Legislative Changes For PY2015. Melodye Mitchell, Branch Chief EFS Development Services

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1 Legislative Changes For PY2015 Melodye Mitchell, Branch Chief EFS Development Services

2 Who is eligible for premium tax credit? A Premium Tax Credit (PTC) may be requested through the Federal or State marketplace. Factors that are considered in determining the amount of the subsidy include: Household family size Household Income between 100% to 400% of the Federal Poverty Line (e.g., $23,550 $94,200 for a family of four in 2013) Not eligible for other health benefits coverage (e.g., Medicaid, Medicare) other than the individual insurance market Be a U.S. citizen or be lawfully present Not be incarcerated (with some exceptions) Not be claimed as a dependent by another individual

3 Who s Exempt from the Shared Responsibility Payment? Prisoners, undocumented immigrants, and Indian tribal members will be exempt from shared responsibility payments. Members of certain religious sects or health care sharing ministries also can apply for a religious exemption. Other U.S. residents who will be exempt include: Certain low-income individuals: Those who cannot afford coverage, or live in states that have opted out of the Medicaid expansion; People who have no plan options in their state's health insurance exchange. Other individuals who meet certain criteria: Specifically, individuals who have suffered a hardship or a coverage gap of three or fewer months.

4 What's Affordable Coverage Under Health Care Reform? Employee's required premium co-share for the lowest-cost (bronze plan), self-only coverage that provides minimum value is not greater than 9.5 percent of an employee's W-2 taxable (Box 1) income. If it is higher, the employee may be eligible for a Premium Tax Credit. NOTE:The cost of dependent coverage is not calculated in the determination of whether the employer is offering affordable coverage. Starting in 2014, individuals offered employer-sponsored coverage that s affordable and provides minimum value won t be eligible for a premium tax credit either for themselves or for their dependents.

5 Affordability Guidelines If employer coverage becomes affordable during the course of a year, eligibility for premium tax credits cease. A determination that employer-sponsored coverage is unaffordable must be redetermined each year and is not automatically extended. If an employer imposes a waiting period of up to ninety days before coverage can begin, as permitted by the ACA, premium tax credit eligibility continues until employer-sponsored coverage is available.

6 Reporting Insurance Coverage at Filing When preparing TY2014 income tax, each taxpayer must (1) Indicate on form 1040 or form 1040A that the taxpayer and all dependents listed on the form had minimum essential health care coverage for all 12 months, OR (2) Include form 8965 which identifies exemptions obtained from the marketplace for months where insurance coverage was not obtained, OR (3) Include a shared responsibility payment with the submission

7 ACA Forms Depicted in this Presentation

8 Claiming a Premium Tax Credit (PTC) Form 8962 must be attached to Form 1040/1040A/1040NR if You are claiming the premium tax credit on Form 8962, line 26. You received an advance payment of the premium tax credit. You have an excess advance payment of the premium tax credit you must repay on Form 8962, line 29. You shared a policy with another tax filer. You are using the alternative calculation for the year of marriage

9 Form 8962, Part 1 Annual and Monthly Contribution Amount

10 Modified Adjusted Gross Income (MAGI). Modified adjusted gross income is your adjusted gross income, plus (1) any amounts excluded from your gross income under section 911 (the exclusion of foreign earned income for taxpayers living in a foreign country), and (2) tax-exempt interest you receive or accrue during the year. If you file Form 1040: Your adjusted gross income is on line 37 of Form 1040 Amounts excluded from gross income under section 911, if any, are on Form 2555 (add amounts from lines 45 and 50) or Form 2555EZ (line 18) Your tax-exempt interest, if any, is on line 8b of Form 1040 If you file Form 1040A: Your adjusted gross income is on line 21 of Form 1040A You did not have any amounts excluded from gross income under section 911 Your tax-exempt interest, if any, is on line 8b of Form 1040A If you file Form 1040EZ: Your adjusted gross income is on line 4 of Form 1040EZ You did not have any amounts excluded from gross income under section 911 Your tax-exempt interest, if any, is in the space to the left of line 2 on Form 1040EZ

11 Form 8962, Part 2, PTC Credit Claim and Reconciliation of APTC

12 Form 8962, Part 3, Repayment of Excess APTC Reconciliation: A reconciliation must then occur between the advanced payment for the tax credit already received and the total amount of the premium tax credit to which the individual is actually entitled. If over the course of the year household income turns out to be greater or less than projected, or if household composition or income has changed, the final tax credit may turn out to be greater or less than the amount already paid. If the taxpayer turns out to have been eligible for more than had been paid, the taxpayer gets a refund. If, however, the government has paid more than the taxpayer in fact turns out to be entitled to, the taxpayer must pay the money back.

13 Form 8962, Part 4, Shared Policy Allocation

14 Form 8962 Part V

15 Form 8965 Taxpayers may submit Form 8965 ito report exemptions they were granted from insurance coverage

16 Form 8965 Pts 1 and 2 If anyone in your tax household has been granted one or more exemptions from the Marketplace, complete Part I for each Marketplace-granted exemption.

17 Form 8965 Pt 3

18 ACA Information Returns

19 Form 1095-A Form 1095-A is filed by the State and Federal Marketplace in accordance with an interagency agreement. A recipient copy will be mailed to the individual policyholder by January 31 st for use in filing their PY2015 tax returns. There is no requirement to submit the 1095-A with your tax return. In PY2015, Heath Care Coverage provided by State and Federal Marketplaces is mandatory.

20 Form 1094-B This form is used by the Health Insurance Policy Issuers to report Health Care coverage. Health care coverage reporting is optional for PY2015 and mandatory for PY2016 This transmittal must be submitted with one or more 1095-B detailed records.

21 Form 1095-B Form 1095-C provides detailed information about the policy holder in Part I, the employersponsored coverage in Part II Part III identifies other coverage providers if applicable Part IV identifies the covered individuals under the policy by Name SSN Date of Birth Months covered

22 Form 1094-C Parts 1 and 2

23 Form 1094C Part III Part three focuses on the monthly ALE Member information including: Whether MES was offered broken down by month Number of FTE Total Number of all employees Part III also addresses whether the ALE Member was part of an Aggregated Group or whether they qualify for transition relief under section 4980H in any given month.

24 Form 1094C Part IV Part IV request that the issuer provide the names and Employer Identification Numbers for other members of the Aggregated ALE Group

25 Questions??

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