What Happens at Tax Time? Tax Penalties and Premium Tax Credit Reconciliation. JoAnn Volk Tricia Brooks Michigan Assister Training October 23, 2014

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1 What Happens at Tax Time? Tax Penalties and Premium Tax Credit Reconciliation JoAnn Volk Tricia Brooks Michigan Assister Training October 23, 2014

2 Warning! This training is intended to remind assisters of the rules regarding tax penalties and reconciliation of premium tax credits, and to give you a glimpse of what consumers will face at tax time. Assisters are not required or expected to assist individuals with tax preparation. Assisters may refer consumers to the Volunteer Income Tax Assistance (VITA) program. Tax preparers and tax preparation software will also help consumers complete the necessary forms. 2

3 Tax filers with income <$52,000 Persons with disabilities Elderly Limited English proficiency VITA Serves

4 What happens at tax time? Uninsured individuals may pay a tax penalty Individuals will reconcile APTC with final PTC Individuals enrolled in the Marketplace not using APTC can claim a tax credit 4

5 1 Individual Mandate and Tax Penalty Unless exempt, everyone who is required to file taxes is required to have minimum essential coverage (MEC) - Most government sponsored and employer insurance is MEC Those without MEC (or an exemption) will pay a shared responsibility payment (aka tax penalty) Coverage requirement, penalties and exemptions apply on monthly basis - If covered or exempt for at least one day in the month, counts as full month 5

6 1 Minimum Tax Filing Threshold Tax Filing Status Tax Filing Threshold (2014) Single $10,150 Head of Household $13,050 Married, filing separately $3,950 Married, filing jointly $20,300 Qualifying Widow/er with Dependent Child $16,530 Not based on whether you file or not, the requirement is based on having income above tax filing threshold. It does not apply to individuals with lower income who file taxes to get refund or get their earned income tax credit (EITC). 6

7 1 Individual Mandate and Tax Penalty Why is there a responsibility to have health insurance? (aka Individual Shared Responsibility) Insurers can no longer discriminate or exclude individuals with existing health conditions Their willingness to do this is contingent on bringing healthy people into the risk pool Important for bringing down the cost of insurance and reducing the burden that the government and providers carry for treating people who are uninsured 7

8 Tax Penalty for No Health Insurance Penalty is the greater of Adult = $95 Child = $47.50 Family = $285 Adult = $325 Child = $ Family = $975 Adult = $695 Child = $ Family = $2,085 OR OR OR 1% of taxable income above filing threshold 2% of taxable income above filing threshold 2.5% of taxable income above filing threshold Future Years Annual Cost-of Living Increases Penalty is capped at national average cost of bronze plan Individual = $2,448 Family = $12,240??? 8

9 Exemptions from Individual Mandate Not required to file tax return Uninsured less than 3 months Lowest cost plan > 8% of household income Member of federally recognized tribe or eligible for Indian Health services Member of recognized health care sharing ministry Member of recognized religious sect Incarcerated Not lawfully present State didn t expand Medicaid Meet hardship requirements 9

10 Who Grants the Exemption? Granted by Marketplace Hardship Exemptions - Life circumstances - Insurance >8% of projected income - Eligible for Indian Health Services - Plan cancellation Member of certain religious sects State didn t expand Medicaid Granted at Tax Filing Income below filing threshold Insurance is unaffordable (>8% of actual income) Certain noncitizens Coverage gap < 3 months (only first gap qualifies) Gap before May 1, 2014 effective date for coverage purchased outside or inside Marketplace Granted by Marketplace or at Tax Filing Indian Tribe membership Incarceration Health care sharing ministry 10

11 Life Circumstances = Hardship Exemption Homeless Eviction in past 6 months or facing eviction/foreclosure Shut-off utility notice Domestic violence Death of close family member Fire, flood or other disaster Filed bankruptcy in past 6 mos. Outstanding medical expenses (24 months) State didn t expand Medicaid Increase in expenses to care for ill, disabled or aging family member You claim a child denied Medicaid/CHIP and another person is court ordered to provide health coverage Approved to enroll in QHP under appeal but were uncovered for some months Individual coverage cancelled and QHPs are not affordable Other hardship getting covered 11

12 Different Forms for Different Exemptions 12

13 Marketplace Exemption Process Apply using proper paper form (by mail only currently) Marketplace reviews and may request additional information. Time depends on reason. Marketplace grants exemption, sends notice and provides exemption certificate number. 13

14 Is documentation required? Must provide income documentation when applying for affordability exemption Must provide cancellation notice when losing coverage if you want to purchase catastrophic coverage Other exemptions may require documentation, see instructions for details Marketplace may request additional information 14

15 Key Points about Most Hardship Exemptions Should apply timely and provide supporting documentation But can apply up to 3 years after month of hardship (will have to document so earlier is better) Consumer is eligible to purchase catastrophic plan If exempted based on hardship or affordability, and During open enrollment or exemption qualifies for SEP Most cases, must report changes Change in circumstance may qualify for SEP Duration at least one month before through one month after Other rules for: Affordability hardship State did not expand Medicaid 15

16 Key Points about Affordability Exemption Based on MAGI Income If eligible for employer MEC Employee lowest cost selfonly plan = >8% of income Employee s spouse and dependents lowest cost family plan = >8% of income ESI = >8% of household income due to failure to qualify for wellness discounts Not eligible for ESI Lowest cost bronze plan after PTCs for all non-exempt family members = >8% income Duration and Timing If granted by Marketplace, Based on projected income Applies only to future months in the year Apply during open enrollment or special enrollment period. To get full year exemption, apply before the year starts If granted by IRS Based on actual income Additional exemption for spouses offered ESI but combined cost >8% income 16

17 Affordability Example: The Garcia Family Maria and Lucas Garcia are married and have two children. Both work but only Lucas is offered health coverage. No one in the family is enrolled. Household income: $47,100/200% FPL Premium Cost for Lucas - $2,000/4.2% Premium Cost for family - $9,000/19.1% Is Lucas eligible for an affordability exemption? Are Maria and the children eligible for an affordability exemption? Bonus question: Is the family eligible for premium tax credits? (Hint remember the family glitch?) 17

18 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 4.2% Lucas only Example: Garcia Family 19.10% Family 9.5% 8% Lucas is NOT eligible for an exemption because coverage for him is less than 8% of income Maria and the childre would eligible for an exemption because coverage for the family is more than 8% of income The FFM does not consider eligibility for CHIP/Medicaid in granting exemptions. The family is NOT eligible for PTCs because coverage for Lucas is less than 9.5% of income 18

19 Example: Aggregate Cost of Coverage Sylvia and John both have jobs that offer health coverage: Household income: $45,000 Premium Cost for Sylvia - $2,400/5.3% Premium Cost for John - $2,100/4.6% Aggregate cost: $4,500/10% Are Sylvia and John eligible for PTCs? Are Sylvia and John eligible for an exemption? 19

20 Example: Sylvia and John 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 10% 5.3% 4.6% Sylvia John Aggregate 9.5% 8% Neither Sylvia or John are eligible for premium tax credits because individual coverage for each of them is less than 9.5% of household income. Sylvia and John do qualify for an exemption when filing their taxes because their combined cost of purchasing employer coverage is more than 10% of household income. 20

21 Reporting or Declaring an Exemption at Tax Time (Form 8965) Form 8965 is used to report the exemption certificate number for members of household granted an exemption by the marketplace or to claim an exemption when income is below filing threshold 21

22 2 Tax Reconciliation of APTCs Final premium tax credit is calculated based on actual taxable income plus non-taxable Social Security benefits Subtract amount of PTC taken as advanced payments If final PTC is greater than APTC = refund If APTC is greater than final PTC = owe taxes 22

23 Examples, coming up!.but first a refresher in how PTCs are determined Cost of silver benchmark plan (2 nd lowest) Minus individual s expected premium contribution (sliding % of income based on FPL level in place ranging from 2% - 9.5%) Equals premium tax credit Keep in mind: PTCs are based on projected income at the time of determination, but the final PTC is determined based on actual income when taxes are filed. 23

24 Refresher: how are premium tax credits determined? $ Cost of silver benchmark plan (for age and service area) - Expected premium contribution (sliding scale percentage of FPL income) $ $ $ $ $ = Premium tax credit (the amount a consumer has to apply toward cost of coverage you select) If a higher or lower cost plan is selected, the actual premium will be higher or lower than the expected premium contribution 24

25 PTC Reconciliation: The Bennett s Cindy and Mark Bennett have a small business. When they applied for Marketplace coverage they projected household income of $47,700 (200% FPL). But when they filed their taxes, their income was slightly lower: $46,507 (195% FPL). 25

26 Bennett s PTC Reconciliation At Application $12,000 Cost of Second Lowest Silver Plan (benchmark) $ 3,005 Projected Annual Income x Expected Premium Contribution ($47,700 = 200% FPL, family of 4, x 6.3%) $ 8,995 Available as an advanced payment of premium tax credit At Tax Time $12,000 Cost of Second Lowest Silver Plan (benchmark) $ 2,823 Actual Annual Income x Expected Premium Contribution ($46,507 = 195% FPL, family of 4, x 6.07%) $ 9,177 Final premium tax credit $ 182 Additional tax credit refund (or offset other taxes owed) 26

27 PTC Reconciliation: Bob and Liz Bob and Liz both work but neither is offered affordable employer coverage. When they applied for Marketplace coverage they reported household income of $31,460 (200% FPL). In December, Bob got an unexpected bonus of $2,000. So their total income at tax time was $33,460 (213% FPL). 27

28 Bob and Liz s PTC Reconciliation At Application $ 8,000 Cost of Second Lowest Silver Plan (benchmark) $ 1,982 Projected Annual Income x Expected Premium Contribution ($31,000 = 200% FPL, family of 2, x 6.3%) $ 6,018 Available as an advanced payment of premium tax credit At Tax Time $ 8,000 Cost of Second Lowest Silver Plan (benchmark) $ 2,298 Actual Annual Income x Expected Premium Contribution ($33,000 = 213% FPL, family of 2, x 6.87%) $ 5,701 Final premium tax credit $ 317 Repayment of Excess Premium Tax Credit 28

29 2 Repayment of Excess PTCs is Capped Household Income (FPL) Individual Family < 200% FPL $300 $ % 300% FPL $750 $1, % 400% FPL $1,250 $2,500 > 400% FPL Full amount of APTC 29

30 3 Tax Credits if No APTC is Used Individual pays full premium Final premium tax credit is based on actual MAGI income subtracted from the cost of 2 nd lowest Silver plan Final PTC is refunded (or used to offset other taxes owed) 30

31 Marketplace sends 1095-A to enrollees by January 31. It lists the enrolled household and the following monthly information: Total premium of enrolled plan Cost of silver benchmark plan APTC taken 31

32 Who you gonna call? The FFM is responsible for issuing and correcting the 1095-A Issuer has key information but may refer enrollees to FFM Not clear how lag in key data transfers between issuers and the FFM (i.e., during late payment grace period) will affect 1095-A 32

33 3 How does reconciliation work? Taxpayers receive form 1095-A from marketplace with key information Taxpayer must itemize deductions (file 1040 or 1040A; not 1040 EZ) Schedule 8962 reconciles APTC and allows individuals who did not take advance payments to claim a premium tax credit 33

34 Consumers will transfer information from the 1095-A to complete schedule This form reconciles advanced premium tax credits and is used to claim a premium tax credit if it was not taken in advance. 34

35 Circumstances that Complicate Tax Reconciliation Penalties and PTCs are prorated on a monthly basis Combination of tax penalty and APTC reconciliation Changes in circumstances - Got married, had a baby or other changes in household size and number of people covered - Changed plans - Reported income change Family members enrolled in different plans and are sharing the PTC (small number) 35

36 Tips for Assisters Encourage clients (and offer assistance) after tax filing, to: - Review 2015 income projection - Make adjustments as necessary During open enrollment help new applicants apply for 2014 exemption Remind enrollees of need to report changes that affect their anticipated annual income 36

37 Unknowns When will exemption process be offered online and over the phone? Will exemptions be granted for people in states that don t expand Medicaid (between 11/15 and 12/31) be valid for 2014 and 2015? When will IRS forms and instructions be finalized? 37

38 Georgetown McCourt School of Public Policy Health Policy Institute Center for Children and Families Center on Health Insurance Reforms Tricia Brooks Website: Say Ahhh! a child health policy blog: og/ JoAnn Volk Website: CHIR Blog: 38

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