Individuals Who Opted to Not Take Advance Premium Tax Credit and Form 1095-A (Health Insurance Marketplace Statement)

If an individual opted to not receive an advance premium tax credit (subsidy) when they obtained their health insurance through the Federal Marketplace, the Form 1095-A (Health Insurance Marketplace Statement) that they receive will have zeros in Part III, column B (Monthly Premium Amount of Second Lowest Cost Silver Plan – SLCSP) for the months that they had health insurance in 2014.

In order for these individuals to be able to calculate a premium tax credit on Form 8962 (Premium Tax Credit), they must enter an amount greater than zero for the Second Lowest Cost Silver Plan in Part II, column B. To determine what this amount should be, the individual can use the Find 2014 Silver Plan Premium look up tool on the healthcare.gov website.

Here is the information an individual will need to determine the Second Lowest Cost Silver Plan amount using the tool:

• Zip Code and County where they lived each month in 2014
• Age of each family member covered
• Months each family member was covered and was not eligible for other coverage outside the marketplace.

If the individual obtained their insurance through one of the 15 State Marketplaces and did not receive a subsidy, then Form 1095-A, Part III, column B may contain zeros for the months that they had health insurance during 2014. If this is the case, they will need to go to the applicable State Marketplace website to determine what the Second Lowest Cost Silver Plan amount should be as follows:

• California – Form 1095-A Information
• Colorado – Find the Second Lowest Cost Silver Plan Premium
• Connecticut – Silver Plan Premium Calculator
• District of Columbia – SLCSP Calculator
• Hawaii – Contact Information
• Kentucky – Benchmark Plan Tool
• Maryland – SLCSP Worksheet
• Massachusetts – General website
• Minnesota – Silver Plan Look up Tool
• Nevada – SLCSP Table
• New York – SLCSP table
• Oregon – SLCSP Lookup Tool
• Rhode Island – Tax FAQs page
• Vermont – Tax Questions page with SLCSP information
• Washington – SLCSP Lookup Tool

Form 8962 (Premium Tax Credit) and Related Form 1095-A (Health Insurance Marketplace Statement)

As we approach the 2015 filing season, now is a good time to clarify how the new Form 8962 (Premium Tax Credit) is laid out and how the Form 1095-A (the information an individual will receive from the Marketplace) is related to the calculation of the premium tax credit for Tax Year 2014.

Form 1095-A (Health Insurance Marketplace Statement)
Any taxpayer who obtained their health insurance through a federal or state exchange (Marketplace) will receive Form 1095-A (Health Insurance Marketplace Statement) in the mail by January 31, 2015. The information on this form will be used to calculate the Premium Tax Credit, especially if the individual received assistance in paying for their health insurance premiums (advance premium tax credit).

Since this information return looks very different from a W-2 or 1099 that an individual is used to receiving, some education for your customers will be necessary to ensure that they understand what Form 1095-A is for and the importance for them to keep it and include it with the rest of their tax information when they have their 2014 federal tax return completed.

If the taxpayer loses the Form 1095-A, a copy may be obtained from the Marketplace where they received their health insurance.

The Form 1095-A (Health Insurance Marketplace Statement) will show the taxpayer the following information:

• Advance premium tax credit (subsidy) they received (if any) to help pay for their monthly premiums. This is shown by month in Part III along with the total for the year. The information reported in Part III will be used to complete Form 8962 (Premium Tax Credit), Part 2 (Premium Tax Credit Claim and Reconciliation of Advance Payment of Premium Tax Credit).
• Health insurance coverage information including a listing of all members of the household who were covered.

See the current draft of Form 1095-A to see how it looks and how it is different from other information returns such as a W-2 or 1099.

Form 8962 (Premium Tax Credit)
This form will be used by any taxpayer who obtained their insurance through the Marketplace and are eligible for the premium tax credit. In most cases, the taxpayer will have received an advance premium tax credit (subsidy) during the year to help pay their monthly health insurance premiums.

It is important to remember that any taxpayer who received a subsidy must complete Form 8962 and reconcile the calculated premium tax credit based on their actual 2014 income and family size with the advance premium tax credit (subsidy) that they received during the year. Also remember that the subsidy went directly to the insurance company and not the taxpayer.

If the taxpayer is required to include the Form 8962 (Premium Tax Credit) with their return and they do not, the following will occur:

• The IRS will not complete processing the return until they receive the Form 8962. This means their refund will be delayed and they will receive a notice from the IRS requesting the Form 8962 be completed and sent to them.
• The taxpayer can be denied an advance of the premium tax credit (subsidy) in future years.

See the current draft of Form 8962 to see what it looks like and how the credit is calculated.

To recap, any individual who obtained their health insurance through the marketplace will receive a Form 1095-A (Health Insurance Marketplace Statement) in the mail by January 31, 2015. If they opted (as most individuals will have done) to receive an advance premium tax credit (subsidy) to help pay for their monthly health insurance premiums, that information will be reported on the Form 1095-A which must be included on Form 8962(Premium Tax Credit) as part of the calculation of their premium tax credit and included with their 2014 federal individual income tax return.

Finally, remember that the calculation of the Premium Tax Credit is a three-step process as follows:

• Step 1 – Calculate the actual premium tax credit for 2014 based on the taxpayer’s 2014 income and family size.
• Step 2 – Enter the advance premium tax credit that the taxpayer received each month of 2014.
• Step 3 – Subtract the advance premium tax credit from the calculated premium tax credit which will result in a:
• Refundable credit if the calculated credit is greater than the total advance premium tax credit (which will be reported on Form 1040, line 69); Or
• Additional Tax if the total amount of advance premium tax credit is greater than the calculated premium tax credit (which will be reported on Form 1040, line 46).

IRS Update: Change in Income or Family Size During 2014 and the Advanced Premium Tax Credit (Subsidy)

For individuals that received an advanced premium tax credit (subsidy) to help pay for their 2014 health insurance premiums, it is important to report any change in their circumstances (such as in their income or family size) to the Health Insurance Marketplace (Exchange) where they obtained their insurance. This is important because any change in circumstances for an individual can affect the subsidy amount that was calculated when they first signed up for health insurance.

The subsidy is actually an advance of the 2014 premium tax credit which is paid directly to an individual’s health insurance provider each month. This amount will be reconciled with the actual premium tax credit that will be calculated on the individual’s 2014 federal return (which is based on the 2014 income and family size reported on it).

The impact of this reconciliation to the individual is as follows:

• A refundable credit will occur if the actual credit is greater than the subsidy received.
• An additional tax will be due if the subsidy received is greater than the actual credit.
• Read More

Click here to read the entire CrossLink Tax Update that includes further information on changes in income or family size during 2014 and how it affects the advanced premium tax credit subsidy.