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Financial Help for Marketplace Health Insurance: Tax Credits & Cost Sharing Affordable Care Enrollment (ACE) TA Center December 4, 2014
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Participant Learning Objectives Learn how to apply for and maintain financial help Know who may be eligible for assistance Understand how underpayments and overpayments are reconciled Learn how some RWHAPs, including ADAPs, are supporting the process
MIRA LAURA LORI AMY Introductions
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Audience Poll What is your role in your RWHAP funded agency? Program manager or staff Case Manager Clinical director or staff Benefits and enrollment staff Director or administrator Quality assurance/compliance staff Other (chat role to Chairperson) N/A (I'm not a grantee or provider)
Audience Poll Have you been on an ACE TA Center webinar before? Yes No N/A
Premium Tax Credits (PTCs) and Cost Sharing Reductions (CSRs)
Premium Tax Credit (PTC) A tax credit to lower the cost of insurance premiums for Marketplace coverage PTC
Cost Sharing Reductions (CSR) A CSR plan is a version of a Silver plan with lower out-of-pocket expenses CSR Reduces deductibles, copays, and coinsurance
What do they have in common? Clients can be eligible for both a PTC and CSR Eligibility is determined during Marketplace application and plan renewals Amount of financial help depends on income and premium cost and can change from year-to-year Help your client review plan options each year based on how much financial help they will get
What costs will my client have to pay? PTCs and CSRs may not cover the entire cost of coverage Check with RWHAP programs, including ADAP, to see if they can help Be clear with clients about their responsibility in paying remaining costs What letters, bills, notices will come in the mail, and when? How much will they need to pay?
How are PTCs and CSRs paid? PTC: Clients have two choices 1. Paid directly to insurer every month 2. Person/family can wait for lump sum when they file federal tax return at year s end CSR: Paid directly to insurer every month
Audience Poll What do PTCs and CSRs have in common? Help pay for insurance premiums Amount depends on income Amount can change from year-to-year Can be used for a Silver plan Can be paid to the client/family
Let s recap: How do PTCs and CSRs compare?
Eligibility considerations
Who is eligible? PTC: 100-400% FPL* CSR: 100-250% FPL Not eligible for CHIP, Medicaid, or Medicare Employer plan doesn t meet criteria for minimum essential coverage Do not file a Married Filing Separate return exception for abuse/abandonment Can t be claimed as a dependent by another person *139% - 400% in states that have expanded Medicaid
What are the income requirements?
What are the income requirements?
What is MAGI? Modified adjusted gross income (MAGI) is Gross income minus exemptions and deductions plus any tax-exempt Social Security, interest or foreign income RWHAP Archived Webinar: Understanding Modified Adjusted Gross Income (MAGI) Nov. 20, 2013 http://bit.ly/1v3zj4d
Does immigration status matter? Clients who are lawfully present and meet all other eligibility requirements may qualify Lawfully present individuals are non-u.s. citizens who have permission to live or work in the U.S. Learn more in our January webinar: Immigration status and health insurance for PLWH under the ACA (date to be announced)
Multiple choice poll: which of these must be true for someone to be eligible for both PTCs and CSRs? 1. Not eligible for Medicaid 2. Income between 100 and 400% FPL 3. Lawfully present in the United States
Applying, renewing, and updating information
Applying and renewing Part of application process through the Marketplace during Open Enrollment CSR eligibility is determined along with PTC Clients must authorize collection of tax data from the IRS Plan renewals Enter the health plan s 14-digit number Update income and household information
Avoid owing money next year Changes in household or employment circumstances can change the amount of PTC or CSR Clients should report: Accurate income information when they apply Any changes to income or family size throughout the year
What happens at the end of the year? Recipients must file a federal tax return! If married, the client must file a joint tax return with his/her spouse (except in cases of domestic abuse) Applicants cannot be claimed as a dependent on someone else s tax return. Free tax filing assistance: http://irs.treasury.gov/freetaxprep/
PTCs and CSRs in action
Case Study: Meet Alex
Case Study: Alex Alex lives alone and makes $35,000 (300% FPL) Immigrated to the U.S. from Mexico Non-U.S. citizen with permission to live or work in the U.S. (lawfully present) Buying health insurance for the first time
Three polls: Helping Alex enroll 1. Is Alex eligible to receive an PTC and/or CSR? PTC only, CSR only, both, neither 2. Is he eligible based on his immigration status? Yes, he is eligible; No, he is not eligible 3. What level plan can Alex enroll in? Platinum; gold; silver; bronze; any level
Case Study: Alex (continued) Alex is lawfully present in the U.S., so he can apply for coverage He is eligible for PTC, not CSR He may select any level (Platinum, Gold, Silver or Bronze) plan At Alex s income level, he must contribute 9.5% of his income (approx. $272 monthly) toward the premium He will be required to file taxes after the end of the year
Case Study: Calvin
Case Study: Calvin Calvin is legally married to his partner, and they have two children Their household income is $59,000 (just below 250% FPL) Calvin and his family are renewing their 2014 health plan
Two polls: Helping Calvin enroll 1. Are Calvin and his family eligible for an PTC and/or CSR? PTC only; CSR only; both; neither 2. Can Calvin enroll in any level plan? Yes; No
Case Study: Calvin (continued) Calvin and his family are eligible for both PTC and CSR They must select Silver plans to get CSRs Calvin needs to use the 14-digit number from his 2014 health plan to apply for 2015 financial help Calvin and his family are required to contribute 8.1% (approximately $395 monthly) toward premium costs Calvin and his partner need to file their taxes jointly after the end of the year
New ACE Tool! FAQ: Financial Help for Health Insurance
Financial reconciliation
Reconciliation: How it works
Reconciliation in action: 2014 tax year example Why does the IRS reconcile premium tax credits? 2013 2014 2015 Consumer earns income and generates a modified adjusted gross income (MAGI) for the 2013 tax year Consumer receives advance premium tax credit based on 2013 federal tax information showing MAGI Consumer should be reporting changes in income to the Marketplace throughout the year to avoid under/over-payments of advance premium tax credits! Consumer files 2014 tax return and reconciles income used to calculate advance premium tax credits with actual income reported for 2014 in federal taxes; under-/overpayment assessed by IRS
What happens at tax time? In January, anyone who received a premium tax credit will receive a form from the Marketplace (IRS Form 1095- A) which will include information on how much the individual received in premium tax credits for the year. When a person files federal taxes, he/she will need to fill out IRS Form 8962 to document premium tax credits received and actual amount of premium tax credits owed based on income and household size.
What happens at tax time? The information a person includes on Form 8962 will be used to indicate whether that person is owed a refund or owes the IRS money because of an advance premium tax credit overpayment. Line 46 on IRS Form 1040 indicates excess premium tax credits a person owes to the IRS Line 69 on IRS Form 1040 indicates net premium tax credit (i.e., amount owed to the taxpayer as refund)
Repayment amounts are capped based on income
ADAP and reconciliation
HRSA/HAB ACA policies on reconciliation The Ryan White Program is the payer of last resort and grantees must vigorously pursue client eligibility for public and private insurance Grantees may not dis-enroll clients from services for failure to enroll in public or private insurance coverage Ryan White program grantees and sub-grantees must vigorously pursue any excess premium tax credit a client receives from the Internal Revenue Service (IRS) upon submission of the client s tax return NOTE: HRSA is considering allowing Ryan White Program grantees to cover client tax liabilities associated with an overpayment of the premium tax credit
Vigorously Pursuing Vigorously Pursuing Best Practices Implement client eligibility screening policy Document client contact Require attestation if client does not enroll in coverage Require client to accept full premium tax credit amount in advance and to acknowledge need to report changes in income to the Marketplace
Questions?
Resources National Alliance of State & Territorial AIDS Directors (NASTAD), www.nastad.org Amy Killelea, akillelea@nastad.org Xavior Robinson, xrobinson@nastad.org HIV Health Reform, http://www.hivhealthreform.org/ HIV Medicine Association, www.hivma.org HRSA/HAB ACA and Ryan White Resources, http://hab.hrsa.gov/affordablecareact/ IRS The Health Insurance Premium Tax Credit for Tax Year 2014 What You Need to Know, http://www.irs.gov/pub/irs-utl/15-premium%20tax%20credit.pdf Health Care Reform Resources Center on Budget and Policy Priorities, Beyond the Basics, http://www.healthreformbeyondthebasics.org State Refo(ru)m, www.statereforum.org Kaiser Family Foundation, www.kff.org Healthcare.gov, www.healthcare.gov
HIV/AIDS Bureau Policies Get information directly from the HIV/AIDS Bureau: http://hab.hrsa.gov/affordablecareact Guidance and policy notices on ACA and RWHAP Responses to frequently asked questions HIV/AIDS Bureau Archived Webcast: Policy Clarification Notices and the Affordable Care Act July 23, 2014 http://bit.ly/1uo39da
Upcoming HRSA / IRS webinar Preparing for Tax Season: What HRSA Grantees Need to Know About Premium Tax Credits and the Individual Shared Responsibility Payment December 16, 2014, 1:30-3:30 PM (EST) Learn more about: Premium tax credits The reconciliation process for advanced premium tax credits Individual Shared Responsibility Payments Navigating new and updated IRS Tax forms (e.g., 1040 and Form 8962) View the webinar here: http://services.choruscall.com/links/hrsa141216.html
Want to know more about 2015 plan renewals? Interested in learning about the ACE TA Center s enrollment and renewal tools? NOV. 12 What You Need to Know: Open Enrollment and Health Insurance Plan Renewals for 2015 View archived webinar recording: targethiv.org/ace/webinars
Questions?
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