Category Archives: Tax Form 1095-A

Everybody’s Happy With Obamacare In California

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On May 13, 2015, Jamie emailed me late at night to ask what it would cost to change from a Covered California PPO plan and re-enroll directly with the same insurance company, off the exchange. [Check out our latest article for students leaving school]

I asked, “Jamie, it’s the same total premium, either way, but don’t you want to keep your $199 per month subsidy?  “…because you can’t have a subsidy unless you go through Covered California.”

Jamie responded, “My CPA told me we have to re-file my tax return and pay back hundreds of dollars because Covered California sent me a revised 1095-A form on May 1st.”  I offered to help and Jamie completed the Insurance Help Form for 1095-A Questions.

“No problem, I thought.”  I phoned Covered California at the special agent line and was placed in line as number 34.  15 minutes later, Dale answered the phone:  “Dale, your customer received no 1095-A form and was unable to file taxes in early January.  We followed your instructions and filed a 1095-A-Dispute-Form.  As promised, after 60 days (March 31st to be exact), we received the 1095-A form and all the numbers looked correct.”  So Jamie filed her taxes.

“Dale, guess what, on May 1st, CoveredCA issued a “corrected 1095-A form” that is unfortunately incorrect.  In fact, there are zeros in all the boxes.”  The customer is upset, naturally, and is faced with additional tax preparation fees for the amended return.  Dale’s solution:  We need to file a new 1095-A-Dispute-Form and wait two more months.

Being a diligent agent, I pushed back and asked him to look in the system log to see what may have generated a new 1095-A form.  Dale responded with “Medi-Cal has this case under review.”  I asked, “what does that mean? Today is May 14th and the application was enrolled and paid for last December…is there insurance or not?”

Dale suggested he transfer me to another unit in Customer Service who may help further.  So he did…I went back to the end of the line and waited 15 minutes before Valerie picked up.  In the meantime, I phoned the insurance company directly and asked if coverage was in-force.  They said “yes, but Covered California has not yet sent the eligibility information to us…but sometimes they don’t send it if the case renews with no changes.”

I confronted Valerie with this information and she very nicely responded, “our records show the customer has not yet paid the first month (January) premium and that is why we have not sent over the enrollment information.”  (I quickly checked the insurance company’s website and it shows all premiums paid to May 1st).

Valerie was not sure how this could be happening, but also noted Medi-Cal has the case under review since March.  I laughed, “if Medi-Cal has been reviewing this for 1.5 months, then it is going to take them 15 years to get through this season’s new enrollments.”  Valerie responded, “the insured is suppose to contact the local county to help the case worker finish their review.”  “Really, and when did you tell the customer this?”

Valerie said there was an “eligibility determination” in late April and a letter was sent out.  I looked it up on their website and she was right.  It reads,

“Congratulations! You qualify for health insurance through Covered California. You also qualify for up to $199 per month in premium assistance to help pay for your health insurance coverage”

I said (nicely) to Valerie, “let me summarize this.”

  • Covered California never provided a 1095-A form until the customer filed a dispute (which is the only way to get a 1095-A form when it is lost or missing)
  • You issued the correct form in March and the customer filed their taxes
  • In May, you sent a revised 1095-A form for no reason and the client has to pay back the tax credit according to the CPA and pay to re-file the tax return
  • You say there is no person at CovCA who can tell us why this happened, and our only remedy is to file another Dispute form and hope for the best
  • You also say the first premium payment (January) was never paid and therefore you have not sent enrollment data to the insurance company
  • Meanwhile, the insurance company says they are indeed receiving premium payments, but you have never sent them the enrollment data
  • The icing on the cake is you say the case is under review with Medi-Cal for the last six weeks, but nobody has informed the customer to call Medi-Cal to speed it along.  Moreover, the letter you supposedly sent to inform them actually says everything is fine and “congratulations.”

Congratulations!  Everybody is happy with Obamacare in California.

Obamacare Press Releases

U.S. TREASURY DEPARTMENT OFFICE OF PUBLIC AFFAIRS

 

 

Questions About Special Events?  Get Local Assistance Now

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California Open Enrollment Extended to

California Open Enrollment Extended to April 30th

Obamacare Choices… Free Assistance Before April 30th

If you (or someone you know) has not yet purchased individual health insurance, good news is here:

Although the California Open Enrollment extended period closed April 30th, you could qualify for a qualifying special enrollment event, if certain circumstances exist. [ Read more about qualifying Special Events here.]

Read why Everybody’s Happy With Obamacare in California

Questions About Special Events?  Get Local Assistance Now

Kaiser Permanente and Tax Form 1095-A

Taxes FAQs — On-Exchange Members

 (Excerpts from a Kaiser Permanente Northern California FAQ released in January 2015)

Includes: Exchange members, both in state and federal exchanges  Note:  If you are not a Kaiser Member, see our related article written for non-Kaiser members who purchased coverage through Covered California.

What is Form 1095-A? What do I do with it?

If you or anyone in your household enrolled in a health plan through the health insurance marketplace in 2014, you’ll get Form 1095-A, Health Insurance Marketplace Statement from the marketplace. You should receive it in the mail by early February. Keep Form 1095-A with other important tax information, like your W-2 forms and other tax records. You’ll use information from the form to fill out your 2014 federal income tax return.

Consumers use the information included on Form 1095-A, Health Insurance Marketplace Statement, to complete Form 8962, Premium Tax Credit (PTC). Consumers file Form 8962 with their 1040 tax returns if they want to claim the premium tax credit or if they received advance payments (APTC) made to their insurance company.

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1.  I’ve heard that my health coverage may impact my taxes. Is that true?

Yes, your 2014 health coverage affects your income taxes in two ways.

1)  Federal tax law requires everyone to have health insurance or to be eligible for an exemption from this requirement in 2014. If you and/or your dependents did not have qualifying health coverage, then you may owe a penalty.

For more information on exemptions for not having health coverage, visit:
https://www.healthcare.gov/fees-exemptions/exemptions-from-the-fee/.

2)  If you received federal financial assistance, you will need to report the amount you received throughout the year to the IRS on your taxes.

a) If the amount of assistance was less than the premium tax credit that you qualified for, then you should receive a credit.

b) If the amount of assistance you received was more than the premium tax credit that you qualified for, then you may need to pay some or all of the advance payment of the premium tax credit back.

c) You may have to complete one or two new tax forms.

d) You may have to get a health coverage exemption or pay a penalty with your tax return if you didn’t have health coverage in 2014. Some exemptions may not be available now. To learn whether you may qualify for an exemption, you should contact your marketplace.

For more information on how health coverage may impact taxes, contact your marketplace, or visit https://www.healthcare.gov/taxes/ or http://www.irs.gov/ACA.

2.  How was my federal financial assistance calculated?

The amount of Advance Premium Tax Credit (APTC — also called federal financial assistance for premium payment) that was paid on your behalf to Kaiser Permanente to lower your premiums in 2014 was based on the income and family size you estimated when you applied for health coverage, as well as the cost of the second lowest priced silver plan offered through your health insurance marketplace.

Based on your actual income and dependent information for 2014, your APTC premium tax credit will be recalculated and will be compared to the amount of the advance payments made to Kaiser Permanente for your premiums now that you’re filing your taxes. Keep in mind that any change to actual income or change in dependents from what you estimated could increase or decrease the actual premium tax credit for which you qualify in 2014.

If, based on your final 2014 information, the amount of assistance was

— less than you were entitled to, you may receive a credit on your taxes, or

 more than you were entitled to, you may need to pay some or all of the advance payment back.

3.  What do I need to file my taxes?

If anyone in your household enrolled in a health plan through the marketplace in 2014, you’ll need to use the 1095-A statement, which you will receive from the marketplace, when you file your federal income taxes. You should receive it in the mail by early February. Keep your 1095-A statement with your W-2 forms and other tax records.

Consumers use the information included on the 1095-A statement to complete Form 8962, Premium Tax Credit (PTC). Consumers file Form 8962 with their 1040 tax returns if they want to claim the premium tax credit or if they received advance payments (APTC) made to their insurance company.

For more information on the 1095-A statement, contact your marketplace, or visit https://www.healthcare.gov/taxes/ or http://www.irs.gov/ACA.

For more information on Form 8962 and Form 1040, visit http://www.irs.gov/ACA. You can also find copies of Form 8962 and Form 1040 on http://www.irs.gov/ACA.

4.  What is Form 1095-A? What do I do with it?

If you or anyone in your household enrolled in a health plan through the health insurance marketplace in 2014, you’ll get Form 1095-A, Health Insurance Marketplace Statement from the marketplace. You should receive it in the mail by early February. Keep Form 1095-A with other important tax information, like your W-2 forms and other tax records. You’ll use information from the form to fill out your 2014 federal income tax return.

Consumers use the information included on Form 1095-A, Health Insurance Marketplace Statement, to complete Form 8962, Premium Tax Credit (PTC). Consumers file Form 8962 with their 1040 tax returns if they want to claim the premium tax credit or if they received advance payments (APTC) made to their insurance company.

For more information on Form 1095-A, contact your marketplace, or visit
https://www.healthcare.gov/taxes/ or http://www.irs.gov/ACA.

5.  If I’m the main household subscriber, will I get one 1095-A statement or multiple 1095-A statements, for each member of the family?

If you are all on the same plan, you’ll get one statement, which has all the members of your household listed. If you are on separate plans, you’ll get separate 1095-A statements.

For more information on Form 1095-A, contact your marketplace, or visit
https://www.healthcare.gov/taxes/ or http://www.irs.gov/ACA.

6.  What if I enrolled in a health plan through the marketplace during a special enrollment period? Will I still get a 1095-A marketplace statement?

Yes, you will receive a 1095-A marketplace statement for the period of enrollment in the health plan through the marketplace.

For more information on Form 1095-A, contact your marketplace, or visit https://www.healthcare.gov/taxes/ or http://www.irs.gov/ACA.
7.  Will I have to pay a penalty if I was covered 10 months in 2014?

For more information, talk to your tax professional if you have one or visit http://www.irs.gov/uac/Am-I-required-to-make-an-Individual-Shared-Responsibility-Payment%3F.

8.  What is Form 8962?

Consumers file Form 8962, Premium Tax Credit (PTC), with their tax return if they want to claim the premium tax credit or if they received advance payments (APTC) made to their health plan. For more information on Form 8962, and to find a copy of Form 8962, visit http://www.irs.gov/ACA.

9.  What does reconciliation mean?

When you file your federal taxes, consumers who received federal financial assistance (also called subsidies) will use the information on Form 1095-A to complete Form 8962, Premium Tax Credit (PTC). You will use Form 8962 to compare how much your health plan received for 2014 premiums that were advance payments of your premium tax credit (based on an estimate of the amount you would be entitled to) to the final premium tax credit you qualify for. For more information, contact your marketplace, or visit https://www.healthcare.gov/taxes/ or http://www.irs.gov/ACA.

10.  How do I get a copy of my Kaiser Tax Form 1095-A? (I lost it or never received it.)

Contact your marketplace for another copy of Form 1095-A.

For Georgia and Virginia members: You can download a copy at HealthCare.gov in a new section of My Account.

For Colorado members: you can download a copy of your form under “my documents” in your Connect for Health Colorado account starting Tuesday, February 3, 2015.

For more information on Form 1095-A, refer to the Form 1095-A instructions, contact your marketplace, or visit https://www.healthcare.gov/taxes/ or http://www.irs.gov/ACA.

11.  Where can I get help filing my taxes?

Consumers may get free assistance with filling out their taxes. This may include free access to tax software programs, or free in-person assistance. For more information, visit http://www.irs.gov/freefile or http://www.irs.gov/VITA.

Consumers can also seek professional tax assistance. For more information about choosing a tax professional, visit http://www.irs.gov/Tax-Professionals.

If you have additional questions about your taxes, visit http://www.irs.gov/ACA.

12.  Why did I get more than one Kaiser Tax Form 1095-A?

Just as some households receive multiple W-2s if individuals have multiple jobs, some households will get multiple Form 1095-As if they were covered under different plans or made changes to their income or dependent information during the year. Be sure to keep all the 1095-As you get and keep them with your important tax documents.

Sometimes a consumer may receive a “Corrected” Form 1095-A. You should use the most recent Form 1095-A that you receive when you complete your taxes. For more information on Form 1095-A, refer to the Form 1095-A instructions, contact your marketplace, or visit https://www.healthcare.gov/taxes/ or http://www.irs.gov/ACA.

13.  What if I think information on my Form 1095-A is incorrect?

For information that you believe is incorrect on Form 1095-A, consumers should contact their marketplace call center for research and resolution.

For more information on Form 1095-A, refer to the Form 1095-A instructions, contact your marketplace, or visit https://www.healthcare.gov/taxes/ or http://www.irs.gov/ACA.

14. What if I already filed my tax return before I got my 1095-A, or before I got a corrected one?

You may have to file an amended federal income tax return. This means you’ll have to file a corrected version of your return with the IRS.

For more information about filing an amended tax return contact your tax professional if you have one, and/or your marketplace or visit https://www.healthcare.gov/taxes/. The IRS also has information about filing an amended return, visit https://www.healthcare.gov/taxes/marketplace-health-plan/.

15.  Will I get a 1095-A if I’m ONLY enrolled in a stand-alone dental plan or a minimum coverage plan (previously called catastrophic plan)?

No, you won’t get a 1095-A statement if you’re enrolled in a minimum coverage plan. These plans don’t qualify for subsidies. However, if you are enrolled in a stand-alone dental plan and a health plan, you may receive a 1095-A statement.

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Obamacare Penalty Tax

An Obamacare Penalty Guide For All California Residents

The purpose of this article is to help individuals, families, and early retirees avoid the Obamacare penalty under the Affordable Care Act.  Obamacare Penalty

Don’t miss the next Open Enrollment season, and avoid mistakes that could cost you money and opportunity.  This is a good reference article, so retain it until you need it.

 

  • Since January 2014, most people will be required to have public or private health insurance or pay a financial penalty AKA the Obamacare Penalty tax.

Avoid the Obamacare Penalty and use the savings to buy vision care insurance

 

  • As of 2016, the penalty has been increased substantially.
  • Parents with children who are tax dependents will be responsible for making sure their children comply or also face penalties.

[Note: If you are a small business or employer representative researching your obligations under the new law, click here.  The remainder of this article is intended for California individuals and families.]

 What Is The Obamacare Penalty For Not Having Health Insurance?

  • In 2014, individual penalty was the greater of 1% of the family income above the tax filing threshold or $95 per adult and $47.50 per child (max $265 per family).
  • By 2016, the maximum penalty grows to the greater of 2.5% and $2,085 per family. 
  • Do you qualify for lower rates with a Premium Assistance Subsidy?  Find out here.
  • CoveredCA-ComparisonChart and Paper Application

How will mandatory health insurance and the Obamacare penalty tax be enforced?

The IRS will administer such penalties on personal tax returns.  Besides the Obamacare penalty aspect, there is also some positives, deserving mention:  Follow the actual experience of an Agent’s first week of Obamacare on this Prezi:  My First Week of Obamacare Open Enrollment

In summary, avoid mistakes that can cost you money and opportunity. Tax issues should be reviewed with your tax advisor.  Here is a resource from the IRS: IRS Affordable Care Act Tax Provisions.

 You can find local assistance.