Tax Reconciliation Cheat Sheet
The Affordable Care Act (ACA) makes health insurance coverage more affordable for many Americans by providing federal premium tax credits (PTC) to eligible individuals purchasing a qualified health plan (QHP) through a health insurance marketplace with individual income below $46,680 in 2014 (or households earning under 400% of the federal poverty line). To help make coverage more affordable for everyone purchasing coverage through marketplaces, the ACA requires that all Americans purchase health insurance coverage or pay a penalty (also known as a “shared responsibility payment”) unless it’s unaffordable or they are exempt. The 2014 tax season will be the first year these new requirements apply and need to be considered in the tax filing process. What this means practically speaking is new terminology, new forms, new requirements, and new questions from tax filers before April 15, 2015. State officials, legislators and consumer assisters will need to understand what these new requirements and forms mean and how to use them.
Between this chart, this blog, and these additional resources, we cover: what the new forms are; who needs to file what forms; what happens if they don’t file the forms; how some people may be able to get money back; who’s exempt; and where people can get more help.
Know of something we should add to this compilation? You can reach Corinne Alberts at calberts@oldsite.nashp.org.
Between this chart, this blog, and these additional resources, we cover: what the new forms are; who needs to file what forms; what happens if they don’t file the forms; how some people may be able to get money back; who’s exempt; and where people can get more help.
Know of something we should add to this compilation? You can reach Corinne Alberts at calberts@oldsite.nashp.org.
| Form/Resource Name | IRS Form Number | Form Information | Other Things to Know |
| Health Insurance Marketplace Statement | 1095-A | What is it? A new form issued by a marketplace to all consumers who purchased a QHP through a marketplace. Both Federally Facilitated Marketplaces (FFMs) and State-Based Marketplaces (SBMs) are required to issue Form 1095-A.
What is it used for? Form 1095-A includes all information needed to complete Form 8962, which is used to determine eligibility for Premium Tax Credits (PTC) and reconcile Advanced Premium Tax Credits (APTC) already received.
Who needs it? (1) Tax filers who purchased a QHP through a marketplace and received financial assistance; and (2) Tax-filers who purchased a QHP through a marketplace and did not receive financial assistance. |
(1) All QHP Purchasers Will Get One: All consumers who purchased a QHP through a marketplace will receive a Form 1095-A, whether or not they received financial assistance from the marketplace;
(2) QHP Households May Get More than One: Households may receive multiple 1095-A forms if: (a) A consumer or members of the consumer’s household are enrolled in more than one plan; (b) There are more than five (5) people on the 1095-A; (c) A consumer had a change in circumstance; or (d) A consumer changed her insurance plan. Complete instructions for Form 1095-A are available here. |
| Premium Tax Credit | 8962 | What is it? A new form that individuals must complete to calculate an individual’s Premium Tax Credit (PTC) and reconcile it with any Advanced Premium Tax Credit (APTC).
What is it used for? To demonstrate eligibility for a PTC and reconcile with any APTC received to determine whether funds are owed to or from the federal government at tax filing.
Who needs it? (1) Tax filers who purchased a QHP through a marketplace and received financial assistance; and (2) Tax-filers who purchased a QHP through a marketplace and did not receive financial assistance. |
(1) Need Form 1095-A To Complete It: In order to complete Form 8962, a tax filer must have a complete and accurate Form 1095-A; (2) Must Include All Tax Filers in the Household: Everyone in the tax filer’s household must be listed on Form 8962; (3) Additional Incentive to Complete this Form: All consumers enrolled in a QHP through the Exchange may want to complete Form 8962, even if the consumer did not receive APTC because APTC is advanced payment, and an individual may be eligible for a PTC, distributed in a lump sum when taxes are filed, and the only method of determining the PTC is by completing Form 8962. |
| Health Coverage Exemptions | 8965 | What is it? The Form that individuals must complete to apply for an exemption from the individual mandate. This is also the form used to calculate an individual’s tax penalty, known as the shared responsibility payment, if the taxpayer failed to obtain health insurance coverage and did not have an exemption.
What is it used for? To apply for an exemption from the tax penalty for failure to have health insurance coverage and to determine the tax penalty owed.
Who needs it? Tax filers who did not have health insurance coverage during the tax filing year for a period more than 3 months. |
Forms and Process Differ for ACA and Marketplace Exemptions: For ACA statutory exemptions claimed on a tax return, the tax-filer will need to file the tax return and complete Form 8965. For marketplace-granted coverage exemptions, the tax filer will need the Exemption Certificate Number (provided by a marketplace once the marketplace has processed an exemption application and approved it) in order to complete Form 8965. Complete instructions for Form 8965 are available here. |
| Health Care Law: What’s New for Individuals & Families | 5187 | What is it? A resource guide published by the IRS.
What is it used for? It provides information that explains how taxpayers satisfy the individual shared responsibility provision by enrolling in minimum essential coverage, qualifying for an exemption, or making a shared responsibility payment. It also provides information about the new premium tax credit.
Who needs it? Anyone who wants more information about new requirements under the ACA for individual and families. |
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| CBPP: The Tax Preparer’s Guide to the Affordable Care Act | n/a | What is it? A resource guide for tax preparers published by the Center on Budget and Policy Priorities.
What is it used for? To educate tax preparers about new ACA requirements and help guide them through the tax filing process in light of the ACA.
Who needs it? Tax preparers |
Notes:
*Please note that individuals receiving Medicaid that meets minimum essential coverage (MEC) requirements are considered insured. If the Medicaid programs offered to an individual do not meet the MEC standards, the individual should qualify for an exemption.
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