Line 3 Limitation Chart and Worksheet Line 3 Limitation Chart and Worksheet Summary: This flowchart is used to determine the amount of deductible limitation for each month. After calculating the amount for each month in 2024, enter the amount on the line for that month in the worksheet, add them all together and divide by 12 to receive the limitation amount to be entered on Form 8853, line 3. Start This is the start of the flowchart. Decision (1) Were you enrolled in Medicare for the month?IF Yes Continue To Process (a)IF No Continue To Decision (2) Process (a) Enter 0 on the line below for the month.Continue To End Decision (2) Were you an eligible individual (see page 1 of the instructions) on the first day of the month?IF Yes Continue To Decision (3)IF No Continue To Process (a) Decision (3) What type of coverage did your High Deductible Health Plan provide on the first day of the month? If you had more than one High Deductible Health Plan, see instructions on page 3.IF Self-only coverage Continue To Process (b)IF Family coverage Continue To Process (d) Process (b) Enter annual deductible (must be at least $2,800 but not more than $4,150)Continue To Process (c) Process (c) Enter 65% (0.65) of the annual deductible on the line below for the month.Continue To End Process (d) Enter annual deductible (must be at least $5,550 but not more than $8,350)Continue To Process (e) Process (e) Enter 75% (0.75) of the annual deductible on the line below for the month. If married filing separately, see "Married filing separately".Continue To End End This is the ending of the flowchart.
