The Affordable Care Act contains comprehensive health insurance reforms and tax provisions that affect individuals, families, businesses, insurers, tax-exempt organizations and government entities. These tax provisions contain important changes, including how individuals and families file their taxes.
American taxpayers and dependents must have minimum, essential health insurance coverage throughout the year unless they qualify for an exemption. Some common exemptions apply to individuals who aren’t required to file a tax return because of income threshold, members of Indian tribes and members of a recognized religious sect with religious objections to insurance.
People who don’t have health coverage through a job, Medicare, Medicaid, the Children’s Health Insurance Program or another source that provides minimum essential coverage can purchase insurance using the Health Insurance Marketplace, or www.healthcare.gov.
Employer-provided health care coverage, health insurance bought through the Health Insurance Marketplace, Medicare, most Medicaid coverage and most health care coverage provided to veterans and active-duty service members qualify as minimum essential coverage.
For coverage beginning Jan. 1, 2016, open enrollment begins Nov. 1. You can’t buy a health insurance plan through the marketplace after Jan. 31 unless you have a life change that qualifies you for a special enrollment period.
Several tax forms indicate the months an individual and their dependents have minimum essential health coverage.
If you purchased coverage through the Health Insurance Marketplace, the marketplace will send form 1095-A to a taxpayer. This form provides information needed to complete form 8962 (see below for more information).
Form 1095-B is sent to the taxpayer by an insurance company, and it is needed for a tax return of an individual, spouse and dependents who had minimum essential coverage for some or all months.
Form 1095-C is sent to the taxpayer by an employer to give information on health insurance offered by an applicable large employer (more than 50 full-time equivalent employees).
If you don’t have coverage in 2016, you’ll pay a penalty of 2.5 percent of your income or $695 per adult – whichever is higher.
Eligible individuals and families with low or moderate income may qualify for a Premium Tax Credit, or a refundable tax credit that can be advanced. The credit can be paid in advance to the insurance company to lower the monthly premium payment, or it can be claimed all at once on a tax return.
If the taxpayer received an advance payment, then the individual must file form 8962 (Premium Tax Credit) to reconcile the credit amount with the actual credit when the tax return is filed. Form 1095-A (Health Insurance Marketplace Statement) provides the information you need to complete form 8962.
If you must repay any excess advance payments of the premium tax credit, you must report the information on line 46 (excess advance premium tax credit repayment).
If you are claiming the premium tax credit and did not benefit from advance payments, you must claim the credit on line 69 (net premium tax credit).
Lines 61 and 62 are also applicable if the taxpayer has minimum essential coverage or owes a shared responsibility payment. There is also a checkbox to indicate if the taxpayer had full-year coverage.
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