Friday, January 9, 2015

Available ACA Documents

Available ACA Documents
  • What are we looking for?
  • We need Form 1095-A/B/C
  • 1095-B&C are voluntary this year, but you should see some of them.
  • Without Form 1095, we'll need to ask for:
    • your insurance cards,
    • monthly payment verification, or
    • year-end pay-stubs showing premium payments
  • Was it family coverage?
  • MEC compliant? 10 Essential Health Care Benefits:
    1. Ambulatory services
    2. Emergency services
    3. Hospitalization
    4. Maternity & Care for New-born babies
    5. Pediatric services
    6. Preventive & wellness care (e.g. flu shots, vaccinations, once per year physical or twice per year physical if diabetic) These should be covered 100% with NO deductible.
    7. Prescription drugs
    8. Mental health & substance abuse
    9. Rehabilitative services & devices
    10. Lab fees
  • Minimum Essential Coverage (MEC) requires 60% minimum coverage
  • Do the best you can under the circumstances and make copies
  • Taxpayers receiving coverage through state-approved exchanges or federal marketplace will receive Form 1095-A (Hold onto it! I have to have that.)
  • Retiree coverage (Medicare) qualifies as MEC. Part A is FREE, as long as you pay for Part B. No further worries.
  • If you are a non-citizen filing a 1040-NR or a US citizen living abroad (US Military is covered), you are exempt
  • US Territories (Puerto Rico, US Virgin Islands, Guam, Mariana Islands, American Samoa, Federated Micronesia, Midway Islands, Marshall Islands et. al) automatic MEC (exempt)
  • HRA's must be integrated with a MEC policy, i.e taxable (Must have full coverage in place; regardless, using bona-fide health care insurance policy) 
  • Exempt from ACA "penalty" Shared Responsibility Payment
    • When premium exceeds 8% of household income
    • Households below "filing threshhold"
      • Single $10,150
      • Couple $20,300
    • Native Americans "federally recognized tribe" (approx. 566 tribes listed in National Register)
    • Short-lapse of coverage (3-months or less)
    • Dependents themselves are exempt (Parent/Guardian are NOT excused from child's penalty). (Note: Finalized Adoption establishes responsible party for health care coverage)
    • Non-resident aliens & non-citizens
    • Religious sect objection to health care benefits
    • Member of Health Care Sharing Ministry under §501(c)(3)
    • Incarcerated persons
    • Citizens living outside the US
    • Other Exempt Certificate Number (ECN) 
  • HHS Special Hardship Exemptions:
    1. Homeless
    2. Evicted in past 6 months
    3. Received shut-off notice from utility company
    4. Recently experienced domestic violence
    5. Death of close family member
    6. Experienced fire, flood, or other natural or human-caused (e.g. arson) disaster
    7. Filed for Bankruptcy in past 6 months
    8. Unable to pay medical bills in last 24 months
    9. Unexpected increase in necessary expenses due to caring for ill, disabled, or aging family member (loved-one disrupts your ability to pay living expenses)
    10. Dependent child denied coverage (Must apply for Medicaid or CHIP before exempt for child penalty only).
    11. Eligible appeals decision
    12. Those eligible for Medicaid under ACA, who were denied Medicaid (because state opted-out)
    13. Current health insurance plan cancelled or MarketPlace plan unaffordable to you (8%)
    14. Any other hardship in obtaining health insurance
"Did you have health insurance for the entire year for your family?"
"Where did you purchase your health insurance?"
Taxpayers should be able to validate their answers.