irs form 1095-a talking points - covered california · 2020-07-06 · irs form 1095-a talking...

IRS FORM 1095-A

TALKING POINTS January 20, 2015

of 22 IRS FORM 1095-A Talking Points

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January 20, 2015 - Covered California updated:

IRS Form 1095-A important notes ROLES AND RESPONSIBILITIES FOR THE IRS FORM 1095-A & IRS FORM 8962 under

Covered California and Consumers

BACKGROUND

Effective January 1, 2014, under the Affordable Care Act (ACA), most individuals are required to enroll in health care coverage that meet the minimum essential coverage standards outlined in the ACA or else they may have to pay a penalty when they file their federal income taxes. Individuals can apply for a health coverage exemption as one of the three choices they have under the mandate: 1) coverage 2) exemption and 3) penalty. Individuals filing their federal income taxes must be able to prove they (the taxpayers and their dependents) were enrolled in qualifying health care coverage. Therefore, the Internal Revenue Service (IRS) created forms for taxpayers to use when filing their federal income taxes. These forms will be covered in the next few sections of this document.

The ACA also requires health care exchanges (marketplaces) like Covered California to report consumers’ health care coverage information to the IRS to ensure individuals are meeting health care coverage requirements. In addition, Covered California is required to mail an IRS Form 1095-A (see Exhibit A) to its enrollees at the beginning of each year that details the amount of the Advanced Premium Tax Credit (APTC) received, if applicable.

There are three types of IRS Forms 1095, as listed below. No federal requirement has been mandated for Medicaid (Medi-Cal) programs administrators, health insurance carriers, and employers to provide IRS Forms 1095 to their consumers for the 2014 calendar year.

IRS Form 1095-A: provided by health care exchanges (marketplaces – Covered California in California)

IRS Form 1095-B: will be provided by Medicaid programs (Medi-Cal in California) but they are not required to provide to consumers for the 2014 calendar year

IRS Form 1095-C: will be provided by health insurance carriers or employers with sponsored health plans but they are not required to provide to consumers for the 2014 calendar year

IRS FORM 1095-A

IRS Form 1095-A (also called the “Health Insurance Marketplace Statement”) will be used by all Health Care Exchanges.

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IRS Form 1095-A details Covered California consumers’ 2014 coverage and contains information that is needed to help consumers validate the amount of APTC they may have received or, if they have not received APTC, to see if they might be eligible to receive a lump sum Premium Tax Credit (PTC) when they file their federal income taxes. The PTC will reimburse consumers for some of the premiums they’ve paid for coverage in 2014. This eligibility evaluation is done by the consumer or tax preparer on IRS Form 8962 (Premium Tax Credit (PTC)).

Covered California mails the Form 1095-A to both the IRS and the individual consumer listed as the primary tax filer on the Covered California application. The form will be prepopulated with information reported by the tax filer when they applied for health insurance through Covered California (with any reported changes).

Consumers will use the information listed on the Form 1095-A in order to complete IRS Form 8962. Consumers must complete IRS Form 8962 (see Exhibit B) and file it with their federal income tax return if they want to claim the Premium Tax Credit or if they received APTC for at least one month in 2014 (whether or not they are required to file a tax return).

If consumers or their family members enrolled in more than one health insurance plan, also known as a Qualified Health Plan (QHP), through Covered California, they will receive a different Form 1095-A for each health insurance plan, but will only need to complete one IRS Form 8962.

IMPORTANT NOTE: o Covered California issued an IRS Form 1095-A to consumers who are enrolled in

a Minimum Coverage Plan (Catastrophic plan). However, these individuals do not have to use this Form 1095-A when filing their federal income taxes.

o Covered California will not issue an IRS Form 1095-A to consumers who purchased health plans through Covered California’s Small Business Health Options Program (SHOP).

o Department of Health Care Services (DHCS) will not issue an IRS Form 1095-B to consumers who are enrolled in the Medi-Cal Program for the 2014 calendar year.

o Consumers who were enrolled in either a Minimum Coverage Plan or in Medi-Cal for the whole 2014 calendar year will not need to complete the IRS Form 8962 since they were not eligible for premium tax credits (premium assistance).

o Consumers who were enrolled in both a health insurance plan through Covered California and in Medi-Cal will only receive an IRS Form 1095-A that reflects the Covered California coverage.

IRS Form 8962

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IRS Form 8962 is the federal tax form that requires individuals to prove that they (the taxpayers and their dependents) were enrolled in health care coverage when filing their federal income tax return.

IRS Form 8962 will be used to calculate the consumer’s eligibility for, and the amount of, Premium Tax Credit (PTC) they are eligible to receive to help make their health insurance coverage more affordable. The consumer’s information on the IRS Form 8962 is compared to the amount of APTC the consumer may have already received in 2014. If they have received too much, they may have to pay back some or all of the tax credits that have been paid for their health care coverage premiums. If they have received too little in APTC, they may be eligible to be paid the extra amount they should have received in the form of a tax refund or PTC.

If consumers chose to be considered for affordability programs such as APTC when they applied for coverage through Covered California, Covered California estimated APTC eligibility at that time by using information about their household and their estimated 2014 yearly Modified Adjusted Gross Income (MAGI) that they provided on their application. IRS Form 8962 will help them determine if they have received too much or too little in APTC, based on what they truly earned and are reporting on their taxes for 2014

For those consumer households that did not receive APTC in 2014, the IRS Form 8962 will help them see if they should have received tax credits for any month in 2014, based on their information when they file their federal income tax return. If they are eligible for tax credits based on the information in Form 8962, they may be eligible to receive the amount of tax credits they should have received throughout 2014 in the form of a tax refund (PTC).

Consumers filing their federal income taxes will need to use their IRS Form 1095-A to prepare the IRS Form 8962. The IRS provides specific instructions on how to understand the form and the information needed to complete it. Visit: http://www.irs.gov/pub/irs-pdf/f8962.pdf or got to www.irs.gov and type in “8962” or “Premium Tax Credit (PTC)” in the search bar.

ROLES AND RESPONSIBILITIES FOR THE IRS FORM 1095-A & IRS FORM 8962

Covered California:

Generates and mails the IRS Form 1095-A with a consumer notice (see Exhibit C – English draft) to applicable consumers enrolled in Covered California and to the IRS. Consumer notices will be generated in the following languages: English, Spanish, Chinese, Korean, and Vietnamese. For assistance in other languages consumers should refer to page 6 of the notice.

http://www.irs.gov/pub/irs-pdf/f8962.pdf


http://www.irs.gov/

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Makes changes to the IRS Form 1095-A as reported and resends to consumers and the IRS.

Will not send IRS Form 1095-A to: o Consumers who purchased health plans through Covered California’s SHOP, and o Consumers enrolled in Medi-Cal, including individuals enrolled in Medi-Cal who

are part of a Mixed Household. Read more information about the Mixed Household status starting on page 6 of this document.

Consumers:

Review the IRS Form 1095-A to ensure all their information is correct. Report to Covered California if there are changes or discrepancies in the APTC amounts

that need corrections. Consumers can compare the APTC amounts on the IRS Form 1095-A with their health insurance plan invoice.

Discrepancies with the health insurance plan premium amounts or APTC amounts should be reported using the Covered California Consumer 1095-A Dispute Form (See Exhibit D draft).

Discrepancies with Name, Date of Birth, Social Security Number, and Address can be reported to the Covered California Service Center or the local county social services office for Mixed Households (households with consumers enrolled in both Medi-Cal and Covered California). Discrepancies with APTC and any other information on the form that needs to be reconciled can only be accomplished via the 1095-A Dispute Form.

Consumers that have not received an IRS 1095-A Form during the first week of February should contact the Covered California Service Center or log into your CoveredCA.com account and go to your secured mailbox to see if there is a 1095-A available for you to download.

Use the IRS Form(s) 1095-A to file their federal income taxes via the IRS Form 8962. Use the IRS Form 8962 to calculate the actual premium tax credit as determined by their

actual tax household size and income for the 2014 calendar year. Can apply for a health coverage exemption by filling out one of the exemption forms

available at healthcare.gov or by filing IRS Form 8965, Health Coverage Exemptions, to claim a coverage exemption on their federal income tax filing.

Certified Enrollment Counselors (CECs), Plan-Based Enrollers (PBEs), and Certified Insurance Agents (CIAs):

Educate consumers about the IRS Form 1095-A purpose and how to read it. Help consumers notify Covered California when there are discrepancies on the IRS Form

1095-A. Discrepancies with names, dates of birth, social security numbers, and addresses can be reported to any Covered California Service Center or the local county

https://www.healthcare.gov/fees-exemptions/apply-for-exemption/


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social services office for Mixed Households (households with consumers enrolled in both Medi-Cal and Covered California). Any other discrepancies that need to be reconciled, including plan and APTC information, can only be accomplished via the 1095-A Dispute Form.

Know the tax penalty rules and how they work. Reference the FAQ for more information.

Do NOT provide or give tax advice to consumers on how to file their federal income taxes.

Do NOT fill out federal tax forms.

IRS FORM 1095-A RECONCILIATION

This section covers how you can help consumers report discrepancies that need to be changed to Covered California. Consumers, Certified Insurance Agents, Certified Enrollment Counselors, and Plan-Based Enrollers may contact any Covered California Service Center to report only the following discrepancies on the IRS 1095-A Form:

Name

Date of Birth

Social Security Number (SSN)

Home or Mailing Address

Consumers should use the Covered California Consumer 1095-A Dispute Form (Exhibit D) to report discrepancies on their IRS 1095-A Form for these types of coverage information:

Incorrect APTC amount listed

Incorrect months of coverage listed (for example: the Form 1095-A shows that you were enrolled for certain months when you were not)

Months of coverage not shown

Incorrect covered individual start date or end date

Incorrect policy start date or end date

The final version of the Covered California 1095-A Dispute Form will be posted on our website towards the end of January 2015.

REVISED IRS FORM 1095-As

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• A revised or corrected Form 1095-A will have the “Corrected” box at the top checked to indicate that the IRS Form 1095-A was corrected from the original form.

• Consumers may need to file an “amended” federal income tax return if:

o Consumers filed their federal income taxes before they received their IRS Form 1095-A from Covered California.

o Consumers did not use the information from the latest corrected IRS Form 1095-A to file their federal income taxes if changes were made to the original IRS Form 1095-A.

• For more information, consumers can visit www.irs.gov and enter the keywords “amended return” in the search bar.

MULTIPLE IRS FORMS 1095-A

Reasons why consumers may receive more than one IRS Form 1095-A for one calendar year:

• Consumer households that contained individuals that were enrolled in more than one health insurance plan during the 2014 calendar year will receive multiple IRS Forms 1095-A (one for each health insurance plan).

o For example, if they were enrolled in Health Net from January 2014 through June 2014 and then enrolled in Kaiser Permanente July 2014 through December 2014, the primary tax filer in the consumer household will receive two IRS Forms 1095-A. One for Health Net and another for Kaiser Permanente.

• Consumers changed their health plan level, also known as “metal tier level”, during the 2014 calendar year.

o For example, consumers changed their health plan level or “metal tier” from Silver to Gold, but did not change their health insurance carrier.

• Consumer households that contained individuals who were not all enrolled in the same health insurance carrier plan.

o For example, Mom, who is a member of a Federally Recognized Indian Tribe, was enrolled in an Indian Tribe plan that has special benefits available to only tribe members. Dad and the children were enrolled in Covered California Western Health Advantage.

http://www.irs.gov/

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• Households with more than four members may receive multiple pages of the form. Part II of the form will list the other household members, while the other sections of the form will contain the same information.

MIXED HOUSEHOLDS (COVERED CALIFORNIA & MEDI-CAL)

Households with at least one member enrolled in Covered California, and at least one member enrolled in Medi-Cal, are referred to as Mixed Households. DHCS will not be sending the IRS Form 1095-B to consumers enrolled in Medi-Cal during the 2014 calendar year. Therefore, Mixed Household consumers will use the IRS Form 1095-A issued by Covered California to report APTC received for the Covered California consumer(s) and provide attestation on their federal tax filing stating that the Medi-Cal consumer had health coverage for the 2014 calendar year.

In an effort to protect the Medi-Cal consumer, Covered California representatives must refer the Medi-Cal consumer to the local county social service offices to make any personal information (name, date of birth, social security number, address) changes needed to a Mixed Household’s case.

Discrepancies to the health insurance plan premium amounts or APTC amounts for Mixed Households should be reported to Covered California Service Center or via the Covered California 1095-A Dispute Form.

RESOURCES

• IRS Instruction Manual: http://www.irs.gov/pub/irs-pdf/p5187.pdf o IRS Form 1095-A, Health Insurance Marketplace Statement:

http://www.irs.gov/pub/irs-pdf/f1095a.pdf o IRS Form 8962, Premium Tax Credit (PTC): http://www.irs.gov/pub/irs-

pdf/f8962.pdf

• Federal Health Care Exchange Marketplace: https://www.healthcare.gov/fees-exemptions/fees-exemptions-overview/

• Covered California Reconciliation Information: http://hbex.coveredca.com/stakeholders/plan-management/PDFs/APTC%20Letter%20(v2)%20DRAFT.pdf

• Covered CA Tax Credit FAQ’s: http://www.coveredca.com/faqs/Tax-Credits/ • Volunteer Income Tax Assistance: Free tax assistance for consumers who generally has

an annual income of $53,000 or less, persons with disabilities, and the elderly and

http://www.irs.gov/pub/irs-pdf/p5187.pdf

http://www.irs.gov/pub/irs-pdf/f1095a.pdf



https://www.healthcare.gov/fees-exemptions/fees-exemptions-overview/

https://www.healthcare.gov/fees-exemptions/fees-exemptions-overview/

http://hbex.coveredca.com/stakeholders/plan-management/PDFs/APTC%20Letter%20(v2)%20DRAFT.pdf

http://hbex.coveredca.com/stakeholders/plan-management/PDFs/APTC%20Letter%20(v2)%20DRAFT.pdf

http://www.coveredca.com/faqs/Tax-Credits/

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limited English speaking taxpayers. To find help, consumers can call 1-800-906-9887 or check online at www.irs.treasury.gov/freetaxprep/.

COVERED CALIFORNIA SERVICE CENTERS

Consumers Covered California Consumer Service Center

1-800-300-1506

Monday through Friday, 8:00 AM – 8:00 PM

Saturday and Sunday, 8:00 AM – 6:00 PM

Certified Insurance Agents Covered California’s Agent Service Center 1-877-453-9198 E-mail: [email protected] Monday thru Friday, 8:00 AM to 8:00 PM Saturdays, 8:00 AM to 6:00 PM

Open some Sundays during Open Enrollment. Check the January Agent Service Center calendar for availability.

Certified Enrollment Counselors & Plan-Based Enrollers

CEC/PBE Help Line

1-855-324-3147

Monday through Friday, 8:00 AM – 8:00 PM

Saturday and Sunday, 8:00 AM – 6:00 PM

http://www.irs.treasury.gov/freetaxprep/

mailto:[email protected]

http://echo4.bluehornet.com/ct/53835187:28856402014:m:1:2843507983:9D15CC23222835FBBB842F39D45B0B3B:r

IRS FORM 1095-A

Exhibit A January 9, 2015


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IRS FORM 8962

Exhibit B January 9, 2015


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DRAFT CONSUMER 1095

NOTICE ENGLISH: 7 Pages

Exhibit C January 9, 2015


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DRAFT CONSUMER 1095

DISPUTE FORM: 5 Pages

Exhibit D January 9, 2015


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irs form 1095-a talking points - covered california · 2020-07-06 · irs form 1095-a talking...

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