Minnesota Long-Term Care Insurance Credit

Long-Term Care Insurance Credit
2023 M1LTI, Long-Term Care Insurance Credit
2023 Schedule M1LTI, Long-Term Care Insurance Credit
Your First Name and Initial

*231811*

Last Name

Social Security Number

If	you	(or	your	spouse,	if	filing	a	joint	return)	paid	premiums	in	2023	for	a	qualified	long-term	care	insurance	policy,	complete	this	schedule	
to	determine	the	amount	of	the	credit	you	may	claim	when	filing	Form	M1,	Individual Income Tax .
To	qualify	for	this	credit,	both	of	these	must	apply	to	your	long-term	care	insurance	policy:
• It	qualifies	as	an	itemized	deduction	on	Schedule	M1SA,	Minnesota Itemized Deductions,	regardless	of	income	limitations
• It	has	a	lifetime	long-term	care	benefit	limit	of	$100,000	or	more
There	are	no	separate	instructions	for	Schedule	M1LTI.
Policy Information (only one qualifying policy per person):
Name of Insured

Insurance Company

Provide	the	information	in	the	appropriate	column	for	each	insured	person.	If	you	are	
filing	a	joint	return	and	both	you	and	your	spouse	are	covered	by	one	policy,	use	half	
of	the	premiums	in	column	A	and	half	in	column	B	(below).

Policy Number

Round amounts to the nearest whole dollar.

A —You

B —Spouse

1 Premiums paid in 2023 for the qualifying long-term care insurance policy  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 1
Did	you	file	Schedule	M1SA?
• If no,	skip	lines	2,	3,	and	4,	and	enter	amounts	from	line	1	on	line	5.
• If yes,	continue	with	line	2.
2	 Amount	of	premiums	paid	on	this	policy	that	are	included	on	line	1	of	Schedule	M1SA	  .  .  .  .  .  .  . 2
3 Amount	from	line	4	of	Schedule	M1SA	(If you and your spouse are claiming
premiums paid, enter half of this amount in each column) .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 3
4	 Amount	from	line	2	or	line	3,	whichever is less  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 4
5	 Subtract	line	4	from	line	1	  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 5
6 Multiply	line	5	by	25%	(.25)	 .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 6
7	 The	maximum	credit	is	$100	per	person	  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 7

100

8 Amount	from	line	6	or	line	7,	whichever is less  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 8
9	 Add	line	8,	columns	A	and	B	  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 9
Full-year residents: Also	enter	this	amount	on	line	2	of	Schedule	M1C.

Part-year Residents and Nonresidents

10	 Multiply	line	9	by	line	30	of	Schedule	M1NR.	
Enter	the	result	here	and	on	line	2	of	Schedule	M1C	  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 1 0

You must include this schedule with your Form M1.

9995

100