As tax season approaches, all tax filers must report whether or not they had health insurance coverage on their 2015 tax returns. The Affordable Care Act requires that most individuals have health coverage that meets certain minimum standards and uses the tax system to enforce that requirement. Depending on how you received your health insurance coverage, you will receive certain forms to help assist with your taxes and confirm that you met the requirement by law to have health insurance.
If you are concerned about completing your tax return by the April 18 deadline, you may want to look into obtaining a tax extension by talking with your tax preparer, going to IRS.GOV or reviewing instructions contained in your tax filing software. If you have already filed your taxes, you may wish to look to those same resources for information on how to file an amended return.
Why is Form 1095-A important: The information on Form 1095-A will help you report your health insurance coverage and any financial assistance you may have received last year to the IRS. Be sure to keep the document in a safe spot you can easily access when you file your 2015 taxes. If you received financial assistance, it was either in the form of an Advance Premium Tax Credit, or you may have opted to file for a premium tax credit when you complete your 2015 income tax return.
Form 1095-A to the head of household for each plan in which individual(s) in the household are enrolled. So you may receive multiple Form 1095-As if you:
Changed plans in the middle of the year.
Added or removed members from the policy during the year.
Have members of your household enrolled in different plans.
Having health insurance is the law. The Patient Protection and Affordable Care Act requires individuals to have qualifying health insurance coverage (also called minimum essential coverage) every month of the year. If you purchased coverage through the Marketplace for you and your family, you’ve met the requirement for the months you were enrolled.
You must file a tax return. The IRS requires you file a federal income tax return if you or any other member of your household wants to claim the premium tax credit, or if an Advance Premium Tax Credit was paid in 2015. If you received the tax credit, or would like to claim one, you must file Form 8962 (Premium Tax Credit) with your tax return. See more about Form 8962 below.
If you were enrolled in a catastrophic plan, you are not eligible for a premium tax credit. You might receive a Form 1095-B from your carrier reflecting your 2015 catastrophic plan coverage. If you are curious about whether or not you will receive a 1095-B regarding your catastrophic coverage, please contact your carrier.
Note: If you did not purchase health insurance in 2015, you may have to pay a penalty.
Changes to your information. If you think information on your Form 1095-A is incorrect, call 1-800-233-1737 to find out how to get a corrected form. If the “CORRECTED” box on the top of your Form 1095-A is checked, this means we made a change to the information we originally provided. Make sure you use the corrected form when you complete Form 8962 and file your federal income tax return. If the “VOID” box on the top of your Form 1095-A is checked, this indicates that the previous Form 1095-A for that policy is now void and do not use this form.
How do I report my tax credit?
Choose the scenario that best describes you:
You were eligible for a Premium Tax Credit in 2015
You WERE NOT eligible for a Premium Tax Credit in 2015
You can also refer to this tax preparation flowchart, which walks you through how and when to report your tax credits when filing your taxes.
Using Form 8962
When you fill out Form 8962, it asks you for the “Annual and Monthly Premium Amount of SLCSP” (see Part 2, Fields B11-23). This information can be found on Form 1095-A in Part III, Fields B21-33.
The Second Lowest Cost Silver Plan, or SLCSP, (also known as the “benchmark plan”), is the second least expensive plan available to you in your area that was at the Silver coverage level. The IRS uses that information, plus additional information about your family size and income, to determine the amount of premium tax credits for which you and your household were eligible.
Please use the official Form 1095-A when filing your federal income taxes. A sample of Form 8962 and instructions can be found on the IRS website.
If your Form 1095-A includes zeros for the SLCSP premium amount or if you had unreported changes in your family in 2015, such as changing zip codes, please use the tool below to calculate your SLCSP premium amount.
Find Your Second Lowest-Cost Silver-Level Plan
Calculating an Affordability Exemption from the Penalty
If the lowest cost Bronze-level Marketplace plan available to you in 2015 cost more than 8.05 percent of your household income, you qualify for a health coverage exemption. This means you wouldn’t have to pay the fee for any months you were uncovered in 2015. IMPORTANT: The only way to know if you qualify for this exemption is to complete your 2015 federal income tax return.
Find Your Lowest Cost Bronze-Level Plan
If you believe any of the above exemptions or circumstances applies to you, you can find the appropriate forms and more information here.
Tax Credit Reconciliation
Once your federal taxes are filed, the IRS will take the three actions below, called “reconciliation:”
The IRS will check to see if the income you reported to us is the same as the income reported on your tax return;
The IRS will also check to see if your tax household size is the same as when you applied for health insurance with us; and
The IRS will then compare the financial assistance already paid to your health plan carrier with the financial assistance that you should qualify for in 2015.
If the household income on your tax return is lower than the income you estimated on your application for financial assistance, you may not have gotten enough financial assistance. At tax time, you may get that extra financial assistance to lower the taxes you owe, or even as a refund.
If the household income on your tax return is higher than the household income you estimated on your application for financial assistance, the IRS may have paid too much financial assistance on your behalf to your health plan carrier. In this case, you may have to pay some or all of the premium assistance back when you file.
Cost-sharing reductions, which lowers the amount you have to pay when you visit the doctor, are not considered tax credits by the IRS and are not reported on your Form 1095-A. You are not required to report receiving cost-sharing reductions to the IRS and you will not be required to reconcile this amount.
What if I have coverage through my employer?
If you receive health insurance from your employer, you may receive a Form 1095-B or a Form 1095-C. If you have questions regarding either form, please contact your human resources representative.
While we can answer some questions about the information on the form, we cannot provide tax advice. We understand this can be complicated and are providing the below resources to you at no cost. The IRS or your tax preparer are also good resources for help.
Free tax assistance is also available for people who generally make $54,000 or less, persons with disabilities, the elderly and limited English speaking taxpayers at a local Volunteer Income Tax Assistance Site (VITA). You can also call 1-800-906-9887.
Call your local tax preparer or the IRS at 1-800-829-1040. You can also find more information on the IRS website, including their FAQs.
Watch the 3 tips about Marketplace coverage and your taxes video.
If you are working with a tax preparer, you may want to share this resource: Tax Preparer’s Guide to the Affordable Care Act
Calculate Your Savings
Use savings calculator to see if you will be able to lower the cost of your health insurance.
Help and Assistance
ND Navigator provides education on the topic of affordable health insurance options. They can provide assistance with enrollment and the application for financial assistance to reduce your monthly costs. Call us at 1-800-233-1737 or e-mail firstname.lastname@example.org
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