Health Insurance Marketplace Tax Forms Overview Consumer ... · Form 8962 – Premium Tax Credits...

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Health Insurance Marketplace

Tax Forms Overview

Consumer Direct Broker Training

January 2015

This document was created for informational purposes only and is not intended to provide legal and/or accounting advice and

should not be relied upon as such. Individuals should consult with their own accountants and/or legal counsel if they have any

questions regarding the financial and legal impacts of the Affordable Care Act.

PROPRIETARY AND CONFIDENTIAL


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Agenda

New Tax Forms Overview (Forms 8962, 8965, 1095A, 1095B & 1095C)

What CareFirst is Doing

Questions


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New Tax Forms as a Result of ACA

ACA members filling out Federal taxes for 2014 will be introduced to new

forms that may be used to prepare their return:

1. Form 8962 -- Premium Tax Credit & Instructions

2. Form 8965 -- Health Coverage Exemptions & Instructions

3. Form 1095A -- Health Insurance Marketplace Statement

NOTE: Forms 1095B and 1095C will be required in 2016 for 2015 tax year.

The following pages provide an overview of the new forms ONLY*.

Questions related to filling out forms 8962 and 8965 need to be directed to

the 2014 member’s tax advisor or to the IRS.

Questions related to errors on the 1095A forms can be reported by the

member to the Exchange in which they where in enrolled in 2014.


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Form 8962 – Premium Tax Credits for 2014

When Exchange members applied for insurance in 2014, they provided

an estimate of 2014 household income and other information.

This information was used to determine the premium tax credit for which

they were eligible in 2014.

The subscriber may have chosen to use "advance payments" of this

premium tax credit to lower what they paid for monthly insurance bills.

When they file the federal income tax return for 2014, they will find out

the final premium tax credit for which they were eligible based on actual

2014 income.

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When subscribers file 2014 Federal taxes, they will complete the new Form 8962 –

Premium Tax Credit.

Form 8962 – What the Form Determines

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If the ACA subscriber… Then, the ACA subscriber…

…took LESS advance payments of

the premium tax credit than the actual

credit for which they are eligible

…will get the

return.

difference as a credit on their tax

…did NOT TAKE ANY advance

payments of the premium tax credit

during 2014

…may find out that they qualify for a credit. If

they can claim it when they file taxes.

so,

…took MORE advance payments of

the premium tax credit than the actual

credit for which they are eligible

…may need to pay some or all of the difference to the

IRS with their Federal tax return.

NOTE: In most cases, but not all, the Internal

Revenue Service (IRS) limits how much they will have

to pay back if they received too much in tax credits.

Household Income as % of

Federal Poverty Level

Repayment Limit

for an individual

Repayment Limit

for a Family

Under 200% $300 $600

200% - under 300% $750 $1,500

300% - under 400% $1,250 $2,500

400% and above Full amount Full amount


2014 Fees for No or Limited Coverage

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If someone didn’t have health coverage for 3 months or more in 2014, they

may have to pay a fee when they file their 2014 Federal income tax return.

The penalty is the lesser of:

– Sum of monthly penalty amounts for each individual in the family, which

is the greater of:

• The flat dollar amount, which for 2014 is the lesser of:

– 3 x $95

– $95 x each adult PLUS $47.50 x each individual in family <18

• The excess income amount, which for 2014 is:

– The taxpayers household income over the taxpayers applicable

filing threshold TIMES 1%.

– Sum of the monthly national average bronze premiums for the family

members without coverage.


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Form 8965 – Health Care Exemptions

Some taxpayers are exempt from the coverage requirement of the

individual shared responsibility provision and do not have to make a

shared responsibility payment when filing a Federal income tax return.

Coverage exemptions are available for individuals specifically described

as having a religious, economic, or other justification for not having

minimum essential coverage.

They don’t have to pay the fee if they can claim a health insurance

exemption.


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Form 8965 – Health Care Exemptions continued

To claim an exemption with their tax return, they can fill out the new Form

8965 - Health Coverage Exemptions.

They may be able to get an exemption because of a special situation

such as:

– Not having any affordable health insurance plans available to them

– Having only a short gap in coverage

– Being eligible for services through the Indian Health Service

Example: if they purchased coverage through Maryland Health

Connection during the initial open enrollment period (October 1, 2013

through March 31, 2014) and coverage started by May 2014, they may

qualify for an exemption for the months before their coverage started.

They can claim some exemptions when they complete the Federal tax

return. Other exemptions can be obtained by submitting an application to

the Federal Department of Health and Human Services (HHS).


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Form 1095 – Health Coverage Statements

A 1095 Health Coverage Statement provides an individual, their spouse, or

dependent(s) enrolled in health insurance proof of coverage and subsidy information.

There are three types of 1095 Health Coverage Statements, 1095A, 1095B and

1095C.

The 1095A Form is received from the Health Insurance Marketplace and distribution

is required beginning in 2015 for 2014 tax year.

– The form is sent to the policyholder, not each individual member on the policy.

– If an individual, their spouse, or dependent(s) enrolled in health insurance through

the Health Insurance Marketplace (Exchanges), they should receive a 1095A

Form.

– The policyholder may receive a 1095A Form for each qualifying policy.

– The form has space for up to 5 separate plans.

• As long as the HIX ID remained the same (and the policyholder enrolled in

less than 6 plans during the year), they should receive a single 1095A.

– It is a requirement in 2015 that the Exchange send 1095A forms to any members

who maintained coverage through the HIX during the 2014 plan year.


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1095A – Form Components

Form 1095A has three parts:

– Part I provides basic information about subscriber the their family, as

well as health insurance start and end dates.

– Part II provides information about each member of the “coverage

household” – those members of the family also covered under the

same policy.

– Part III provides information for every month of the year for three

items:

1. the monthly premium amount of the health plan selected,

2. the premium amount of the second lowest cost Silver Plan

available, also known as the benchmark premium, and

3. the advance payments of the premium tax credit paid on the

subscriber or a household member’s behalf to the issuer of the

policy.

• The premium amount of the second lowest cost silver plan is

provided because the law requires that this plan’s premium

amount is used to calculate the premium tax credit.


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The 1095B Form is received from Health Insurance Carrier

(CareFirst) and distribution is required in 2016 for 2015 tax year.

– If an individual, their spouse, or dependent(s) enrolled in health

insurance directly through an insurance carrier, or are part of a self-

insured group health plan under a plan sponsor, they will receive a

1095B form for each qualifying policy from that policy carrier.

– Since it is not a requirement until 2016, CareFirst is not

furnishing these forms to members until that time.

– Examples of members that will receive this form are those that were

enrolled under a:

• Small business health options program

• Employer-sponsored coverage

• Government-sponsored program

• Individual market insurance (Under 65 only)

• Multi-employer plan

• Miscellaneous minimum essential coverage


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The 1095C Form is received from Large Employer Group (CareFirst

to employees) and distribution is required in 2016 for 2015 tax year.

– If an individual, their spouse, or dependent(s) enrolled under a self-

insured employer-sponsored plan then they will receive a 1095C

form for each qualifying policy from their employer.

– The only members that will receive these forms from CareFirst are

employees of CareFirst. CareFirst will not be sending these forms in

January 2015, since there is not a requirement to do so until 2016.


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Other Coverage Note

If a person had health coverage from another source, like a job, Medicare,

Medicaid or a plan bought outside an Exchange, they can report this by

checking a box on the Federal income tax form.

These people will not get a Form 1095-A.

If a person had any kind of minimum essential coverage for all of 2014, then

he or she won’t have to pay the “penalty” or fee that people without coverage

might have to pay. They won’t need an exemption from the penalty. He or

she is considered “covered” under the Affordable Care Act.

Types of minimum essential coverage

– Any job-based plan, including retiree plans and COBRA coverage

– Medicare

– Medicaid

– Maryland Children’s Health Program (MCHP)

– Most individual health plans you bought outside an exchange, including

"grandfathered" plans. There are some exceptions.

– If you’re under 26, coverage under a parent’s plan


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2015 and the 1095A --

What is Happening and When?

The Healthcare Exchanges are currently mailing our members a

completed Form 1095A:

– FFM Mailings began 1/20

– MD and DC mailings planned for 1/26- 1/31

– Must be postmarked by 2/2/15

The form will give them important tax information needed to correctly fill

out in their federal income taxes.

In addition to Form 1095A, they will also receive a cover letter and Form

1095A instructions.


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2015 and the 1095A –

Form Errors and Tax Questions

Members with questions related to the 1095A form need to contact the

Exchange; this includes possible issues or concerns with amounts on the

form.

Members looking for more specific help with using the form to file taxes

can contact the IRS.

– Many people who signed up for Marketplace coverage can get free

assistance with their taxes.

– This may include free access to tax software programs, or free in-

person assistance.

– Visit IRS.gov/freefile or IRS.gov/VITA for more information.

– For additional tax information, tools, and videos visit IRS.gov.


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2015 and the 1095A –


Although not mandated to mail 1095B Forms until January 2016 for 2015

coverage, CareFirst is preparing to handle calls from both On and Off

Exchange members looking for Proof of Coverage for 2014.

– Members looking for Proof of Coverage from CareFirst can obtain a

copy of a Plan Verification letter for their personal files.

– Members can make this request by calling the telephone number on

the back of their ID card.


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2015 and the 1095A –


NEW Plan Verification letters have been approved and will be available

for members inquiring about proof of coverage.

– Two versions of the letter have been developed

• Off Exchange/On Exchange (no APTC) and Grandfathered

• On Exchange with APTC

– Letter summarizes time of coverage; monthly premium amounts

paid; subsidies (if applicable) and a list of covered members under

the plan.

Members can also access eBill or My Account to download copies of

their 2014 invoices

– eBill members’ history may be limited to when they enrolled in the

payment system

– In the near future, My Account -- My Documents section will show

invoices


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What Can a Broker Do?

Brokers can call their dedicated support line if they want to assist a

member in obtaining plan verification letter

Broker Customer Service representatives at CareFirst will fill out Plan

Verification letter and send directly to the member.


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This document was created for informational purposes only and is not intended to provide legal and/or accounting advice and

should not be relied upon as such. Individuals should consult with their own accountants and/or legal counsel if they have any

questions regarding the financial and legal impacts of the Affordable Care Act.

Health Insurance Marketplace Tax Forms Overview Consumer ... · Form 8962 – Premium Tax Credits...

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