Additional Affordable Care Act Related Information Returns that Individuals May Receive for Health Care Coverage for 2015

Beginning in early 2016, individuals will begin to receive new Affordable Care Act (ACA) related information returns regarding their 2015 health insurance coverage. It is important to note that the following two information forms are for informational purposes only and are not needed to complete an individual’s 2015 federal tax return. The purpose of these forms is to inform individuals that they had health insurance for 2015, who was covered by their policy, and how many months they had coverage.

Form 1095-B (Health Coverage)
All health insurance issuers (insurance companies), self-insured employers, government agencies, and other entities that provided health insurance coverage to individuals during 2015 will be required to send each individual they covered a Form 1095-B (Health Coverage).

All individuals that had health insurance coverage during 2015 will receive a Form 1095-B in early 2016. If the individual had coverage from more than one health insurance provider during the year they will receive a Form 1095-B for each one.

The Form 1095-B will give the individual health insurance policy holder the following information:

• The name, address, and SSN of each person covered by the policy
• The number of months each person was covered during the year
• The name of the health insurance issuer
• Name of Employer (if it is employer sponsored coverage)

The Form 1095-B is proof that the taxpayer and his/her dependents were covered by health insurance for all or part of 2015.

None of the information that is on the Form 1095-B is entered on the 2015 federal tax return. Therefore, it is not necessary for an individual to have received a Form 1095-B in order to complete and file their 2015 federal tax return.

Form 1095-C (Employer Provided Health Insurance Offer and Coverage)
All individuals that worked for a company that was considered an applicable large employer (employed 50 or more full-time equivalent employees) and received or were offered health insurance coverage during 2015 will receive a Form 1095-C (Employer Provided Health Insurance Offer and Coverage) in early 2016 from their employer.

The Form 1095-C will inform the employee of the following:

• Name, address, and SSN of the employee
• Name and SSN of the employee’s dependents that were covered and for which months they were covered during 2015
• Name, address, and EIN of Employer
• For those who elected not to receive coverage, information on the coverage offered

The Form 1095-C is proof that the taxpayer and his/her dependents were covered by health insurance for all or part of 2015 by their employer.

None of the information that is on the Form 1095-C is entered on the 2015 federal tax return. Therefore, it is not necessary for an individual to have received a Form 1095-C in order to complete and file their 2015 federal tax return.

Additional Tax (Penalty) for Not Having Health Insurance for 2014

It is important that everyone understands what the penalty will be for not having health insurance for all or part of 2014.

If someone does not have health insurance for Tax Year 2014 the penalty is calculated as the greater of:

• 1% of their modified adjusted gross income that exceeds their personal exemption (doubled for those who file married filing jointly) plus the standard deduction for their filing status.
  Modified Adjusted Gross Income is defined as Adjusted Gross Income plus:
• Tax exempt interest
• Portion of social security income not included in income
• Foreign earned income and the housing cost of individuals who live abroad
This means the penalty will begin to be calculated once the modified adjusted gross income exceeds:
• $10,150 for single individuals
• $20,300 for married couples filing jointly
Or
• A flat dollar amount of $95 per adult family member age 18 and older, and $47.50 for each dependent under age 18. This amount is capped at $285 for Tax Year 2014.

One percent (1%) of income will begin to exceed the flat dollar amount when their modified adjusted gross income exceeds:

• $19,650 for Single individuals
• $39,300 for Married couples with no dependents
• $44,050 for Married couples with one dependent under age 18
• $48,800 for Married couples with two or more dependents under age 18

Put another way, Single individuals subject to a penalty will pay the flat dollar amount when their income is between $10,150 and $19,650. Once their income exceeds $19,650 they will pay 1% of their income.

Married couples subject to the penalty will pay the flat dollar amount when their income exceeds $20,300 and is below the income amounts above based on their family size. Once their income exceeds that amount they will pay 1% of their income.

If the taxpayer owes a penalty they must include it on their 2014 federal return.

Under the following circumstances, a taxpayer who does not have health insurance will not be subject to the penalty:

• Taxpayer does not have to file a federal income tax return because their income is below the filing threshold
• Taxpayer is uninsured for less than 3 months of the year
• The lowest cost health insurance coverage available to the taxpayer would cost more than 8% of their household income
• Taxpayer is in jail or prison
• Taxpayer is not lawfully present in the United States
• Taxpayer has a qualifying religious exemption
• Taxpayer is a member of one of the following:
• Federally recognized Indian tribe
• A recognized health care sharing ministry
• Taxpayer obtains a hardship exemption

For more information on when a taxpayer may qualify for a hardship exemption and how to apply for one, see How do I Qualify for an exemption from the fee for not having health coverage on the HealthCare.gov website.

Health Insurance Sign-up Date to Avoid Penalty Extended

The last day to sign up for health insurance and avoid an additional tax penalty has been extended to coincide with the open enrollment end date of March 31, 2014.  This was announced by the Obama administration on October 28, 2013.

Before this change, a person had to enroll by February 15, 2014 in order to ensure that their insurance went into effect before March 31, 2014 and avoid the possibility of being subject to a penalty for not having insurance for at least nine months out of the year under the Affordable Care Act.

Individual Requirement to Have Insurance and State Insurance Exchanges

As we near the open enrollment period for the individual insurance requirement, now is the time to become more familiar with what people without health insurance will need to do when October 1, 2013 arrives. Below are the highlights of what the Affordable Care Act requirements are for obtaining health insurance, how the enrollment process on a State Exchange will operate, and how the premium assistance subsidy will work.

Individual Requirement to Obtain Health Insurance

Everyone will be required to have health insurance that meets a minimum level of benefits beginning on January 1, 2014.

If a person does not obtain health insurance for 2014, they will be required to pay an additional tax when they file their 2014 Federal income tax return. The additional tax for 2014 will be calculated as the greater of:

• 1% of their income that exceeds their filing threshold based on their filing status; or
• $95 for the taxpayer and if applicable, the spouse and dependents not to exceed $285 for 2014. The additional tax for dependents under age 18 is $47.50 for 2014.

For a complete explanation of how the additional tax will be calculated, see the Individual Penalty for Not Having Health Insurance page on the CrossLink website.

State Exchanges and Premium Assistance Subsidy

People who do not have health insurance will be able to obtain it at the State Exchange located in their State of residence. The State Exchange will also determine the potential amount of premium assistance subsidy that individuals qualify for.

The subsidy is designed to help people pay for their 2014 health insurance premiums. It is essentially a pre-payment of the premium tax credit that will be calculated when they file their 2014 Federal income tax return.

Here is how the State Exchange will work:

• Most people will sign up with the exchange via the internet by creating an account and filling out an online application on their State Exchange's website.
• The Exchange will use the information from the application and their income from their 2012 Federal return to first determine if they are eligible for coverage under a government health insurance program such as Medicaid.
• If not eligible for a government program, the exchange will determine what their subsidy is.
• Finally, the person applying may select an insurance plan that is offered by their State Exchange.

For more information on State Exchanges, see the following pages on the Federal government's Healthcare.gov website:

• Welcome to the Marketplace
• Health Insurance Marketplace

Health Insurance Premium Subsidy
The Health Insurance Premium Subsidy is also known as the Advance Premium Tax Credit.

A person is eligible for a subsidy (advance premium tax credit) to help pay for their 2014 health insurance premiums if they obtain their insurance at a State Exchange and their income is between 100% and 400% of the Federal Poverty Line.

It is important to remind people that the subsidy does not pay for the entire premium and the subsidy is paid directly to the insurance company. Individuals must pay a minimum amount of the premium based on where they fall on the Federal Poverty Line.

The minimum amount a person must pay is calculated as a percentage of their income and it ranges from 2%, if they fall between 100% and 133% of the Federal Poverty Line, up to 9.5%, if they fall between 300% and 400% of the Federal Poverty Line.

For a more detailed explanation of how the subsidy is determined, see the Premium Assistance Subsidy page on the CrossLink website.

Affordable Care Act Update - Employer Reporting and Penalty Provisions Delayed for One Year

The employer penalty and reporting provisions under the Affordable Care Act have been postponed for one year until 2015. The Administration explained that this delay was necessary in order to simplify the reporting requirements and to give employers more time to adapt their reporting systems and become familiar with the affordability and minimum value standards for the health insurance plans they offer their employees.

This means that for 2014, employers with 50 or more full-time employees will not be subject to a penalty if they do not offer health insurance to their employees, or if they do offer insurance and they fail to meet the affordability and minimum value standards.

Also for 2014, the employer reporting requirements relating to the health insurance an employer offers their employees will be voluntary. The employer reporting requirements will be required beginning in 2015.

It is important to note that this postponement of the employer penalty and reporting provisions does not affect the requirement that all individuals must obtain health insurance for themselves and their family beginning in 2014.

For more information, see the following:

• IRS Notice 2013-45 - Transition Relief for 2014 Under Sec 6055 and 6056 (Information Reporting) and Sec 4980H (Employer Shared Responsibility Provisions)
• July 2nd U.S. Department of Treasury Notes (Continuing to Implement ACA in a Careful, Thoughtful Manner)
• January 2nd White House Blog (We're Listening to Businesses About the Health Care Law)