California requires most residents and their dependents to maintain Minimum Essential Coverage (MEC) throughout the year or qualify for a coverage exemption. Form 3853 is used to report health coverage, claim exemptions, and calculate any California Individual Shared Responsibility Penalty.
Program Navigation
Go to either:
- State > California Return > Health Care Shared Responsibility Tax (Form 3853
- State > CA Return > Health Care Shared Responsibility Tax (Form 3853)
Who Needs to Complete Form 3853?
You generally need to complete Form 3853 if:
- You, your spouse, or a dependent did not have health coverage for the entire year.
- You need to claim a California health coverage exemption.
- You received an Exemption Certificate Number (ECN) from Covered California.
- You or a member of your household did not have health coverage for one or more months and may owe a California Shared Responsibility Penalty.
You generally do not need Form 3853 if everyone in your household had Minimum Essential Coverage for the entire year.
Step 1 - Did Everyone Have Full-Year Health Coverage?
Question:
Did the Taxpayer have Full Year Minimum Essential Health Care Coverage for all members of the household?
Answer Yes if:
- The taxpayer,
- Spouse (if applicable), and
- All dependents
had qualifying health insurance coverage for every month of the year.
Note: If you answer Yes, Form 3853 will be removed and no additional entries are generally required.
Answer No if:
Anyone in the household:
- Did not have coverage for one or more months, or
- Needs to claim a coverage exemption.
Step 2 - Marketplace-Granted Coverage Exemptions (Part I)
Some exemptions must be approved through Covered California and require an Exemption Certificate Number (ECN).
Examples include:
- General Hardship
- Members of Certain Religious Sects
- Coverage Considered Unaffordable Based on Projected Income
Step 3 - Coverage Exemptions (Part III)
Complete this section if someone did not have coverage for all or part of the year but qualifies for a California exemption.
Household Members Claimed on the Federal Return
This section includes:
- Taxpayer
- Spouse
- Dependents
How to Complete
1. Select the Individual
Choose the taxpayer, spouse, or dependent from the drop-down list.
2. Determine Whether the Exemption Applies for the Entire Year
If the same exemption applies for all 12 months:
- Select the exemption in the Full Year field.
- Do not complete the monthly fields.
3. Complete Monthly Exemptions if Necessary
If the exemption applies for only certain months:
- Leave the Full Year field blank.
- Select the appropriate exemption code for each month the exemption applies.
Common Exemption Options
- Coverage is Considered Unaffordable
- Aggregate Self-Only Coverage Considered Unaffordable
- Short Coverage Gap
- Citizens Living Abroad and Certain Noncitizens
- Nonresident or Part-Year Resident
- Members of a Health Care Sharing Ministry
- Members of Federally Recognized Indian Tribes
- Incarceration
- Member of Tax Household Born or Adopted During the Year
- Member of Tax Household Died During the Year
- Certain Medi-Cal Programs That Are Not Minimum Essential Coverage
- Health Coverage may be selected for months the individual had Minimum Essential Coverage rather than an exemption.
- No Exemption Code
Important: If you select an exemption that requires an ECN, enter the ECN in the Shared Responsibility Payment section.
Important: After entering an exemption code in Part III, go to the Shared Responsibility Payment section and indicate the months that were covered by the exemption.
Household Members Not Claimed on the Federal Return
How to Complete
Enter:
- First Name
- Middle Initial (if applicable)
- Last Name
- Social Security Number
Then:
- Select a Full Year exemption if the same exemption applies all year, or
- Enter the applicable exemption for each month.
Step 4 - Shared Responsibility Payment
Use this section to report health coverage months, exemption information, and affordability information used to determine whether a California Shared Responsibility Penalty applies.
Did You Elect Not to Claim a Dependent You Could Have Claimed?
Answer:
- Yes if you chose not to claim someone who qualified as your dependent.
- No if all eligible dependents were claimed.
Individuals Claimed on the Federal Return
This section includes:
- Taxpayer
- Spouse
- Dependents
How to Complete
1. Select the Individual
Choose the appropriate person from the drop-down list.
2. Enter Exemption Certificate Numbers (ECNs)
If Covered California issued an exemption certificate, enter the ECN provided.
3. Indicate Coverage or Exemption Months
For each month:
- Select Yes if the individual had health coverage or qualified for an exemption.
- Select No if neither applied.
4. Enter Annualized Required Contribution Amounts
Only complete these entries if you are using the Coverage Affordability Worksheet.
Individuals Not Claimed on the Federal Return
Enter:
- First Name
- Middle Initial
- Last Name
- SSN
Then:
- Enter any ECNs received from Covered California.
- Indicate the months the individual had health coverage.
- Enter affordability amounts if applicable.
Additional Household Information
The Shared Responsibility Payment section may also request:
- Household Income
- Dependents' Adjusted Gross Income
- Dependents' Tax-Exempt Interest
- Dependents' Form 2555 Amounts
- Dependents' Nontaxable Social Security Benefits
- Premium Amount Paid Through Salary Reduction Arrangement
Step 5 - Coverage Affordability Worksheet
Use this worksheet only if you need to determine whether health insurance was considered affordable.
Enter:
Monthly Premium for the Lowest Cost Bronze Plan
Enter the monthly premium for the lowest-cost Bronze plan available for the applicable individual.
Monthly Premium for the Second Lowest Cost Silver Plan
Enter the monthly premium for the second-lowest-cost Silver plan available for the applicable individual.
Important
Any Annualized Required Contribution Amounts calculated using this worksheet must be entered in the Shared Responsibility Payment section for the applicable individual.