23,928

Lowndes

7,206

18,688

Isanti

8,631

22,222

Watonwan

10,352

22,188

Madison

7,604

19,180

Itasca

10,107

22,968

Wilkin

8,643

23,575

Marion

7,206

18,688

Jackson

9,117

22,580

Winona

8,999

23,347

Marshall

7,921

23,091

Kanabec

8,631

22,222

Wright

8,348

23,928

Monroe

7,206

18,688

Kandiyohi

9,311

21,521

Yellow Medicine

9,311

21,521

Montgomery

7,206

18,688

Kittson

8,842

24,327

Neshoba

7,206

18,688

Koochiching

10,107

22,968

Newton

7,206

18,688

Lac qui Parle

9,311

21,521

7,206

18,688

Mississippi

Employee- Dependent,
Only
Family, etc.

Noxubee

Lake

10,107

22,968

County

Oktibbeha

7,206

18,688

Lake of the Woods

10,107

22,968

Adams

7,206

18,688

Panola

7,206

18,688

Le Sueur

10,352

22,188

Alcorn

7,206

18,688

Pearl River

7,593

18,156

7,206

18,688

Lincoln

9,117

22,580

Amite

Perry

7,593

18,156

Lyon

9,311

21,521

Attala

7,206

18,688

Pike

7,206

18,688

Mahnomen

8,842

24,327

Benton

7,416

18,912

Pontotoc

7,416

18,912

7,206

18,688

Marshall

8,842

24,327

Bolivar

Prentiss

7,206

18,688

Martin

10,352

22,188

Calhoun

7,206

18,688

Quitman

7,206

18,688

McLeod

9,311

21,521

Carroll

7,206

18,688

Rankin

7,604

19,180

7,206

18,688

Meeker

9,311

21,521

Chickasaw

Scott

7,206

18,688

Mille Lacs

8,631

22,222

Choctaw

7,206

18,688

Sharkey

7,206

18,688

Morrison

8,631

22,222

Claiborne

7,206

18,688

Simpson

7,604

19,180

7,206

18,688

Mower

8,999

23,347

Clarke

Smith

7,206

18,688

Murray

9,117

22,580

Clay

7,206

18,688

Stone

7,844

23,137

Nicollet

10,352

22,188

Coahoma

7,206

18,688

Sunflower

7,206

18,688

7,604

19,180

Nobles

9,117

22,580

Copiah

Tallahatchie

7,206

18,688

Norman

8,842

24,327

Covington

7,206

18,688

Tate

7,921

23,091

7,921

23,091

Olmsted

8,999

23,347

DeSoto

Tippah

7,416

18,912

Otter Tail

8,643

23,575

Forrest

7,593

18,156

Tishomingo

7,206

18,688

Pennington

8,842

24,327

Franklin

7,206

18,688

Tunica

7,921

23,091

7,844

23,137

Pine

8,631

22,222

George

Union

7,416

18,912

Pipestone

9,117

22,580

Greene

7,593

18,156

Walthall

7,206

18,688

Polk

8,842

24,327

Grenada

7,206

18,688

Warren

7,604

19,180

7,844

23,137

Pope

8,643

23,575

Hancock

Washington

7,206

18,688

Ramsey

8,348

23,928

Harrison

7,844

23,137

Wayne

7,206

18,688

Red Lake

8,842

24,327

Hinds

7,604

19,180

Webster

7,206

18,688

22,580

Holmes

7,206

18,688

Wilkinson

7,206

18,688

9,117

Redwood

20

2024 Average Premium Tables

Winston

7,206

18,688

Iron

7,440

18,701

St. Francois

8,291

21,100

Yalobusha

7,206

18,688

Jackson

8,884

23,815

St. Louis

8,291

21,100

Yazoo

7,206

18,688

Jasper

8,606

20,620

St. Louis City

8,291

21,100

Jefferson

8,291

21,100

Ste. Genevieve

8,291

21,100

Johnson

7,494

19,730

Stoddard

8,722

22,895

8,548

20,952

Stone

7,880

21,502

Missouri
County

Employee- Dependent,
Only
Family, etc.

Knox
Laclede

7,880

21,502

Sullivan

8,548

20,952

Adair

8,548

20,952

Lafayette

7,494

19,730

Taney

7,880

21,502

Andrew

10,197

20,405

Lawrence

7,880

21,502

Texas

7,440

18,701

Atchison

10,197

20,405

Lewis

8,548

20,952

Vernon

7,494

19,730

Audrain

8,818

22,273

Lincoln

8,291

21,100

Warren

8,291

21,100

Barry

7,880

21,502

Linn

8,548

20,952

Washington

8,291

21,100

Barton

8,606

20,620

Livingston

10,197

20,405

Wayne

8,722

22,895

Bates

7,494

19,730

Macon

8,548

20,952

Webster

7,880

21,502

Benton

7,494

19,730

Madison

8,722

22,895

Worth

10,197

20,405

Bollinger

8,722

22,895

Maries

8,818

22,273

Wright

7,880

21,502

Boone

8,818

22,273

Marion

8,548

20,952

Buchanan

10,197

20,405

McDonald

8,606

20,620

Butler

8,722

22,895

Mercer

10,197

20,405

Caldwell

10,197

20,405

Miller

8,818

22,273

County

Employee- Dependent,
Only
Family, etc.

Callaway

8,818

22,273

Mississippi

8,722

22,895

Beaverhead

8,693

20,506

Camden

8,818

22,273

Moniteau

8,818

22,273

Big Horn

8,693

20,506

Cape Girardeau

8,722

22,895

Monroe

8,818

22,273

Blaine

8,693

20,506

Carroll

10,197

20,405

22,273

Broadwater

7,606

22,167

Carter

7,440

18,701

Morgan

8,818

22,273

Carbon

8,123

22,023

Cass

8,884

23,815

New Madrid

8,722

22,895

Carter

8,693

20,506

Cedar

7,880

21,502

20,620

Cascade

7,606

22,167

Chariton

8,818

22,273

Nodaway

10,197

20,405

Chouteau

7,606

22,167

Christian

7,880

21,502

Oregon

7,440

18,701

Custer

8,693

20,506

Clark

8,548

20,952

22,273

Daniels

8,693

20,506

Clay

8,884

23,815

Ozark

7,880

21,502

Dawson

8,693

20,506

Clinton

10,197

20,405

Pemiscot

8,722

22,895

Deer Lodge

7,606

22,167

Cole

8,818

22,273

22,895

Fallon

8,693

20,506

8,693

20,506

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Montgomery

Newton

Osage

Perry

8,818

8,606

8,818

8,722

Montana

Cooper

8,818

22,273

Pettis

7,494

19,730

Fergus

Crawford

7,440

18,701

Phelps

7,440

18,701

Flathead

7,863

20,820

Dade

7,880

21,502

Pike

8,548

20,952

Gallatin

7,606

22,167

Dallas

7,880

21,502

Platte

8,884

23,815

Garfield

8,693

20,506

Daviess

10,197

20,405

Polk

7,880

21,502

Glacier

8,693

20,506

DeKalb

10,197

20,405

Pulaski

7,440

18,701

Golden Valley

8,693

20,506

Dent

7,440

18,701

Putnam

8,548

20,952

Granite

8,693

20,506

Douglas

7,880

21,502

Ralls

8,548

20,952

Hill

8,693

20,506

Dunklin

8,722

22,895

Randolph

8,818

22,273

Jefferson

7,606

22,167

Franklin

8,291

21,100

Ray

10,197

20,405

Judith Basin

7,606

22,167

Gasconade

8,818

22,273

18,701

Lake

7,863

20,820

Gentry

10,197

20,405

Ripley

7,440

18,701

Lewis and Clark

7,606

22,167

Greene

7,880

21,502

Saline

7,494

19,730

Liberty

8,693

20,506

Grundy

10,197

20,405

20,952

Lincoln

8,693

20,506

Harrison

10,197

20,405

Scotland

8,548

20,952

Madison

8,693

20,506

Henry

7,494

19,730

Scott

8,722

22,895

McCone

8,693

20,506

Hickory

7,880

21,502

18,701

Meagher

8,693

20,506

8,693

20,506

Reynolds

Schuyler

Shannon

7,440

8,548

7,440

Holt

10,197

20,405

Shelby

8,548

20,952

Mineral

Howard

8,818

22,273

St. Charles

8,291

21,100

Missoula

7,863

20,820

Howell

7,440

18,701

19,730

Musselshell

8,123

22,023

2024 Average Premium Tables

St. Clair

7,494

21

Park

8,693

20,506

Dodge

8,710

24,343

Seward

9,037

25,222

Petroleum

8,693

20,506

Douglas

8,710

24,343

Sheridan

9,959

25,388

Phillips

8,693

20,506

Dundy

9,959

25,388

Sherman

9,372

27,787

Pondera

8,693

20,506

Fillmore

9,037

25,222

Sioux

9,959

25,388

Powder River

8,693

20,506

Franklin

9,372

27,787

Stanton

9,372

27,787

Powell

8,693

20,506

Frontier

9,959

25,388

Thayer

9,037

25,222

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Prairie

8,693

20,506

Furnas

9,372

27,787

Thomas

9,959

25,388

Ravalli

8,693

20,506

Gage

9,037

25,222

Thurston

8,710

24,343

Richland

8,693

20,506

Garden

9,959

25,388

Valley

9,372

27,787

Roosevelt

8,693

20,506

Garfield

9,372

27,787

Washington

8,710

24,343

Rosebud

8,693

20,506

Gosper

9,372

27,787

Wayne

9,372

27,787

Sanders

8,693

20,506

Grant

9,959

25,388

Webster

9,372

27,787

Sheridan

8,693

20,506

Greeley

9,372

27,787

Wheeler

9,372

27,787

Silver Bow

7,606

22,167

Hall

9,372

27,787

York

9,037

25,222

Stillwater

8,123

22,023

Hamilton

9,372

27,787

Sweet Grass

8,123

22,023

Harlan

9,372

27,787

Teton

7,606

22,167

Hayes

9,959

25,388

Toole

8,693

20,506

Hitchcock

9,959

25,388

County

Employee- Dependent,
Only
Family, etc.

Treasure

8,693

20,506

Holt

9,372

27,787

Carson City

8,478

22,103

Valley

8,693

20,506

Hooker

9,959

25,388

Churchill

9,240

25,254

Wheatland

8,693

20,506

Howard

9,372

27,787

Clark

8,353

20,646

8,478

22,103

Nevada

Wibaux

8,693

20,506

Jefferson

9,037

25,222

Douglas

Yellowstone

8,123

22,023

Johnson

9,037

25,222

Elko

9,240

25,254

27,787

Esmeralda

9,240

25,254

9,240

25,254

Kearney

Nebraska

9,372

Keith

9,959

25,388

Eureka

Keya Paha

9,372

27,787

Humboldt

9,240

25,254

25,388

Lander

9,240

25,254

9,240

25,254

County

Employee- Dependent,
Only
Family, etc.

Adams

9,372

27,787

Knox

9,372

27,787

Lincoln

Antelope

9,372

27,787

Lancaster

9,037

25,222

Lyon

8,478

22,103

Arthur

9,959

25,388

25,388

Mineral

9,240

25,254

Banner

9,959

25,388

Logan

9,959

25,388

Nye

8,353

20,646

Blaine

9,372

27,787

Loup

9,372

27,787

Pershing

9,240

25,254

Boone

9,372

27,787

27,787

Storey

8,478

22,103

8,941

21,180

9,240

25,254

Kimball

Lincoln

Madison

9,959

9,959

9,372

Box Butte

9,959

25,388

McPherson

9,959

25,388

Washoe

Boyd

9,372

27,787

Merrick

9,372

27,787

White Pine

Brown

9,959

25,388

Morrill

9,959

25,388

Buffalo

9,372

27,787

Nance

9,372

27,787

Burt

8,710

24,343

Nemaha

9,037

25,222

Butler

9,372

27,787

Nuckolls

9,372

27,787

Cass

8,710

24,343

Otoe

9,037

25,222

Cedar

9,372

27,787

Pawnee

9,037

25,222

Chase

9,959

25,388

Perkins

9,959

25,388

Cherry

9,959

25,388

Phelps

9,372

27,787

Cheyenne

9,959

25,388

Pierce

9,372

27,787

Clay

9,372

27,787

Platte

9,372

27,787

Colfax

9,372

27,787

Polk

9,372

27,787

Cuming

9,372

27,787

Red Willow

9,959

25,388

Custer

9,372

27,787

Richardson

9,037

25,222

Dakota

9,372

27,787

Rock

9,372

27,787

Dawes

9,959

25,388

Saline

9,037

25,222

Dawson

9,372

27,787

Sarpy

8,710

24,343

Deuel

9,959

25,388

Saunders

8,710

24,343

Dixon

9,372

27,787

Scotts Bluff

9,959

25,388

22

New Hampshire
County

Employee- Dependent,
Only
Family, etc.

All

8,591

26,225

New Jersey
County

Employee- Dependent,
Only
Family, etc.

All

9,236

27,428

New Mexico
County

Employee- Dependent,
Only
Family, etc.

Bernalillo

8,237

23,762

Catron

9,379

29,015

Chaves

9,379

29,015

Cibola

9,379

29,015

2024 Average Premium Tables

Colfax

9,379

29,015

Hamilton

9,421

25,195

Bertie

8,509

26,401

Curry

9,379

29,015

Herkimer

9,421

25,195

Bladen

7,906

24,138

De Baca

9,379

29,015

Jefferson

9,421

25,195

Brunswick

7,906

21,413

Doña Ana

8,406

22,155

Kings

11,243

29,771

Buncombe

8,305

23,233

Eddy

9,379

29,015

Lewis

9,421

25,195

Burke

8,144

24,425

Grant

9,379

29,015

Livingston

8,726

24,145

Cabarrus

7,893

24,763

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Guadalupe

9,379

29,015

Madison

9,421

25,195

Caldwell

8,144

24,425

Harding

9,379

29,015

Monroe

8,726

24,145

Camden

8,509

26,401

Hidalgo

9,379

29,015

Montgomery

9,358

23,483

Carteret

9,047

22,207

Lea

9,379

29,015

Nassau

11,316

30,611

Caswell

7,851

25,284

Lincoln

9,379

29,015

New York

11,243

29,771

Catawba

8,144

24,425

Los Alamos

9,379

29,015

Niagara

9,036

22,871

Chatham

7,851

25,284

Luna

9,379

29,015

Oneida

9,421

25,195

Cherokee

8,305

23,233

McKinley

9,379

29,015

Onondaga

9,203

23,570

Chowan

8,509

26,401

Mora

9,379

29,015

Ontario

8,726

24,145

Clay

8,305

23,233

Otero

9,379

29,015

Orange

10,472

25,016

Cleveland

8,254

22,198

Quay

9,379

29,015

Orleans

9,036

22,871

Columbus

7,906

21,413

Rio Arriba

9,379

29,015

Oswego

9,421

25,195

Craven

9,047

22,207

Roosevelt

9,379

29,015

Otsego

9,421

25,195

Cumberland

7,906

24,138

San Juan

9,045

25,668

Putnam

10,472

25,016

Currituck

8,509

26,401

San Miguel

9,379

29,015

Queens

11,243

29,771

Dare

9,047

22,207

Sandoval

8,237

23,762

Rensselaer

9,358

23,483

Davidson

8,418

23,593

Santa Fe

8,598

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

9,358

23,483

Durham

7,851

25,284

Taos

9,379

29,015

Schenectady

9,358

23,483

Edgecombe

8,970

27,984

Torrance

8,237

23,762

Schoharie

9,358

23,483

Forsyth

8,418

23,593

Union

9,379

29,015

Schuyler

9,203

23,570

Franklin

7,278

22,866

Valencia

8,237

23,762

Seneca

8,726

24,145

Gaston

8,254

22,198

St. Lawrence

9,421

25,195

Gates

8,509

26,401

Steuben

9,203

23,570

Graham

8,305

23,233

11,316

30,611

Granville

7,889

22,653

New York
County

Employee- Dependent,
Only
Family, etc.

Suffolk
Sullivan

10,472

25,016

Greene

8,970

27,984

Albany

9,358

23,483

Tioga

9,203

23,570

Guilford

7,650

21,582

Allegany

9,036

22,871

Tompkins

9,203

23,570

Halifax

8,509

26,401

Bronx

11,243

29,771

Ulster

10,472

25,016

Harnett

7,906

24,138

Broome

9,203

23,570

Warren

9,358

23,483

Haywood

8,305

23,233

Cattaraugus

9,036

22,871

Washington

9,358

23,483

Henderson

8,305

23,233

Cayuga

9,203

23,570

Wayne

8,726

24,145

Hertford

8,509

26,401

Chautauqua

9,036

22,871

Westchester

11,243

29,771

Hoke

7,906

24,138

Chemung

9,203

23,570

Wyoming

9,036

22,871

Hyde

9,047

22,207

Chenango

9,421

25,195

Yates

8,726

24,145

Iredell

8,144

24,425

Clinton

9,421

25,195

Jackson

8,305

23,233

Columbia

9,358

23,483

Cortland

9,203

23,570

Delaware

10,472

25,016

Dutchess

10,472

Erie

North Carolina

Johnston

7,278

22,866

Jones

9,047

22,207

County

Employee- Dependent,
Only
Family, etc.

Lee

7,851

25,284

25,016

Alamance

7,851

25,284

Lenoir

9,047

22,207

9,036

22,871

Alexander

8,144

24,425

Lincoln

8,254

22,198

Essex

9,421

25,195

Alleghany

8,494

23,965

Macon

8,305

23,233

Franklin

9,421

25,195

Anson

7,893

24,763

Madison

8,305

23,233

Fulton

9,358

23,483

Ashe

8,494

23,965

Martin

8,509

26,401

Genesee

9,036

22,871

Avery

8,305

23,233

McDowell

8,305

23,233

Greene

9,358

23,483

Beaufort

9,047

22,207

Mecklenburg

7,893

24,763

2024 Average Premium Tables

23

Mitchell

8,305

23,233

Cavalier

9,654

24,739

Auglaize

8,467

21,287

Montgomery

9,310

22,169

Dickey

9,654

24,739

Belmont

8,279

19,458

Moore

9,310

22,169

Divide

9,654

24,739

Brown

8,612

19,544

Nash

8,970

27,984

Dunn

9,654

24,739

Butler

8,907

23,720

New Hanover

7,906

21,413

Eddy

9,654

24,739

Carroll

7,908

22,733

Northampton

8,509

26,401

Emmons

9,654

24,739

Champaign

8,680

22,090

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Onslow

7,906

21,413

Foster

9,654

24,739

Clark

8,680

22,090

Orange

7,851

25,284

Golden Valley

9,654

24,739

Clermont

8,612

19,544

Pamlico

9,047

22,207

Grand Forks

8,680

24,032

Clinton

8,612

19,544

Pasquotank

8,509

26,401

Grant

9,654

24,739

Columbiana

8,630

23,707

Pender

7,906

21,413

Griggs

9,654

24,739

Coshocton

8,279

19,458

Perquimans

8,509

26,401

Hettinger

9,654

24,739

Crawford

8,016

20,711

Person

7,851

25,284

Kidder

9,654

24,739

Cuyahoga

8,906

23,234

Pitt

8,970

27,984

La Moure

9,654

24,739

Darke

8,680

22,090

Polk

8,305

23,233

Logan

9,654

24,739

Defiance

8,234

21,370

Randolph

7,650

21,582

McHenry

9,654

24,739

Delaware

8,104

22,087

Richmond

7,906

24,138

McIntosh

9,654

24,739

Erie

8,598

22,960

Robeson

7,906

24,138

McKenzie

9,654

24,739

Fairfield

8,104

22,087

Rockingham

7,650

21,582

McLean

9,654

24,739

Fayette

8,104

22,087

Rowan

7,893

24,763

Mercer

9,654

24,739

Franklin

8,104

22,087

Rutherford

8,305

23,233

Morton

9,179

25,095

Fulton

8,234

21,370

Sampson

7,906

24,138

Mountrail

9,654

24,739

Gallia

10,511

27,998

Scotland

7,906

24,138

Nelson

9,654

24,739

Geauga

8,906

23,234

Stanly

7,893

24,763

Oliver

9,654

24,739

Greene

8,680

22,090

Stokes

8,418

23,593

Pembina

9,654

24,739

Guernsey

8,279

19,458

Surry

8,418

23,593

Pierce

9,654

24,739

Hamilton

8,907

23,720

Swain

8,305

23,233

Ramsey

9,654

24,739

Hancock

8,467

21,287

Transylvania

8,305

23,233

Ransom

9,654

24,739

Hardin

8,467

21,287

Tyrrell

9,047

22,207

Renville

9,654

24,739

Harrison

8,279

19,458

Union

7,893

24,763

Richland

9,654

24,739

Henry

8,234

21,370

Vance

7,889

22,653

Rolette

9,654

24,739

Highland

8,612

19,544

Wake

7,278

22,866

Sargent

9,654

24,739

Hocking

9,718

21,428

Warren

7,889

22,653

Sheridan

9,654

24,739

Holmes

7,086

20,621

Washington

9,047

22,207

Sioux

9,654

24,739

Huron

8,598

22,960

Watauga

8,494

23,965

Slope

9,654

24,739

Jackson

10,511

27,998

Wayne

8,970

27,984

Stark

9,654

24,739

Jefferson

8,279

19,458

Wilkes

8,494

23,965

Steele

9,654

24,739

Knox

8,104

22,087

Wilson

8,970

27,984

Stutsman

9,654

24,739

Lake

8,906

23,234

Yadkin

8,418

23,593

Towner

9,654

24,739

Lawrence

10,511

27,998

Yancey

8,305

23,233

Traill

9,654

24,739

Licking

8,104

22,087

Walsh

9,654

24,739

Logan

8,104

22,087

Ward

9,654

24,739

Lorain

8,906

23,234

Wells

9,654

24,739

Lucas

8,234

21,370

Williams

9,654

24,739

Madison

8,104

22,087

Mahoning

8,630

23,707

Marion

8,196

21,747

North Dakota
County

Employee- Dependent,
Only
Family, etc.

Adams

9,654

24,739

Barnes

9,654

24,739

Benson

9,654

24,739

8,799

22,928

9,654

24,739

County

Employee- Dependent,
Only
Family, etc.

Medina

Billings

Meigs

9,718

21,428

Bottineau

9,654

24,739

Adams

8,612

19,544

Mercer

8,467

21,287

Bowman

9,654

24,739

Allen

8,467

21,287

Miami

8,680

22,090

Burke

9,654

24,739

Ashland

8,799

22,928

Monroe

8,279

19,458

Burleigh

9,179

25,095

Ashtabula

8,906

23,234

Montgomery

8,680

22,090

Cass

8,467

24,039

Athens

9,718

21,428

Morgan

8,279

19,458

24

Ohio

2024 Average Premium Tables

Morrow

8,196

21,747

Custer

8,126

22,340

Wagoner

8,397

22,281

Muskingum

8,279

19,458

Delaware

8,126

22,340

Washington

8,126

22,340

Noble

8,279

19,458

Dewey

8,126

22,340

Washita

8,126

22,340

Ottawa

8,598

22,960

Ellis

8,126

22,340

Woods

8,126

22,340

Paulding

8,467

21,287

Garfield

8,126

22,340

Woodward

8,126

22,340

Perry

8,279

19,458

Garvin

8,126

22,340

Oregon

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Pickaway

8,104

22,087

Grady

8,463

21,499

Pike

10,511

27,998

Grant

8,126

22,340

Portage

8,799

22,928

Greer

8,126

22,340

County

Employee- Dependent,
Only
Family, etc.

Preble

8,680

22,090

Harmon

8,126

22,340

Baker

9,689

24,154

8,150

21,869

Putnam

8,467

21,287

Harper

8,126

22,340

Benton

Richland

8,016

20,711

Haskell

8,126

22,340

Clackamas

7,498

22,379

22,340

Clatsop

9,288

23,313

9,288

23,313

Ross

10,511

27,998

Hughes

8,126

Sandusky

8,598

22,960

Jackson

8,126

22,340

Columbia

Scioto

10,511

27,998

Jefferson

8,126

22,340

Coos

9,288

23,313

22,340

Crook

9,689

24,154

9,288

23,313

Seneca

8,598

22,960

Johnston

8,126

Shelby

8,680

22,090

Kay

8,126

22,340

Curry

Stark

7,908

22,733

Kingfisher

8,126

22,340

Deschutes

9,018

23,403

8,560

22,476

Summit

8,799

22,928

Kiowa

8,126

22,340

Douglas

Trumbull

8,630

23,707

Latimer

8,126

22,340

Gilliam

9,689

24,154

Tuscarawas

8,279

19,458

Le Flore

7,472

22,477

Grant

9,689

24,154

9,689

24,154

Union

8,104

22,087

Lincoln

8,463

21,499

Harney

Van Wert

8,467

21,287

Logan

8,463

21,499

Hood River

9,689

24,154

22,340

Jackson

8,560

22,476

9,689

24,154

Vinton

10,511

27,998

Love

8,126

Warren

8,907

23,720

Major

8,126

22,340

Jefferson

Washington

9,718

21,428

Marshall

8,126

22,340

Josephine

8,560

22,476

22,340

Klamath

9,018

23,403

9,018

23,403

Wayne

7,086

20,621

Mayes

8,126

Williams

8,234

21,370

McClain

8,463

21,499

Lake

Wood

8,234

21,370

McCurtain

8,126

22,340

Lane

8,150

21,869

22,340

Lincoln

9,288

23,313

8,150

21,869

Wyandot

8,598

22,960

Oklahoma

McIntosh

8,126

Murray

8,126

22,340

Linn

Muskogee

8,126

22,340

Malheur

9,689

24,154

22,340

Marion

7,817

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

7,498

22,379

Alfalfa

8,126

22,340

Oklahoma

8,463

21,499

Polk

7,817

21,686

Atoka

8,126

22,340

Okmulgee

8,397

22,281

Sherman

9,689

24,154

Beaver

8,126

22,340

Osage

8,397

22,281

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

22,281

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

21,499

Pontotoc

8,126

22,340

Washington

7,498

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

7,498

22,379

Choctaw

8,126

22,340

Roger Mills

8,126

22,340

Cimarron

8,126

22,340

Rogers

8,397

22,281

Cleveland

8,463

21,499

Seminole

8,126

22,340

Coal

8,126

22,340

Sequoyah

7,472

22,477

Comanche

7,985

22,334

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

22,281

Tulsa

8,397

22,281

2024 Average Premium Tables

Pennsylvania
County

Employee- Dependent,
Only
Family, etc.

Adams

9,198

25,368

Allegheny

8,444

23,654

Armstrong

8,444

23,654

Beaver

8,444

23,654

25

Bedford

8,683

23,856

Susquehanna

8,712

24,628

McCormick

8,590

25,926

Berks

9,198

25,368

Tioga

8,712

24,628

Newberry

9,202

25,451

Blair

8,683

23,856

Union

9,135

26,717

Oconee

9,341

25,843

Bradford

8,712

24,628

Venango

8,287

23,609

Orangeburg

8,291

27,773

Bucks

8,951

26,308

Warren

8,287

23,609

Pickens

7,983

24,372

Butler

8,444

23,654

Washington

8,444

23,654

Richland

8,087

23,880

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Cambria

8,683

23,856

Wayne

8,712

24,628

Saluda

8,422

25,030

Cameron

7,824

25,938

Westmoreland

8,444

23,654

Spartanburg

7,709

22,457

Carbon

8,712

24,628

Wyoming

8,712

24,628

Sumter

7,846

22,540

Centre

9,135

26,717

York

9,198

25,368

Union

7,512

24,821

Chester

8,951

26,308

Williamsburg

7,776

24,683

Clarion

8,287

23,609

York

8,046

24,473

Clearfield

8,683

23,856

Clinton

8,712

24,628

County

Employee- Dependent,
Only
Family, etc.

Columbia

9,135

26,717

All

8,796

Crawford

8,287

23,609

Cumberland

9,207

26,359

Dauphin

9,207

26,359

Delaware

8,951

26,308

Elk

7,824

25,938

Erie

8,287

23,609

Fayette

8,444

23,654

Forest

8,287

23,609

9,207

Franklin

26,359

Fulton

9,207

26,359

Greene

8,444

23,654

8,683

Huntingdon

23,856

Indiana

8,444

23,654

Jefferson

8,683

23,856

Juniata

9,207

26,359

Lackawanna

8,712

24,628

Lancaster

9,198

25,368

Lawrence

8,444

23,654

Lebanon

9,207

26,359

Lehigh

9,135

26,717

Luzerne

8,712

24,628

Lycoming

8,712

24,628

McKean

8,287

23,609

Mercer

8,287

23,609

Mifflin

9,135

26,717

Monroe

8,712

24,628

Montgomery

8,951

26,308

Montour

9,135

26,717

Northampton

9,135

26,717

Northumberland

9,135

26,717

Perry

9,207

26,359

Philadelphia

8,951

26,308

Pike

8,712

24,628

Potter

7,824

25,938

9,135

Schuylkill

26,717

Snyder

9,135

26,717

Somerset

8,683

23,856

8,712

Sullivan

26

24,628

Rhode Island

South Dakota

24,780

South Carolina

County

Employee- Dependent,
Only
Family, etc.

Aurora

9,122

24,641

Employee- Dependent,
Only
Family, etc.

Beadle

8,840

23,411

County

Bennett

9,114

24,101

Abbeville

8,099

25,245

Bon Homme

9,122

24,641

Aiken

7,627

21,404

Brookings

8,840

23,411

Allendale

7,955

25,181

Brown

8,840

23,411

Anderson

8,023

22,069

Brule

9,122

24,641

Bamberg

7,564

25,305

Buffalo

9,122

24,641

Barnwell

7,463

24,273

Butte

9,114

24,101

Beaufort

8,126

22,179

Campbell

8,840

23,411

Berkeley

8,717

24,688

Charles Mix

9,122

24,641

Calhoun

7,775

24,882

Clark

8,840

23,411

Charleston

7,808

24,202

Clay

8,877

24,736

Cherokee

7,663

25,466

Codington

8,840

23,411

Chester

8,071

25,855

Corson

9,114

24,101

Chesterfield

7,988

27,470

Custer

9,114

24,101

Clarendon

7,483

24,799

Davison

9,122

24,641

Colleton

8,068

24,118

Day

8,840

23,411

Darlington

8,319

25,996

Deuel

8,840

23,411

Dillon

8,040

24,580

Dewey

9,114

24,101

Dorchester

9,023

25,047

Douglas

9,122

24,641

Edgefield

7,465

25,099

Edmunds

8,840

23,411

Fairfield

7,982

25,211

Fall River

9,114

24,101

Florence

8,165

25,677

Faulk

8,840

23,411

Georgetown

8,100

23,971

Grant

8,840

23,411

Greenville

8,011

24,279

Gregory

9,114

24,101

Greenwood

8,635

25,072

Haakon

9,114

24,101

Hampton

8,305

24,909

Hamlin

8,840

23,411

Horry

7,746

25,456

Hand

9,122

24,641

Jasper

8,592

26,043

Hanson

9,122

24,641

Kershaw

8,349

25,688

Harding

9,114

24,101

Lancaster

8,029

21,741

Hughes

9,122

24,641

Laurens

8,099

23,471

Hutchinson

9,122

24,641

Lee

7,814

24,762

Hyde

9,122

24,641

Lexington

8,215

25,460

Jackson

9,114

24,101

Marion

8,491

25,302

Jerauld

9,122

24,641

Marlboro

8,036

24,970

Jones

9,114

24,101

2024 Average Premium Tables

Kingsbury

8,840

23,411

DeKalb

7,648

16,567

Robertson

7,943

19,360

Lake

8,877

24,736

Dickson

8,003

20,153

Rutherford

7,943

19,360

Lawrence

9,114

24,101

Dyer

7,972

20,883

Scott

7,734

19,674

Lincoln

8,877

24,736

Fayette

8,097

20,071

Sequatchie

7,515

18,619

Lyman

9,114

24,101

Fentress

7,648

16,567

Sevier

7,734

19,674

Marshall

8,840

23,411

Franklin

7,515

18,619

Shelby

8,097

20,071

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
McCook

8,877

24,736

Gibson

7,972

20,883

Smith

7,648

16,567

McPherson

8,840

23,411

Giles

8,003

20,153

Stewart

8,003

20,153

Meade

9,114

24,101

Grainger

7,734

19,674

Sullivan

7,921

20,837

Mellette

9,114

24,101

Greene

7,921

20,837

Sumner

7,943

19,360

Miner

9,122

24,641

Grundy

7,515

18,619

Tipton

8,097

20,071

Minnehaha

8,877

24,736

Hamblen

7,734

19,674

Trousdale

7,943

19,360

Moody

8,877

24,736

Hamilton

7,515

18,619

Unicoi

7,921

20,837

Pennington

9,114

24,101

Hancock

7,921

20,837

Union

7,734

19,674

Perkins

9,114

24,101

Hardeman

7,972

20,883

Van Buren

7,648

16,567

Potter

8,840

23,411

Hardin

7,972

20,883

Warren

7,648

16,567

Roberts

8,840

23,411

Hawkins

7,921

20,837

Washington

7,921

20,837

Sanborn

9,122

24,641

Haywood

8,097

20,071

Wayne

8,003

20,153

Shannon

9,114

24,101

Henderson

7,972

20,883

Weakley

7,972

20,883

Spink

8,840

23,411

Henry

7,972

20,883

White

7,648

16,567

Stanley

9,114

24,101

Hickman

8,003

20,153

Williamson

7,943

19,360

Sully

9,122

24,641

Houston

8,003

20,153

Wilson

7,943

19,360

Todd

9,114

24,101

Humphreys

8,003

20,153

Tripp

9,114

24,101

Jackson

7,648

16,567

Turner

8,877

24,736

Jefferson

7,734

19,674

Union

8,877

24,736

Johnson

7,921

20,837

County

Employee- Dependent,
Only
Family, etc.

Walworth

8,840

23,411

Knox

7,734

19,674

Anderson

8,962

23,071

8,962

23,071

Texas

Yankton

9,122

24,641

Lake

7,972

20,883

Andrews

Ziebach

9,114

24,101

Lauderdale

8,097

20,071

Angelina

8,962

23,071

20,153

Aransas

9,425

26,628

8,947

21,740

Lawrence

Tennessee
County

Employee- Dependent,
Only
Family, etc.

8,003

Lewis

8,003

20,153

Archer

Lincoln

8,003

20,153

Armstrong

10,030

25,166

19,674

Atascosa

8,327

22,010

8,309

24,016

Loudon

7,734

Anderson

7,734

19,674

Macon

7,648

16,567

Austin

Bedford

8,003

20,153

Madison

7,972

20,883

Bailey

8,962

23,071

Benton

7,972

20,883

Marion

7,515

18,619

Bandera

8,327

22,010

Bledsoe

7,515

18,619

Marshall

8,003

20,153

Bastrop

8,000

21,243

Blount

7,734

19,674

Maury

8,003

20,153

Baylor

8,962

23,071

Bradley

7,515

18,619

McMinn

7,515

18,619

Bee

8,962

23,071

Campbell

7,734

19,674

McNairy

7,972

20,883

Bell

9,416

20,865

Cannon

7,648

16,567

Meigs

7,515

18,619

Bexar

8,327

22,010

Carroll

7,972

20,883

Monroe

7,734

19,674

Blanco

8,962

23,071

Carter

7,921

20,837

Montgomery

7,943

19,360

Borden

8,962

23,071

Cheatham

7,943

19,360

20,153

Bosque

8,962

23,071

Chester

7,972

20,883

Morgan

7,734

19,674

Bowie

8,393

22,860

Claiborne

7,734

19,674

Obion

7,972

20,883

Brazoria

8,309

24,016

Clay

7,648

16,567

16,567

Brazos

7,118

20,853

Cocke

7,734

19,674

Perry

8,003

20,153

Brewster

8,962

23,071

Coffee

8,003

20,153

Pickett

7,648

16,567

Briscoe

8,962

23,071

Crockett

7,972

20,883

18,619

Brooks

8,962

23,071

8,962

23,071

Moore

Overton

Polk

8,003

7,648

7,515

Cumberland

7,648

16,567

Putnam

7,648

16,567

Brown

Davidson

7,943

19,360

Rhea

7,515

18,619

Burleson

7,118

20,853

Decatur

7,972

20,883

19,674

Burnet

8,962

23,071

2024 Average Premium Tables

Roane

7,734

27

Caldwell

8,000

21,243

Freestone

8,962

23,071

Kimble

8,962

23,071

Calhoun

8,661

24,764

Frio

8,962

23,071

King

8,962

23,071

Callahan

8,149

21,645

Gaines

8,962

23,071

Kinney

8,962

23,071

Cameron

8,199

25,284

Galveston

8,309

24,016

Kleberg

8,962

23,071

Camp

8,962

23,071

Garza

8,962

23,071

Knox

8,962

23,071

Carson

10,030

25,166

Gillespie

8,962

23,071

Lamar

8,962

23,071

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Cass

8,962

23,071

Glasscock

8,962

23,071

Lamb

8,962

23,071

Castro

8,962

23,071

Goliad

8,661

24,764

Lampasas

9,416

20,865

Chambers

8,309

24,016

Gonzales

8,962

23,071

LaSalle

8,962

23,071

Cherokee

8,962

23,071

Gray

8,962

23,071

Lavaca

8,962

23,071

Childress

8,962

23,071

Grayson

8,602

23,138

Lee

8,962

23,071

Clay

8,947

21,740

Gregg

7,675

23,661

Leon

8,962

23,071

Cochran

8,962

23,071

Grimes

8,962

23,071

Liberty

8,309

24,016

Coke

8,962

23,071

Guadalupe

8,327

22,010

Limestone

8,962

23,071

Coleman

8,962

23,071

Hale

8,962

23,071

Lipscomb

8,962

23,071

Collin

8,920

24,468

Hall

8,962

23,071

Live Oak

8,962

23,071

Collingsworth

8,962

23,071

Hamilton

8,962

23,071

Llano

8,962

23,071

Colorado

8,962

23,071

Hansford

8,962

23,071

Loving

8,962

23,071

Comal

8,327

22,010

Hardeman

8,962

23,071

Lubbock

8,242

22,683

Comanche

8,962

23,071

Hardin

9,444

22,698

Lynn

8,962

23,071

Concho

8,962

23,071

Harris

8,309

24,016

Madison

8,962

23,071

Cooke

8,962

23,071

Harrison

8,962

23,071

Marion

8,962

23,071

Coryell

9,416

20,865

Hartley

8,962

23,071

Martin

8,962

23,071

Cottle

8,962

23,071

Haskell

8,962

23,071

Mason

8,962

23,071

Crane

8,962

23,071

Hays

8,000

21,243

Matagorda

8,962

23,071

Crockett

8,962

23,071

Hemphill

8,962

23,071

Maverick

8,962

23,071

Crosby

8,242

22,683

Henderson

8,962

23,071

McCulloch

8,962

23,071

Culberson

8,962

23,071

Hidalgo

9,094

23,698

McLennan

6,596

19,545

Dallam

8,962

23,071

Hill

8,962

23,071

McMullen

8,962

23,071

Dallas

8,920

24,468

Hockley

8,962

23,071

Medina

8,327

22,010

Dawson

8,962

23,071

Hood

8,962

23,071

Menard

8,962

23,071

Deaf Smith

8,962

23,071

Hopkins

8,962

23,071

Midland

8,633

26,481

Delta

8,920

24,468

Houston

8,962

23,071

Milam

8,962

23,071

Denton

8,920

24,468

Howard

8,962

23,071

Mills

8,962

23,071

DeWitt

8,962

23,071

Hudspeth

8,962

23,071

Mitchell

8,962

23,071

Dickens

8,962

23,071

Hunt

8,920

24,468

Montague

8,962

23,071

Dimmit

8,962

23,071

Hutchinson

8,962

23,071

Montgomery

8,309

24,016

Donley

8,962

23,071

Irion

10,683

26,166

Moore

8,962

23,071

Duval

8,962

23,071

Jack

8,962

23,071

Morris

8,962

23,071

Eastland

8,962

23,071

Jackson

8,962

23,071

Motley

8,962

23,071

Ector

9,303

19,166

Jasper

8,962

23,071

Nacogdoches

8,962

23,071

Edwards

8,962

23,071

Jeff Davis

8,962

23,071

Navarro

8,962

23,071

El Paso

7,581

17,606

Jefferson

9,444

22,698

Newton

8,962

23,071

Ellis

8,920

24,468

Jim Hogg

8,962

23,071

Nolan

8,962

23,071

Erath

8,962

23,071

Jim Wells

8,962

23,071

Nueces

9,425

26,628

Falls

8,962

23,071

Johnson

8,920

24,468

Ochiltree

8,962

23,071

Fannin

8,962

23,071

Jones

8,149

21,645

Oldham

8,962

23,071

Fayette

8,962

23,071

Karnes

8,962

23,071

Orange

9,444

22,698

Fisher

8,962

23,071

Kaufman

8,920

24,468

Palo Pinto

8,962

23,071

Floyd

8,962

23,071

Kendall

8,327

22,010

Panola

8,962

23,071

Foard

8,962

23,071

Kenedy

8,962

23,071

Parker

8,920

24,468

Fort Bend

8,309

24,016

Kent

8,962

23,071

Parmer

8,962

23,071

Franklin

8,962

23,071

Kerr

8,962

23,071

Pecos

8,962

23,071

28

2024 Average Premium Tables

Virginia

Polk

8,962

23,071

Webb

9,163

24,168

Potter

10,030

25,166

Wharton

8,962

23,071

Presidio

8,962

23,071

Wheeler

8,962

23,071

County

Employee- Dependent,
Only
Family, etc.

Rains

8,962

23,071

Wichita

8,947

21,740

Accomack

8,416

21,812

Randall

10,030

25,166

Wilbarger

8,962

23,071

Albemarle

8,974

21,460

Reagan

8,962

23,071

Willacy

8,962

23,071

Alexandria City

8,866

23,327

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Real

8,962

23,071

Williamson

8,000

21,243

Alleghany

8,416

21,812

Red River

8,962

23,071

Wilson

8,327

22,010

Amelia

8,589

22,408

Reeves

8,962

23,071

Winkler

8,962

23,071

Amherst

7,345

21,481

7,345

21,481

Refugio

8,962

23,071

Wise

8,920

24,468

Appomattox

Roberts

8,962

23,071

Wood

8,962

23,071

Arlington

8,866

23,327

Robertson

7,118

20,853

Yoakum

8,962

23,071

Augusta

8,416

21,812

8,416

21,812

Rockwall

8,920

24,468

Young

8,962

23,071

Bath

Runnels

8,962

23,071

Zapata

8,962

23,071

Bedford

7,345

21,481

Rusk

7,675

23,661

Zavala

8,962

23,071

Bedford City

7,345

21,481

Bland

8,416

21,812

Botetourt

9,404

23,034

8,911

22,177

Sabine

8,962

23,071

San Augustine

8,962

23,071

San Jacinto

8,309

24,016

Utah

Employee- Dependent,
Only
Family, etc.

Bristol City

San Patricio

9,425

26,628

County

Brunswick

8,416

21,812

San Saba

8,962

23,071

Beaver

7,720

23,521

Buchanan

8,416

21,812

Schleicher

8,962

23,071

Box Elder

7,304

22,242

Buckingham

8,416

21,812

8,509

27,990

Scurry

8,962

23,071

Cache

Buena Vista City

8,416

21,812

Shackelford

8,962

23,071

Carbon

7,720

23,521

Campbell

7,345

21,481

23,071

Daggett

7,720

23,521

Caroline

8,589

22,408

8,048

22,868

Shelby

8,962

Sherman

8,962

23,071

Davis

Carroll

8,416

21,812

Smith

8,824

26,008

Duchesne

7,720

23,521

Charles City

8,589

22,408

23,071

Emery

7,720

23,521

Charlotte

8,416

21,812

7,720

23,521

Somervell

8,962

Starr

8,962

23,071

Garfield

Charlottesville City

8,974

21,460

Stephens

8,962

23,071

Grand

7,720

23,521

Chesapeake City

8,433

21,119

23,071

Iron

9,091

22,710

Chesterfield

8,589

22,408

7,720

23,521

Sterling

8,962

Stonewall

8,962

23,071

Juab

Clarke

8,866

23,327

Sutton

8,962

23,071

Kane

7,720

23,521

Colonial Heights City

8,589

22,408

23,071

Millard

7,720

23,521

Covington City

8,416

21,812

7,304

22,242

Swisher

8,962

Tarrant

8,920

24,468

Morgan

Craig

9,404

23,034

Taylor

8,149

21,645

Piute

7,720

23,521

Culpeper

8,416

21,812

8,509

27,990

Terrell

8,962

23,071

Rich

Cumberland

8,589

22,408

Terry

8,962

23,071

Salt Lake

8,048

22,868

Danville City

8,956

21,176

Throckmorton

8,962

23,071

San Juan

7,720

23,521

Dickenson

8,416

21,812

7,720

23,521

Titus

8,962

23,071

Sanpete

Dinwiddie

8,589

22,408

Tom Green

10,683

26,166

Sevier

7,720

23,521

Emporia City

8,416

21,812

Travis

8,000

21,243

Summit

8,048

22,868

Essex

8,416

21,812

8,048

22,868

Trinity

8,962

23,071

Tooele

Fairfax

8,866

23,327

Tyler

8,962

23,071

Uintah

7,720

23,521

Fairfax City

8,866

23,327

23,661

Utah

7,741

22,767

Falls Church City

8,866

23,327

8,048

22,868

Upshur

7,675

Upton

8,962

23,071

Wasatch

Fauquier

8,866

23,327

Uvalde

8,962

23,071

Washington

9,091

22,710

Floyd

8,416

21,812

23,071

Wayne

7,720

23,521

Fluvanna

8,974

21,460

Weber

7,304

22,242

Franklin

9,404

23,034

Franklin City

8,416

21,812

Frederick

8,473

22,447

Fredericksburg City

8,866

23,327

Galax City

8,416

21,812

Giles

7,196

22,599

Val Verde

8,962

Van Zandt

8,962

23,071

Victoria

8,661

24,764

Walker

8,962

23,071

Waller

8,309

24,016

Ward

8,962

23,071

Washington

8,962

23,071

2024 Average Premium Tables

Vermont
County

Employee- Dependent,
Only
Family, etc.

All

8,933

24,399

29

Gloucester

8,433

21,119

Radford City

7,196

22,599

Kittitas

8,275

22,940

Goochland

8,589

22,408

Rappahannock

8,416

21,812

Klickitat

8,082

22,147

Grayson

8,416

21,812

Richmond

8,416

21,812

Lewis

7,967

20,942

Greene

8,974

21,460

Richmond City

8,589

22,408

Lincoln

8,152

21,592

Greensville

8,416

21,812

Roanoke

9,404

23,034

Mason

7,967

20,942

Halifax

8,416

21,812

Roanoke City

9,404

23,034

Okanogan

8,275

22,940

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Hampton City

8,433

21,119

Rockbridge

8,416

21,812

Pacific

7,967

20,942

Hanover

8,589

22,408

Rockingham

7,634

21,742

Pend Oreille

8,152

21,592

Harrisonburg City

7,634

21,742

Russell

8,416

21,812

Pierce

7,967

20,942

Henrico

8,589

22,408

Salem City

9,404

23,034

San Juan

7,967

20,942

Henry

8,416

21,812

Scott

8,911

22,177

Skagit

7,967

20,942

Highland

8,416

21,812

Shenandoah

8,416

21,812

Skamania

8,082

22,147

Hopewell City

8,589

22,408

Smyth

8,416

21,812

Snohomish

7,967

20,942

Isle of Wight

8,433

21,119

Southampton

8,416

21,812

Spokane

8,152

21,592

James City

8,433

21,119

Spotsylvania

8,866

23,327

Stevens

8,152

21,592

King and Queen

8,589

22,408

Stafford

8,866

23,327

Thurston

7,967

20,942

King George

8,416

21,812

Staunton City

8,416

21,812

Wahkiakum

7,967

20,942

King William

8,589

22,408

Suffolk City

8,433

21,119

Walla Walla

8,275

22,940

Lancaster

8,416

21,812

Surry

8,433

21,119

Whatcom

7,967

20,942

Lee

8,416

21,812

Sussex

8,589

22,408

Whitman

8,275

22,940

Lexington City

8,416

21,812

Tazewell

8,416

21,812

Yakima

8,275

22,940

Loudoun

8,866

23,327

Virginia Beach City

8,433

21,119

Louisa

8,589

22,408

Warren

8,866

23,327

Lunenburg

8,416

21,812

Washington

8,911

22,177

Lynchburg City

7,345

21,481

Waynesboro City

8,416

21,812

County

Employee- Dependent,
Only
Family, etc.

Madison

8,416

21,812

Westmoreland

8,416

21,812

Barbour

9,864

27,010

21,119

Berkeley

9,757

24,140

9,302

26,140

Manassas City

8,866

23,327

Williamsburg City

8,433

West Virginia

Manassas Park City

8,866

23,327

Winchester City

8,473

22,447

Boone

Martinsville City

8,416

21,812

Wise

8,416

21,812

Braxton

9,567

25,392

21,812

Brooke

9,722

27,737

21,119

Cabell

9,980

25,542

Calhoun

9,567

25,392

Clay

9,567

25,392

Doddridge

10,055

25,014

Mathews

8,433

21,119

Mecklenburg

8,416

21,812

Middlesex

8,416

21,812

Montgomery

7,196

22,599

Wythe
York

8,416
8,433

Washington

Nelson

8,974

21,460

New Kent

8,589

22,408

County

Employee- Dependent,
Only
Family, etc.

Fayette

9,567

25,392

8,275

22,940

Gilmer

10,055

25,014

Newport News City

8,433

21,119

Adams

Norfolk City

8,433

21,119

Asotin

8,275

22,940

Grant

8,996

24,907

Northampton

8,416

21,812

Benton

8,275

22,940

Greenbrier

9,567

25,392

8,275

22,940

Hampshire

8,996

24,907

Northumberland

8,416

21,812

Chelan

Norton City

8,416

21,812

Clallam

7,967

20,942

Hancock

9,722

27,737

Nottoway

8,416

21,812

Clark

8,082

22,147

Hardy

8,996

24,907

8,275

22,940

Harrison

9,864

27,010

Orange

8,416

21,812

Columbia

Page

8,416

21,812

Cowlitz

7,967

20,942

Jackson

10,257

28,051

21,812

Douglas

8,275

22,940

Jefferson

9,757

24,140

8,152

21,592

Kanawha

11,133

28,870

Patrick

8,416

Petersburg City

8,589

22,408

Ferry

Pittsylvania

8,956

21,176

Franklin

8,275

22,940

Lewis

10,055

25,014

21,119

Garfield

8,275

22,940

Lincoln

9,302

26,140

8,275

22,940

Logan

9,302

26,140

Poquoson

8,433

Portsmouth City

8,433

21,119

Grant

Powhatan

8,589

22,408

Grays Harbor

7,967

20,942

Marion

10,055

25,014

21,812

Island

7,967

20,942

Marshall

9,722

27,737

7,967

20,942

Mason

9,980

25,542

Prince Edward

8,416

Prince George

8,589

22,408

Jefferson

Prince William

8,866

23,327

King

7,911

22,808

McDowell

9,302

26,140

22,599

Kitsap

7,967

20,942

Mercer

10,309

25,218

7,196

Pulaski

30

2024 Average Premium Tables

Mineral

8,996

24,907

Dodge

7,800

23,179

Sawyer

9,003

25,622

Mingo

9,302

26,140

Door

7,748

22,230

Shawano

7,748

22,230

Monongalia

10,055

25,014

Douglas

9,003

25,622

Sheboygan

7,800

23,179

Monroe

10,309

25,218

Dunn

8,268

24,992

St. Croix

9,799

25,884

Morgan

8,996

24,907

Eau Claire

8,268

24,992

Taylor

8,574

23,234

Nicholas

9,567

25,392

Florence

7,143

21,458

Trempealeau

8,221

22,747

TREASURY/IRS
AND OMB USE
ONLY DRAFT
November 21, 2024
Ohio

9,722

27,737

Fond du Lac

7,800

23,179

Vernon

8,133

23,995

Pendleton

8,996

24,907

Forest

7,143

21,458

Vilas

7,143

21,458

Pleasants

10,257

28,051

Grant

8,133

23,995

Walworth

8,347

26,145

Pocahontas

9,864

27,010

Green

8,347

26,145

Washburn

9,003

25,622

Preston

9,864

27,010

Green Lake

9,071

29,125

Washington

8,177

24,978

Putnam

9,980

25,542

Iowa

8,133

23,995

Waukesha

8,177

24,978

Raleigh

10,309

25,218

Iron

7,143

21,458

Waupaca

7,800

23,179

Randolph

9,864

27,010

Jackson

8,221

22,747

Waushara

7,800

23,179

Ritchie

10,257

28,051

Jefferson

8,347

26,145

Winnebago

7,800

23,179

Roane

9,567

25,392

Juneau

9,071

29,125

Wood

9,019

25,476

Summers

10,309

25,218

Kenosha

9,382

26,795

Taylor

9,864

27,010

Kewaunee

7,748

22,230

Tucker

9,864

27,010

La Crosse

8,221

22,747

Tyler

10,257

28,051

Lafayette

8,133

23,995

County

Employee- Dependent,
Only
Family, etc.

Upshur

9,864

27,010

Langlade

7,143

21,458

Albany

9,933

26,086

9,933

26,086

Wyoming

Wayne

9,980

25,542

Lincoln

9,019

25,476

Big Horn

Webster

9,864

27,010

Manitowoc

7,748

22,230

Campbell

9,933

26,086

25,476

Carbon

9,933

26,086

9,933

26,086

Wetzel

10,055

25,014

Marathon

9,019

Wirt

10,257

28,051

Marinette

7,748

22,230

Converse

Wood

10,257

28,051

Marquette

9,071

29,125

Crook

9,933

26,086

22,230

Fremont

9,933

26,086

9,933

26,086

Wyoming

9,302

26,140

Wisconsin

Menomonee

7,748

Milwaukee

7,946

26,745

Goshen

Monroe

8,221

22,747

Hot Springs

9,933

26,086

22,230

Johnson

9,933

26,086

9,815

25,076

Employee- Dependent,
Only
Family, etc.

Oconto

County

Oneida

7,143

21,458

Laramie

Adams

9,071

29,125

Outagamie

7,800

23,179

Lincoln

9,933

26,086

Ashland

9,003

25,622

24,978

Natrona

10,359

27,595

9,933

26,086

Ozaukee

7,748

8,177

Barron

8,574

23,234

Pepin

8,268

24,992

Niobrara

Bayfield

9,003

25,622

Pierce

9,799

25,884

Park

9,933

26,086

Brown

7,748

22,230

Polk

9,799

25,884

Platte

9,933

26,086

Buffalo

8,221

22,747

Portage

9,019

25,476

Sheridan

9,933

26,086

Burnett

9,003

25,622

Price

8,574

23,234

Sublette

9,933

26,086

Calumet

7,800

23,179

Racine

9,382

26,795

Sweetwater

9,933

26,086

Chippewa

8,268

24,992

Richland

9,071

29,125

Teton

9,933

26,086

Clark

8,574

23,234

Rock

8,347

26,145

Uinta

9,933

26,086

Columbia

8,347

26,145

Rusk

8,574

23,234

Washakie

9,933

26,086

Crawford

8,133

23,995

Sauk

9,071

29,125

Weston

9,933

26,086

Dane

7,594

25,699

2024 Average Premium Tables

31