1. HITCAP Overview: Let’s Talk ACA Tax Forms!
Volunteer Mini-Training June 2015

2. What Do You Need to Know? What are the new ACA tax forms?
The difference between APTC and PTC
How to answer basic questions about the new forms
How and where to refer callers who have questions about their tax forms
How to enter these calls in the CHA database

3. Terminology: Let’s Talk Terms
Premium Tax Credit (PTC): A credit that is used to help pay for health insurance purchased through a Marketplace, like nystateofhealth.ny.gov in New York
This tax credit is claimed:
When you file taxes
Or in advance during the year
Second Lowest Cost Silver Plan (SLCSP): Your county’s SLCSP is used to calculate your PTC based on your income
Minimum Essential Coverage (MEC): Health insurance that meets minimum standards set by the Federal Government

4. Terminology: Let’s Talk Terms
Federal Poverty Level (FPL): The Federal government sets the FPL to define the poverty income level
FPL is a factor for PTC eligibility
A NYSOH enrollee is eligible for PTC with incomes between 138%-400% FPL
Modified Adjusted Gross Income (MAGI): The threshold income level that is compared to FPL to determine the amount of an enrollee’s PTC
MAGI is shown on line 37 of the Form 1040

5. How is the IRS going to track all of this? Let’s Meet The New Forms!
Talking Points:
Introduce yourself.
How is the IRS going to track all of this? Let’s Meet The New Forms!

6. Meet the 1095-A: The Statement from the NYSOH
Will be sent to people who enrolled in a Bronze, Silver, Gold, or Platinum Marketplace plan
Catastrophic plans are not eligible for the PTC and will not receive this Form

7. Consumers Can Get Form 1095-A In Their NYSOH Account
NYSOH mails and posts the Form 1095-A online in inboxes by January 31st.

8. The Main Tax Form is the 1040

9. Form 8962: The Reconciliation Form
You complete this form if you received APTC or you want to claim PTC at the end of the year as a part of your taxes.

10. Process Timeline
By January 31: NYSOH sent 2014 enrollment information to QHP enrollees in January 2015
*Form 1095-A from NYSOH
February 1-April 15: Consumers reconciled APTC or claimed PTC on their federal tax return during tax filing season
*Used Form 1095-A from NYSOH to complete IRS Form 8962
Example: Juan is an unmarried adult with no dependents. He lives in Queens and enrolled in a Marketplace plan for 12 months in When Juan signed up for coverage, he estimated his 2014 income to be $28,000 (244% of FPL). Juan got an APTC of $111 per month and used the full amount towards his premium, for an annual total of $1,338.
When Juan completed his federal tax return, his actual 2014 income was $22,000 (191% FPL). The amount of PTC he was eligible for based on his actual income was $186 per month or $2,230 for the year.

11. Advance Premium Tax Credit
Rules for PTC v. APTC
Rules for
Premium Tax Credit
Calculated at tax filing time
Not paid in advance
Rules for the
Advance Premium Tax Credit
Monthly credits that reduce premiums
Based on estimated income
Must reconcile estimated and actual income with IRS
Rules for
Both
Just for NY State of Health plans
Not available on catastrophic plans

12. Other PTC Eligibility Rules
Eligibility rules to qualify for the PTC are:
Taxpayer must enroll in a health plan through NY State of Health
Taxpayer must be lawfully present in the United Stated of America
Married taxpayers must file a joint return
Taxpayer is not eligible for other MEC, like:
Employer-Sponsored Coverage
Government Sponsored Coverage (Medicaid, Medicare, VA, CHIP, etc.)

13. APTC v. PTC Timeline APTC TIMELINE
Taxpayer reconciles estimated income v. actual income
Taxpayer receives APTCs J M A S O N D F
2015
2016
Taxpayer applies for PTC using the IRS Forms*
PTC TIMELINE
Taxpayer doesn’t take APTCs and pays the full monthly premium J M A S O N D F
2015
2016
Reconciliation: Truing Up Those APTCS
Enrollment = A taxpayer who gets financial assistance estimates his or her 2015 income to determine the amount of APTC. She takes some, all or none of the APTC.
2014 Income = Taxpayer figures out actual 2014 income which may be the same as, more or less than the estimated income.
Tax Time = Taxpayer reports their actual income and reconciles their PTC in their taxes.
*Remember = No reconciliation is required for PTC if it was not taken in advance.
Taxpayers use Form 8962 to claim the credit.

14. Must pay back everything
APTC Repayment Cap
Enrollee’s income determines whether they will have to pay back excess credits to the IRS.
If your household income is:
Filing Single
Other Filing Status
Less than 200%
At least 200 but less than 300%……
At least 300 but less than 400%
$300
$750
$1,250
$600
$1,500
$2,500
400 or more…………………………..
Must pay back everything
Example: Bob estimates his 2014 income to be $20,000. He is single individual with no dependents, enrolled in a Marketplace plan for all 12 months in 2014 and Bob used $3,459 in APTCs. When Bob did his 2014 taxes, he learned his 2014 actual income was $28,000 (244% of FPL). Bob should have only got $2,292 in APTCs. This means he would have to repay $1,166 to reconcile his PTC. However, because his repayment is more than the cap for his income level, Bob needs to only give back $750.

15. Reminder: What if you are uninsured in 2015?
Coverage is required for everyone, unless exempt.
Penalty is prorated by coverage months.
No penalty if uncovered for less than a gap of 3 months.
One-Day Rule: Coverage for one day in a month counts as coverage for the whole month.
Individual Shared Responsibility Payment
Coverage year
Whichever is greater
2014
$95 per adult
1% of family income
2015
$325 per adult
2% of family income
2016
$695 per adult
2.5% of family income

16. Example: Michael, Brooklyn Part I
Michael had no MEC in What can he expect when he finalizes his taxes? He made $40,150 in taxable income in 2015 What is Individual Shared Responsibility Payment for him?
The payment in 2015 is $325 or 2% of the income above the filing threshold. Michael will pay the greater of $325 or:
$40,150 (household income) - $10,150 (individual filing threshold) = $30,000 x 2% = $600.
Michael will pay $600 in additional taxes. This amount will increase each year. In 2016, Michael can expect to pay $750 (2.5% of annual income) .To avoid this, Michael should check out his options on NY State of Health.

17. Entering HITCAP Cases in the CHA Database
HITCAP cases should always go in the CHA database
Always ask callers how they found out about us
Funding source is HITCP
Leave detailed notes, just like CHA cases
Primary case handler should be Emily Clark

19. Funding Source: HITCAP

22. Time to Test What You Have Learned
What is the difference between PTC and APTC?
What are the benefits of one or the other?
What is Reconciliation? When it is needed and how does it work?
What is the Form 1095-A?
Who will receive a copy?
What should a consumer do with it?
How can you help a client to understand why they are receiving a new tax Form?
How can you access the 1095-A?
What do you do if there are errors? 30

23. What Kind of Help Can We Provide
APTC and PTC
The basic differences between them
Form 1095-A
What the form is and why it is important
Who receives the forms and where recipients can access them
Where to send recipients for more information

24. What Kind of Help We Should NOT Provide
We cannot provide any tax advice to callers
Examples of tax advice:
How to complete Form 8962 or Form 1040
Who to claim as a dependent
How to report healthcare coverage on a tax return
Whether a consumer will have to pay back tax credits or will get additional tax credits
Whether a consumer will have to make an Individual Shared Responsibility Payment (penalty for not having coverage)

25. Who Can Help Consumers? CHA (HITCAP) CHA can help with:
Education about the PTC, new IRS Forms
Explaining to a consumer how they can access their 1095-A
Helping a consumer select the correct SLCSP
Explaining the repayment cap if the consumer underestimated their income
NYSOH is available at
NYSOH can help when:
A consumer needs a replacement 1095-A Form
A consumer would like to request a corrected 1095-A
IRS is responsible for answering all questions related to tax advice.
The IRS is available at
VITA/TCE provides free tax assistance at sites throughout NY State.

26. Resources NY State of Health
Form 1095-A Cover Letters
SLCSP table
FAQ on Form 1095-A
Additional Consumer Materials
Webinar hosted by NYSOH:
IRS Information: Act/Individuals-and-Families/The-Premium-Tax-Credit
Tax Preparers 32

27. Questions?