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Reporting Health Insurance Coverage for Individuals and Families:

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Presentation on theme: "Reporting Health Insurance Coverage for Individuals and Families:"— Presentation transcript:

1 Reporting Health Insurance Coverage for Individuals and Families:
Individual Shared Responsibility Provision & Premium Tax Credit Hello, I’m Kris Ashley and I want to thank you attending today’s presentation. Today I am here to discuss the 2 key tax provisions that will affect everyone’s 2018 federal income tax returns. These are the Affordable Care Act’s Individual Shared Responsibility Provision (ISRP) and the Premium Tax Credit (PTC). Kris Ashley Stakeholder Partnership Education & Communication (SPEC) Internal Revenue Service

2 Agenda Individual Shared Responsibility Provision (ISRP)
Minimum Essential Coverage Coverage Exemptions Form 8965, Health Coverage Exemptions Health Insurance Premium Tax Credit (PTC) Eligibility Advance Payments of Premium Tax Credit Form 8962 , Premium Tax Credit Resources Here is the agenda for today’s session: Individual Shared Responsibility Minimum Essential Coverage Coverage Exemptions Form 8965, Health Coverage Exemptions Health Insurance Premium Tax Credit (PTC) Eligibility Advance Payments of Premium Tax Credit (APTC) Form 8962 , Premium Tax Credit Resources – we’ll talk about some of the resources that are out there, to help taxpayers and help you.

3 Tax Terminology…. The “Health Care Assister’s Guide to Tax Rules” booklet also has a good general explanation of most of these terms.

4 Filing Status Single – not legally married on Dec. 31 of the tax year
Married Filing Jointly – legally married on Dec. 31; includes taxpayers whose spouse passed away after the start of the tax year. Married Filing Separately – legally married but doesn’t want to file joint If MFS, then NOT eligible for Premium Tax Credit unless qualified for an exception as a victim of domestic violence To help your clients make the best estimate they can when claiming the Advanced PTC, you need to understand some income tax concepts that you might not have really considered before. I’ve been working to learn some of the Marketplace language – now I’ll teach you some of our IRS language.

5 Filing Status Head of Household Unmarried (or “considered unmarried”)
Paid more than ½ the cost of keeping up the home where taxpayer lived with a qualifying person for more than ½ the year (exception if the qualifying person is a parent) Qualifying person can be child, or a close relative that is also claimed as a dependent. A married taxpayer can be “considered unmarried” for Head of Household if: Lived apart from spouse for the entire last 6 months of the year Qualifying person must be child or step-child taxpayer can claim as dependent Head of Household is one of the trickier tax law concepts. For an unmarried person who is providing a home for dependent children, or certain other dependents, Head of Household will usually give a better bottom line that filing Single. But the taxpayer has to meet ALL the criteria: If a person meets some of the tests, but not all – then they cannot use Head of Household.

6 Filing Status Qualifying Widower
Spouse died in 2016 or 2017 (not 2018) Paid more than ½ the cost of keeping up the home where TP lived with a dependent child or stepchild for more than ½ the year AND Not remarried

7 Who is the “tax family”? The tax family consists of:
the individual (unless someone else can claim as a dependent) their spouse if filing jointly (unless someone else can claim as a dependent); and any dependents listed on the taxpayers Form 1040 or Form 1040NR For purposes of the PTC, a tax family consists of the individual as long as they can't be claimed as a dependent on someone else's tax return; their spouse if filing jointly as long as they can't be claimed as a dependent on someone else's tax return; and any dependents listed on the taxpayers Form 1040 or Form 1040NR Due to some of the changes under the Tax Cuts and Jobs Act, the wording of the definition of “tax family” has changed a little bit, but the basic idea is the same. Everyone listed on the tax return is part of the tax family, and that tax return will explain the ACA situation of everyone in the “tax family” .

8 Tax family - Who is a dependent?
To be a dependent: The taxpayer claiming the dependent cannot be a dependent on another TP’s return. A dependent cannot file a joint return unless no tax liability would exist for either spouse on separate returns. Dependent must be U.S. citizen, U.S. resident alien, U.S. national, or a resident of Canada or Mexico, for some part of the year. A dependent must be either a qualifying child or qualifying relative. It’s possible to be able to claim someone as a dependent, but they might not be receiving coverage on the Marketplace. “Family size” for the credit is determined by how many exemptions you can claim – not by how many people are receiving coverage. However, the premium for the “second lowest cost silver plan” will vary according to how many people you are purchasing coverage for.

9 Qualifying Child Dependent
Relationship Test – Child, brother or sister (or a descendant of one of these), or a foster child placed by an authorized agency Residency Test – Child must have lived with TP for more than half of tax year Age Test – under 19, full-time student under 24, or permanently disabled at any age Support Test – dependent cannot provide more than ½ of own support Child must be younger than the TP (unless disabled) Temporary absences (for school, medical care, etc.) are OK

10 Qualifying Relative Dependent
Not a Qualifying Child Member of the TP’s Household for all year or close family relationship (closer than cousin) Gross Income Test - less than $4,150 for 2018 Support Test – TP must have provided more than ½ of dependent’s total support

11 Need help figuring out dependent or filing status?
Use the “Interactive Tax Assistant” at Or go to and search on “ITA” or “interactive” If you need help figuring out what filing status a consumer would use, or if a person can really be considered their dependent --- there are tools on the IRS.gov website that can help you.

12 Individual Shared Responsibility Provision
(SRP) Next, we’ll next discuss the ACA “Individual Shared Responsibility Provision” or “SRP”.

13 For each person in your tax family:
The individual shared responsibility provision requires all individuals to have for each month in the year either minimum essential coverage (also known as MEC), or an exemption. If for any month in the year an individual doesn’t have coverage or an exemption, they must make a payment for those months when filing their income tax return. Most individuals in the United States already have health coverage today that qualifies as MEC, and will not need to do anything more than continue the coverage they now have. So, who is subject to this provision? The individual shared responsibility provision applies to individuals of all ages, including children. Every individual must address the MEC coverage requirement on their 2018 tax return; all of the 1040 forms will be updated so that an individual can either (1) indicate that everyone in their family had coverage for the whole year, (2) attach a schedule to report or claim an exemption or (3) report and make the shared responsibility payment. An adult or married couple who can claim a child or another individual as a dependent for federal income tax purposes is responsible for ensuring that all their dependents have minimum essential coverage or have an exemption from the coverage requirement. They will need to make a payment for each month they or any of their dependents did not have coverage or an exemption. Senior citizens also are subject to these requirements, but both Medicare Part A and Medicare Part C (also known as Medicare Advantage) qualify as MEC. Now let’s review what I went over: Each person must have “minimum essential coverage” OR, a coverage exemption. If they do not, then a shared responsibility payment is required. I will now explain what minimum essential coverage means and then I will get into who may be exempt. Finally, I will cover reporting and making a payment.

14 Minimum Essential Coverage (MEC)
MEC coverage is: Offered by an employer, COBRA and retiree coverage Purchased through private insurance or Health Insurance Marketplace Provided by government-sponsored programs, including veteran’s coverage, most Medicare and Medicaid Internal Revenue Code Section 5000A(f) spells out what types of coverage qualify as Minimum Essential Coverage or MEC. The major categories are listed on the screen here. Also, the IRS has posted a chart listing specific plan types that meet MEC and those that do not on IRS.gov/aca. So you don’t have to take notes on which plans are MEC as we cover them today – just visit our website. You can also check HealthCare.gov. Plans that do meet MEC include:  Coverage provided by an employer, including COBRA plans and retiree coverage. This category covers most group health plans, both insured and self-insured, provided by employers for the benefit of employees and their dependents.  Coverage under most health plans purchased in the individual market, and all qualified health plans offered through the Health Insurance Marketplace.  Coverage under certain government-sponsored programs, such as Medicare Part A and Part C most Medicaid coverage, the Children’s Health Insurance Program (CHIP), and certain other government programs. You can find a complete list of government programs that qualify as MEC on our website at IRS.gov/aca. Now that I provided you with examples of coverage that meet the MEC standard, I will cover the health-related insurance policies that do not meet the definition of MEC. Generally, specialized coverage is not MEC. Some examples are: Coverage solely for vision or dental care, Workers compensation, Accident or disability policies, and Medicaid coverage that provides only specialized services like family planning, tuberculosis-related services and limited treatment of certain conditions. You can find other examples of specialized coverage on the ACA pages of the IRS website, at IRS.gov/aca. As I said earlier, most individuals in the United States have health coverage today that qualifies as MEC, and will not need to do anything more than continue the coverage that they now have. Individuals who have insurance coverage as shown on this slide do not need to purchase any other coverage to satisfy the shared responsibility provision. For those individuals who do not have coverage, or who anticipate discontinuing the coverage they have currently, or who want to explore whether more affordable options are available, you may refer them to the Health Insurance Marketplace at HealthCare.gov. The Marketplace helps individuals compare available coverage options, assess their eligibility for financial assistance and find minimum essential coverage that fits their budget.

15 How will MEC be Reported?
If everyone on the return has MEC or an exemption for the entire year: Check a box on Page 1 of Form 1040 As I said before , every individual must address the MEC coverage requirement on their tax return; all of the 1040 forms are being updated so that an individual can either (1) indicate that everyone in their family had coverage for the whole year, (2) attach a form to claim an exemption or (3) report and make the shared responsibility payment. Taxpayers whose entire tax household maintained minimum essential coverage for every month of the year will report that coverage on their Form 1040 when filing their tax return. On the2018 (draft) Form 1040 there is now a checkbox on page 1 that allows the taxpayer to attest to having coverage OR having an exemption for all year Example: Suzie had employer sponsored coverage for the entire year and checks the box on her Form 1040 when filing her federal tax return. As Suzie has maintained Minimum Essential Coverage, no payment or additional schedule is required.

16 Information Statements
Marketplace - Form 1095-A, Health Insurance Marketplace Statement Insurers - Form 1095-B, Health Coverage Large Employers – Form 1095-C, Employer-Provided Health Insurance Coverage and Offer So how will people know if they have Minimum Essential Coverage? Information reporting statements about health coverage will be sent to your clients next January for some or all months of the year for the taxpayer, their spouse and/or dependents. Form 1095-A will be issued by the Marketplace for those who have enrolled in Qualifying Health Plans. Next year will be the second year that these documents will be issued by the Marketplaces. Form 1095-B is a new form that will be sent by Health Insurance providers showing who was covered by Minimum Essential Coverage. Form 1095-C is a new form that will be sent by large employers showing what coverage was offered and provided to the employee and their family. Clients may receive one or more than one for the tax year depending on who provides their insurance, if they have more than one insurance provider during the year, or if the taxpayer, spouse and dependents have different insurers. The 1095-B and 1095-C forms are for information only and will help you determine which members of the taxpayers household coverage.

17 Coverage Exemptions Coverage Exemptions only available at tax filing
Coverage Exemptions available through the Marketplace If someone in the tax family doesn’t have MEC for one or more months, they may be covered by an exemption. These fall into two categories – those that are claimed on the tax return, and the exemptions that are given by the Marketplace. The Exemptions that can only be obtained through the Marketplace are: Religious conscience: An individual who is a member of a religious sect that is recognized by the Social Security Administration as being conscientiously opposed to accepting any insurance benefits. Hardship: An individual who suffered a hardship that makes them unable to obtain coverage, as defined by the Department of Health and Human Services. This could include, but is not limited to, homelessness, eviction, foreclosure, domestic violence, death of a close family member, and unpaid medical bills. In addition to this general hardship, HHS has designated certain other situations that qualify as hardship exemptions. Some of those hardship exemptions can be claimed on a tax return, and others, like this general hardship exemption, can only be granted by the Marketplace. Check the exemption chart at IRS.gov/aca for more information on hardship exemptions.  Guidance on how to obtain an exemption from the Marketplace is available on HealthCare.gov. Once an application is approved, the Marketplace will assign an Exemption Certificate Number (or ECN) when granting an exemption; the ECN will be used to report the exemption as part of the 1040 tax return filing. Requests for exemptions that can be granted only by the Marketplace should be submitted as soon as possible, so that you can properly report the exemption on your federal income tax return.   If the Marketplace has not processed your application before you file your tax return, taxpayers will write the word “PENDING” on Form 8965 of their tax return when reporting those Marketplace exemptions. The Exemptions that can be granted by the Marketplace OR IRS as part of filing a tax return are:   Health care sharing ministry: An individual who is a member of a health care sharing ministry. A health care sharing ministry is defined as a section 501(c)(3) organization whose members share a common set of ethical or religious beliefs and have shared medical expenses in accordance with those beliefs continuously since at least December 31, 1999.  Incarceration: An individual who was convicted and is serving a sentence in a jail, prison, or similar penal institution or correctional facility. The health care sharing ministry and incarceration exemptions are only granted by the Marketplace retrospectively, however.

18 Coverage Exemptions available when filing a tax return:
Member of a federally recognized Indian tribe/eligible for services through an Indian Health Care Provider Income below the filing threshold No affordable coverage ( > 8.05% HHI for tax year 2018) Short coverage gap (< 3 months) Citizens living abroad and certain noncitizens Member of tax household born, adopted, or died Member of a Health care sharing ministry General Hardships *new* So what qualifies as an exemption? Here are the exemptions that can be claimed on the tax return now include. It was JUST announced on Sept 12 that taxpayers will also be able to claim a hardship exemption on the tax return, but I haven’t seen many details yet. On the Form 8965, it will be exemption code G. Indian tribes: An individual who is a member of a federally recognized Indian tribe. Individuals eligible for services through an Indian Health Care Provider: You are an American Indian, Alaska Native, or a spouse or descendant who is eligible for services through an Indian health care provider You can now claim a coverage exemption for certain types of hardships on your tax return. See the Types of Coverage Exemptions chart and General hardship (code G), for more information. General hardships can include: Homelessness; Being evicted or facing eviction; Receiving a shut-off notice from a utility company; Experiencing domestic violence; Experiencing the death of a close family member; Experiencing a fire, flood, or other disaster; Filing for bankruptcy; Medical expenses you can’t pay; Unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member; Your child was denied Medicaid and CHIP, and another person is required by court order to provide coverage to the child; You were without coverage while awaiting an appeals decision from the Marketplace; You were determined ineligible for Medicaid in a state that did not expand Medicaid coverage; Living in a country where there is no qualified health plan offered, there is only one issuer offering coverage, or all afforda-ble plans provide abortion coverage contrary to your beliefs; Experiencing personal circumstances that create a hard-ship, such as when no affordable plans provide access to needed specialty care; or Experiencing a hardship not included in this list that prevented you from getting health insurance. To claim this coverage exemption, enter code “G” in Part III, column (c), and identify the months to which the exemption applies To provide additional flexibility for those in need of a hardship exemption for 2018, CMS is announcing that consumers may claim all hardship exemptions available under § (d)(1) either by obtaining an ECN through the FFE using the existing application process, or on a federal income tax return without presenting the documentary evidence or written explanation generally required for hardship exemptions. Consumers should keep with their other tax records any documentation that demonstrates qualification for the hardship exemption. A description of the hardship exemptions available under § (d)(1) that CMS intends to add to the list of exemptions currently described in § (e) can be found here:

19 Coverage Exemptions available through the Marketplace
Member of a recognized religious sect conscientiously opposed to accepting insurance benefits Coverage considered unaffordable based on projected income Certain Medicaid programs that are not minimum essential coverage Hardship (Defined by HHS)  The Exemptions that can be obtained through the Marketplace include Harships and Member of a religious sect opposed to accepting insurance benefits Members of certain religious sects—The Marketplace determined that you are a member of a recognized religious sect. Ineligible for Medicaid based on a state’s decision not to expand Medicaid coverage—The Marketplace found that you would have been determined ineligible for Medicaid solely because the state in which you resided didn't participate in Medicaid expansion under the Affordable Care Act. Coverage considered unaffordable based on projected income—The Marketplace determined that you didn’t have access to coverage that is considered affordable based on your projected household income. Certain Medicaid programs that are not minimum essential coverage-- The Marketplace determined that you were (1) enrolled in Medicaid coverage provided to a pregnant woman that isn’t recognized as minimum essential coverage; (2) enrolled in Medicaid coverage provided to a medically needy individual (also known as Spend-down Medicaid or Share-of-Cost Medicaid) that isn’t recognized as minimum essential coverage; or (3) enrolled in Medicaid coverage provided to a medically needy individual and were without coverage for other months because the spend-down had not been met. Hardship: An individual who suffered a hardship that makes them unable to obtain coverage, as defined by the Department of Health and Human Services. This could include, but is not limited to, homelessness, eviction, foreclosure, domestic violence, death of a close family member, and unpaid medical bills. In addition to this general hardship, HHS has designated certain other situations that qualify as hardship exemptions. Some of those hardship exemptions can be claimed on a tax return, and others, like this general hardship exemption, can only be granted by the Marketplace. Check the exemption chart at IRS.gov/aca for more information on hardship exemptions.  Requests for exemptions that can be granted only by the Marketplace should be submitted as soon as possible, so that you can properly report the exemption on your federal income tax return.   Guidance on how to obtain an exemption from the Marketplace is available on HealthCare.gov. The Marketplace will assign an Exemption Certificate Number (or ECN) when granting an exemption; the ECN will be used to report the exemption as part of the 1040 tax return filing.

20 Form 8965 Health Coverage Exemptions
Submit Form 8965 with federal tax return to claim coverage exemptions granted by either the Health Insurance Marketplace or IRS The instructions have worksheets for the affordability exemption and for calculating the Shared Responsibility Payment. If everyone on the return has MEC or an exemption for the entire year - check the box on Page 1 of Form 1040 This is the new Form 8965, Health Coverage Exemptions. You will use this form to claim Marketplace granted or IRS granted exemptions from the coverage requirement and attach it to your federal tax return. I’d like to emphasize that the IRS will accept requests for an exemption from coverage only at the time of filing. IRS will not grant an exemption from coverage by phone or correspondence. For purposes of Form 8965, your tax household generally includes you, your spouse, (if filing a joint return), and any individual you can claim on your tax return. Only one Form 8965 should be filed for the household and will be used to claim all individual and household coverage exemptions on the return. Form 8965 contains 3 parts which will be covered next: Part 1 is used if the Marketplace granted you or another member of your family an exemption Part 2 is used if your household has income below the filing threshold Part 3 is used to claim IRS granted coverage exemptions Depending on your situation, you may need to complete one or more parts of the Form 8965.

21 When Would an Individual Need to Make a Shared Responsibility Payment (SRP)?
Taxpayers calculate SRP if everyone on the return does not have: MEC for every month of the year, or An exemption for the months without MEC. So now that we have discussed Health Coverage exemptions, when would an individual need to make a payment? If a taxpayer (or any of their dependents) doesn’t have MEC and doesn’t qualify for a coverage exemption, they will need to make a shared responsibility payment or SRP when filing their tax return. A payment is due for an individual and any dependents if they don’t have: MEC for every month of the year, or An exemption for the months without MEC. This information – MEC, exemption or payment – will be reported to the IRS on the federal income tax return each year. The SRP amount due is reported on Schedule 4, line 61 as “Other Taxes” section, and carries to the 2018 Form 1040 on line 14. Next, we’ll get into how the payment is calculated.

22 How is the 2018 Payment Calculated?
For the year, based on the greater of the calculated: percentage of income (2.5%) or flat dollar amount ($695 per adult) Limited to maximum of $2,085 per household Prorated for months without coverage/exemption The total shared responsibility payment amount cannot exceed the national average premium for bronze level qualified health plans for 2018 ($3,396 for an individual for 2018) So, if someone doesn’t have MEC or coverage exemption for a given month, how is their Individual Shared Responsibility Payment calculated? First, taxpayers must know their household income and applicable income tax return filing threshold to calculate the SRP amount owed. You can use tax filing software or complete a worksheet – contained in the Form 8965 Instructions – to calculate the shared responsibility payment, but you do not attach the worksheet or Form to Form 1040 when you file if you are making an SRP. The payment computation, to put it as simply as possible, is the greater of a percentage of income or a flat dollar amount, but no more than the national average premium for bronze level coverage. The percentage of income amount is the percentage of the excess portion of household income over the federal income tax filing threshold for the primary tax filer (or joint filers) in the family.  For 2018, the percentage is set at 2.5% of Household Income. Now let’s look at the flat dollar amount method. The “flat dollar amount” remains at $695 for tax year 2018; half of that if the individual without coverage is under 18 as of the beginning of the month. The maximum flat dollar amount for a family cannot exceed 300% of the amount for one adult no matter how many dependents are in the family. So, for it’s $2,085 per household or $695 x 3. We must compare the flat dollar amount and the income percentage amount and use the greater of the two amounts. The resulting amount is then capped at the national average premium for a “bronze level” health plan that is offered through the Marketplace and provides coverage for the applicable family size involved. Thus, the individual shared responsibility payment is the greater of the flat dollar amount or the percentage of income amount, but never more than the national average premium for the “bronze level” plan.  ($283 per month for 2018, from Rev Proc ) This ensures that the payment amount is never more than the approximate cost of basic coverage for a year. Using tax preparation software simplifies the calculation of the shared responsibility payment. and completion of Form 8965 to report and claim exemptions. The IRS also encourages individuals to file their tax returns electronically.

23 Household Income for the Shared Responsibility Provision
Modified Adjusted Gross Income (MAGI) = total of: Adjusted Gross Income (AGI) – Form 1040, line 7 + Tax Exempt Interest – Form 1040, line 2a + Foreign Earned Income Exclusion and Housing Deduction Household income = combined MAGI of all members of the tax family with a filing requirement Form 8965 instructions : If a child’s income is reported on Form 8814 with their parent’s return, include the dependent's MAGI in the household income by adding Form 8814, line 1b and the smaller of Form 8814, line 4 or 5. The 2018 Permanent Fund Dividend is expected to be $ That means that all dependents receiving the PFD will have a filing requirement – and so their MAGI will need to be included in the parents’ household income. Dependents with more than $1,050 in unearned income must file a return – this year, dependents receiving the PFD will have a filing requirement.

24 Sample Calculation Facts: Single individual, no dependents,
No minimum essential coverage for any month Does not qualify for an exemption Household income = $40,000 Filing threshold = $12,000 Payment calculation: Percentage of income: $40,000 – 12,000 = $28,000, 2.5% x $28,000 = $700 Flat dollar: $695  This sample calculation is for a single individual with $40,000 income: Jim, an unmarried individual with no dependents, does not have minimum essential coverage for any month during 2016 and does not qualify for an exemption. For 2016, Jim’s household income is $40,000 and his filing threshold is $12,000 for (*See the filing thresholds chart in any of our individual tax form instruction booklets or on IRS.gov) To determine his payment using the percentage of income formula, subtract $12,000 (filing threshold) from $40,000 (2018 household income). The filing threshold is quite a bit higher than last year, as a result of the changes from the Tax Cut and Jobs Act. As a result, this taxpayer’s Shared Responsibility Payment is about $40 lower than it was last year, with the same facts. The annual national average premium for bronze level coverage for one person in 2018 is $3,396 Jim will make his shared responsibility payment for the months he was uninsured when he files his 2018 income tax return, which is due in April If he had coverage or an exemption for some of those months, his SRP would be pro-rated accordingly. 2018 ISRP = $700 ($700 is greater than $695 and less than $ 3,396 (the national average for bronze level coverage))

25 How will ISRP be Reported?
Form 8965 is used to report or claim a coverage exemption Full year coverage or exemption is reported by checking a box on the front of the tax return Payment, if due, is reported and paid with the tax return Let’s recap how will an individual notify the IRS that they have MEC or an exemption, or how will they make an individual shared responsibility payment when they file their 2018 federal individual income tax in 2019 On the2018 (draft) Form 1040 there is now a checkbox on page 1 that allows the taxpayer to attest to having coverage OR having an exemption for all year Taxpayers who did not have MEC all year may claim a coverage exemption using Form 8965to request coverage exemptions from the IRS and to report exemptions received from the Marketplace. Taxpayers who did not have coverage for the whole year and were not exempt will have to make the shared responsibility payment with their tax return. They will use the worksheets located in the instructions to Form 8965 to figure the SRP amount due. The SRP amount due is reported on Form 1040, line 61 in the “Other Taxes” section, Form 1040A – Line 38 in “Tax, Credits and Payments” section, and Form 1040-EZ – Line 11 in the “Payments, Credit and Tax” section.  Some individuals will have enough credits or withholding to offset the individual shared responsibility payment and may still have a refund.  The IRS routinely works with taxpayers who cannot pay an amount they owe at the time of filing, such as by setting up a payment plan or an installment agreement. Although the IRS does not have authority to file a notice of lien or levy to collect the individual shared responsibility payment, the IRS does have the authority to offset any overpayment – that is to reduce any refund due by the amount owed – to collect the shared responsibility payment. To sum it up, Form 1040 will be used to report MEC, exemptions, and the individual shared responsibility payment amount, if any. For example, remember our taxpayer scenario for Jim. His payment of $700 will be reported on their Form 1040 and to calculate that payment he can use the worksheet provided in the instructions. In addition, taxpayers may also report their payment on Form 1040A or Form 1040EZ.

26 The Premium Tax Credit (PTC)
Now let’s discuss the ACA provisions for the Premium Tax Credit or “PTC”

27 Household Income for the Premium Tax Credit
Modified Adjusted Gross Income (MAGI) = total of: Adjusted Gross Income (AGI) – Form 1040, line 7 + Tax Exempt Interest – Form 1040, line 2a + Foreign Earned Income Exclusion and Housing Deduction + Non-Taxable Social Security Benefits (difference between Form 1040, line 5a and line 5b) Household income = combined MAGI of all members of the tax family with a filing requirement Dependents with more than $1,050 in unearned income must file a return – this year, all dependents receiving the PFD will have a filing requirement.

28 What is the Premium Tax Credit?
Refundable tax credit claimed on Form 8962, Premium Tax Credit Two options: - advance payments of PTC - no advance payments (get all benefit of PTC when filing return) Marketplace administers advance payment of PTC So, what is the premium tax credit? To be eligible, an individual or a family member must have enrolled in insurance through a federal or state Health Insurance marketplace. It helps eligible individuals and families with the cost of purchasing health insurance from the Marketplace. Their household income (I’ll talk more about household income later) must be between 100 and 400 percent of the federal poverty line for the family size, but there are exceptions for certain taxpayers under 100 percent . Essentially, the credit reduces a person’s out-of-pocket costs incurred for health insurance premiums – hence the name “premium” tax credit. The credit amount is based on a sliding scale, with greater credit amounts available to those with lower incomes. Other factors that affect the credit amount include which family members enroll, the cost of available insurance coverage, the premiums for the plan enrolled in, and family size. As you can see, an eligible individual purchasing insurance through the Marketplace has the option to choose advance payments of the credit, which are based on an estimate by the Marketplace of the taxpayer’s premium tax credit, or get all of the benefit of the credit when he or she files a tax return claiming the credit. Advance payments of the anticipated credit are made directly by the Marketplace to the insurer before a tax return is filed. The advance payments of the premium tax credit lower the cost of health insurance premiums the individual must pay each month. Eligible individuals may choose to have the full amount, or a lesser amount, of the advance credit payments provided directly to the insurance company. Getting advance payments of the anticipated credit is done through an application process at the appropriate Marketplace. The amount of the advance credit payment is based on the person’s projected household income for the upcoming year, along with other factors such as projected family size, address of the taxpayer and who in the family is eligible for other non-Marketplace coverage. Advance credit payments are likely to differ from the credit amount, which is based on actual household information (household income, family size, etc.) when the tax return is filed. For this reason, the advance credit payment amount must be reconciled against the actual credit amount on the tax return for the year. It’s imperative that an individual report any change in circumstances to the Marketplace so that the advance payments of the premium tax credit can be adjusted as appropriate to minimize the effect on the amount of refund or tax due at tax filing time. Taxpayers can also choose to forego advance credit payments and get all of the benefit of the premium tax credit at the time of filing a tax return. Because the premium tax credit is claimed on the federal income tax return that is filed the following year, foregoing advance credit payments means the taxpayer will, in effect, get a reimbursement of a portion of the insurance premiums the taxpayer already paid for a plan they purchased in the Marketplace.. Taxpayers, including those who get advance credit payments, must claim the credit by filing a federal income tax return. Taxpayers who get APTC must file a tax return to reconcile (compare) the APTC to the credit computed on the return even if not otherwise required to file a tax return. The premium tax credit can reduce a person’s federal tax liability and lower a balance due, or it may create or increase the amount of a refund. Because the premium tax credit is refundable, an individual who has little or no income tax liability can still receive the full benefit of the credit as a refund. If an individual’s actual allowable credit is more than the advance credit payments, the difference will be added to the individual’s refund or subtracted from the balance due. On the other hand, individuals whose advance credit payments are more than their premium tax credit will owe the excess as an addition to their tax, subject to a repayment cap if their income below 400 percent of the federal poverty line. The 1040 has been re-designed for TY18, and it’s a lot shorter. There are some new schedules that gather together some of the less common items, and then totals are carried from the new schedules to the So for tax year 2018, the Premium Tax Credit will go from Form 8962 to Schedule 5, and then to line 17 of the Form 1040. If a person receives the benefit of advance payments of the premium tax credit, the amount of advance payments made on the taxpayer’s behalf during the year must be reconciled with the actual premium tax credit allowed on the income tax return for that year. The person must do this reconciliation even if he or she would not otherwise be required to file a tax return for the year. I will talk about the reconciliation process and the repayment cap in more detail later.

29 PTC Eligibility You may be eligible if you meet all of the following:
buy health insurance through Marketplace are ineligible for coverage through employer or government plan “Household income” is at least 100% and no more than 400% of the Federal Poverty Line do not file a Married Filing Separately tax return (unless you meet the criteria in section 1.36B-2T(b)(2) of the Temporary Income Tax Regulations, for certain victims of domestic abuse and spousal abandonment cannot be claimed as a dependent by another person Now we’ll take a look at who is eligible for the credit and cover a little bit of new terminology. To get the premium tax credit, an individual must meet all of the following:  You or a family member enrolls (individual, spouse and dependents) in a Qualified Health Plan (QHP) at the Marketplace for one or more months in which the enrollee is not eligible for other minimum essential coverage through an employer or government plan (to enroll, an individual must be a U.S. citizen or lawfully present and cannot be incarcerated) Has household income between 100 and 400 % of Federal Poverty Line (FPL) based on family size, with some exceptions If married, files a joint tax return (with some exceptions) Cannot be claimed as a dependent, and Pay or have someone else pay the premiums by the due date of the tax return for the year of coverage (including extensions) for one or more of those same months; and Generally, married individuals cannot get a premium tax credit if they use the Married Filing Separately status unless they meet the criteria in temporary regulations), which allows certain victims of domestic abuse or spousal abandonment to claim the premium tax credit using the married filing separately filing status. The temporary regulations also provide that a taxpayer is a victim of spousal abandonment for a taxable year if, taking into account all facts and circumstances, the taxpayer is unable to locate his or her spouse after reasonable diligence. Taxpayers may not qualify for relief from the joint filing requirement for a period that exceeds three consecutive years. More information about the use of MFS status is available on the IRS website. Also, if they qualify, married individuals may claim the premium tax credit using the Head of Household filing status because for tax purposes they are treated as unmarried. Married individuals who use the MFS status but do not meet the criteria in the temporary regulation are not allowed a premium tax credit and must repay all of the advance credit payments made on their behalf, subject to a repayment cap. Generally, to be an applicable taxpayer, the taxpayer’s household income must be no less than 100% of the FPL. However, Individuals who receive advance payments of the premium tax credit but then have household income that falls below 100% of the FPL at the end of the year, typically because of a change in circumstance, will still be treated as applicable taxpayers as long as they meet the other applicable taxpayer criteria. In addition, under a special rule, individuals who have at least one family member who is an alien lawfully present in the United States but not eligible for Medicaid, are treated as applicable taxpayers even if they have household income below 100% of the FPL, as long as they meet the other applicable taxpayer criteria. A key point to remember is that: Many people already have qualifying health insurance coverage (called minimum essential coverage), such as coverage through their current employers. If they have other, non-Marketplace minimum essential coverage, they do not qualify for coverage subsidized by the PTC. Only taxpayers who, or whose family members, enrolled in coverage through the Marketplace may be eligible for a premium tax credit.    I can now provide some more detail on some new terminology that is part of the Affordable Care Act. I am going to talk about this briefly and there is a glossary of new terms at the end of this presentation for your future reference.     Household Income, for the purpose of the premium tax credit, is the Modified Adjusted Gross Income (MAGI) of the taxpayer and the taxpayer’s spouse, plus the MAGI of all the dependents in the tax household who are required to file a tax return because the dependent’s income meets the income tax return filing threshold. Modified Adjusted Gross Income includes the adjusted gross income from the federal income tax return, plus any excluded foreign income, non-taxable Social Security benefits (including tier 1 railroad retirement benefits), and tax-exempt interest received during the taxable year. MAGI does not include Supplemental Security Income (SSI). You should note that the definition of household income for the premium tax credit differs slightly from the definition as it is applied to the Individual Shared Responsibility Provision, which does not include non-taxable Social Security (or railroad retirement benefits) income in MAGI.

30 2018 Income Limits are based on 2017 Federal Poverty Line (FPL) – for Alaska:
One Individual: $15,060 (100% FPL) - $60,240 (400% FPL) Family of Two: $20,290 (100% FPL) - $81,160 (400% FPL) Family of Four: $30750 (100% FPL) - $123,000 (400% FPL) Example: Based on the FPL, a family of four could have a household income up to and including $123,000 and still be eligible for the PTC. THIS SLIDE SHOWS FEDERAL POVERTY LEVEL FOR ALASKA. For purposes of the premium tax credit, eligibility for a certain year is based on the most recently published set of poverty lines on the first day of the annual open enrollment period. As a result, the tax credit for 2018 will be based on the 2017 poverty lines. The federal poverty line amounts that are in effect on the first day of the open enrollment period determine income eligibility for advance payments of the premium tax credit for the entire coverage year (including special enrollment periods) and for the premium tax credit claimed on the tax return.

31 Advanced Premium Tax Credit
During enrollment through the Marketplace, the Marketplace will estimate the amount of the premium tax credit you will be able to claim on your tax return. If you are eligible for the credit, you can choose to: Get It Now: have some or all of the estimated credit paid in advance directly to your insurance company to lower what you pay out-of-pocket for your monthly premiums; or Get It Later: wait to get all of the credit when you file your tax return. The estimate is based on the information provided by the consumer about projected income and family composition for the year 88% of the Marketplace clients in Alaska used the Advanced PTC to offset their premiums. They are all required to file a tax return. The other 12% will WANT to file a tax return, because they may be eligible for the Premium Tax Credit when they file and know their actual household income.

32 Calculating the Premium Tax Credit
To calculate the PTC, you need to know: The size of the tax family Household Income of the tax family Second Lowest Cost Silver Plan (SLCSP or benchmark) for the covered individuals – might change from month to month SLCSP is provided to the taxpayer on Form 1095-A Your family size (affecting FPL) will include all dependents, whether or not you had to buy coverage for them – this is your “tax family.” BUT the second lowest cost silver plan premium will go up or down, depending on how many individuals you are actually getting coverage for on the Marketplace – this is your “coverage family.” The benchmark (SLCSP) will depend on your area. It is important to note that the calculation of advance payments of PTC is based on estimated income; however, final eligibility for the PTC is calculated with the actual income on the Form 1040. It is important to note that the calculation of advance payments of PTC is based on estimated income; however, final eligibility for the PTC is calculated with the actual income on the Form 1040.

33 Key Considerations Advance payments of PTC are optional.
Reconciling advance payments is required and a tax return must be filed. Differences between advance credit payments and the credit are likely. Changes in circumstances can affect the PTC amount and the difference between PTC and advance credit payments. I previously mentioned that individuals may choose to have advance payments of the premium tax credit sent directly to their insurer. As part of the enrollment process, the Marketplace makes the determination whether or not an applicant is eligible for advance payment of the premium tax credit. But it is the applicant who chooses whether to get the benefit of advance credit payments and, if so, how much. Advance credit payments made to your insurance company are based on an estimate of the credit that you will claim on your federal income tax return. It is important to report changes in circumstances to get the proper type and amount of financial assistance and to avoid large differences between the advance credit payments and the actual credit allowed. Reporting changes in circumstances will allow the Marketplace to adjust your advance credit payments. This adjustment will help you avoid getting a smaller refund or owing money that you did not expect to owe on your federal tax return. Individuals should bear in mind that there are several important considerations involved with the choice to receive the benefit of advance credit payments: Advance credit payments are optional. Advance credit payments must be reconciled with the actual credit allowed. Differences between advance credit payments and the actual premium tax credit allowed are likely. Changes in circumstance can affect the differences. They must file a tax return to reconcile these differences and to claim the credit even if not otherwise required to file. Individuals will complete the Form 8962, Premium Tax Credit, at the end of the coverage year to reconcile advance payments of PTC and to claim the PTC. Details of the Form 8962 will be discussed in the next section. If you find during the reconciliation process that the actual premium tax credit is less than advance credit payments, the difference, subject to certain caps, will be additional tax that may reduce your refund or add to your balance due.

34 How Does Reconciliation Work?
Advance payments $4,000 Calculation of PTC - $3,000 Difference $1,000 Repayment amount = $1,000 * *Amount from Form 8962 that would be entered on Form 1040 Note: A tax return must be filed to reconcile advance credit payments regardless of any other filing requirement. Now, let’s go over a simple example to demonstrate the basic principle of how reconciliation will work. Say the taxpayer received advance credit payments totaling $4,000 and the calculation of the premium tax credit on the tax return shows a credit of $3,000. The difference, $4,000 minus $3000, equals $1,000. Therefore, $1,000 is the excess amount to be repaid, subject to a repayment cap for taxpayers with household income below 400 percent of the FPL. The repayment amount, is transferred to the income tax return. As I mentioned, if you find during the reconciliation process that the actual premium tax credit is less than advance credit payments, the difference, subject to certain caps, will be additional tax that may reduce your refund or add to your balance due.  For single filers, the caps are $300 (household income below 200 percent of the FPL), $775 (household income below 300 percent of the FPL), and $1,300 (household income below 400 percent of the FPL). For all other filers in these ranges, the caps are double the amount for single filers: $600, $1,550, and $2,600. [tax year 2017]  Remember, an individual for whom advance credit payments were made must file a tax return to reconcile the advance credit payments with the premium tax credit allowed regardless of whether the individual otherwise has a filing requirement. Failure to reconcile advance credit payments may affect qualification for advance payments in future enrollment years. On the next couple of slides, I will introduce the new forms that will be used to claim the Premium Tax Credit and reconcile advance payments.  Speakers Notes (reactive text only): Even if they receive advance credit payments, taxpayers can request an automatic extension until Oct. 15. However, the IRS and HHS will share information in late September. If a taxpayer has not yet filed, the lack of IRS verification of reconciliation may affect the determination by HHS of eligibility for advance credit payments in the following year.

35 What Information Documents will an Individual Receive?
Form 1095-A will be issued by the Health Insurance Marketplace by January 31: Documentation of coverage by month Premiums for plan or plans enrolled in Premiums for the applicable second lowest cost silver plan, and Advance payments of PTC The first form I would like to discuss is Form 1095-A. The Marketplace will send, Form 1095A, (Health Insurance Marketplace Statement) by January 31 of the year following the year of coverage showing the individuals who were enrolled, the premiums for the plan or plans an individual and his or her family members enrolled in (enrollment premiums), the premium for the second lowest cost silver plan that applies to the family and the advance credit payments made for coverage of the individuals. Although the form will be new, the concept is similar to Form 1099-INT and W-2 reporting, whereby one copy of the form is filed with the IRS and another copy is provided to the individual (called the tax filer or responsible adult). For example, the tax filer or responsible adult will receive the 2018 information return by Jan. 31, 2019, and can use this information to compute the premium tax credit on the 2018 tax return and to reconcile the advance credit payments made on that person’s behalf with the amount of the premium tax credit. An individual who does not receive the Form 1095-A from a Marketplace should contact the Marketplace to request a copy. Taxpayers will enter information from the Form 1095-A onto the Form Taxpayers will submit the Form 8962, but not the Form 1095A, with the tax return.

36 Form 8962 - Premium Tax Credit
Form 8962 must be submitted with a federal tax return to claim the Premium Tax Credit and reconcile advance payments of the PTC If Form 8962 isn’t filed, the taxpayer may not be eligible for advance payments the following year. The second new form, Form 8962 (Premium Tax Credit) will be used to claim the premium tax credit, regardless of whether any advance credit payments were made, and reconcile the advance credit payments with the premium tax credit allowed. Form 8962 has several sections that we will be going over in subsequent slides. The process of transferring the information to the individual income tax return will be familiar to you. There will be new lines on the Form 1040 series returns for claiming the premium tax credit, reconciling the advance payments of PTC with actual credit amount and for the repayment of any excess advance payments of the premium tax credit. Taxpayers will attach Form 8962 to Form 1040 or 1040 NR..

37 Changes in Circumstance
Taxpayers should alert the Marketplace about any change in circumstance that could affect the Premium Tax Credit: Change in income Change in family size Change in address What type of thing could cause a change in circumstance? The bigger PFD this year might catch people by surprise, since last year it was just below the filing threshold for a dependent. Changed jobs, or just got hours increased or cut. Had a baby, got married or divorced, had a child move out If you move, your benchmark plan amount may change

38 Other situations… For purposes of the credit, premiums paid by someone else are treated as having been paid by the taxpayer That means that even if the taxpayer’s premium was paid for by a program like T-SHIP, the taxpayer must file a return to reconcile their premium tax credit. Example 4. Q, an American Indian, enrolls in a qualified health plan for Q’s tribe pays the portion of Q’s qualified health plan premiums not covered by advance credit payments. Under paragraph (c)(2) of this section, the premiums that Q’s tribe pays for Q are treated as paid by Q. Thus, the months when Q is covered by a qualified health plan and not eligible for other minimum essential coverage are coverage months under paragraph (c)(1) of this section in computing Q’s premium tax credit under paragraph (a) of this section.

39 PTC Common Errors Did not reconcile APTC
Claimed PTC but failed to attach Form 8962 Form 1095-A data not correctly reported Transposed digits Miscalculated Monthly PTC Allowed Miscalculated Repayment Amount of Excess APTC The most common situation I heard about from partners this year were taxpayers who received the Advanced payment of the Premium Tax Credit, but didn’t attach Form 8962 to reconcile. Usually, these taxpayers didn’t provide their F1095-A to their tax preparer, and the return just indicated that the taxpayer had MEC all year. Then, these taxpayers get a notice from IRS asking for the F8962. So, as you are helping taxpayers get signed up for Marketplace coverage, be sure they realize that they will get a Form 1095-A in January, and they need that information to do their taxes.

40 Summary INDIVIDUAL SHARED RESPONSIBILTY PROVISION PREMIUM TAX CREDIT
Taxpayers and their dependents are required to: have minimum essential coverage, or have an exemption, or make a shared responsibility payment when filing a federal income tax return. PREMIUM TAX CREDIT Taxpayers who (or whose family members) enrolled in health insurance coverage through the Health Insurance Marketplace: may be eligible for PTC and must reconcile any advance payments of PTC when filing a federal income tax return. The Affordable Care Act addresses health insurance coverage and financial assistance options for individuals and families, including the individual shared responsibility provision and coverage exemptions from that provision, as well as the premium tax credit. In general, all U.S. taxpayers must have MEC for each month, qualify for a coverage exemption, or make a payment when filing his or her federal income tax return. Many people already have minimum essential coverage and don’t need to do anything more than maintain that coverage. People who have either coverage or an exemption for every month for everyone in the tax family can just check a box on page 1 of the Form 1040. Households who have MEC all year will indicate this on Form 1040 by checking the box in Line 61 in the Other Taxes section. Coverage exemptions are claimed on Form 8965. Any Shared Responsibility Payment due is entered on Form 1040 in the Other Taxes section. Taxpayers should use the Shared Responsibility Payment Worksheet in the instructions to Form 8965 to figure the amount of the SRP due. The premium tax credit is calculated and the advance payment is reconciled on Form Taxpayers will receive Form 1095-A from the Marketplace, which will contain the information necessary to complete Form 8962. Only taxpayers who, or whose family members, enrolled in coverage through the Marketplace are allowed a premium tax credit. Eligible taxpayers may choose to get the benefit of advance credit payments, the amount of which is based on their estimated premium tax credit, to reduce the cost of monthly premiums. Taxpayers who chose to forgo advance credit payments get all of the benefit of the premium tax credit when they claim it on the tax return. A net credit (refund amount) is reported in the Payments section of Form 1040. Any excess advance premium tax credit that must be repaid is entered in the Tax and Credits section of the Form 1040.

41 Things to keep in mind Tell the Marketplace about any changes to income and family size (handouts) Be cautious when HHI approaches 400% of FPL Don’t forget the PFD for everyone when estimating household income! Form 1095-A and Exemption Certificate Numbers will be needed for the tax return. A tax return must be filed if the Advanced Premium Tax Credit is received Pub 5152

42 Tax Cuts and Jobs Act – tax changes for 2018
Lower tax rates Higher Standard Deduction Personal Exemption = $0 Some Itemized Deductions deleted or limited New Qualified Business Income Deduction Enhanced Child Tax Credit New Credit for Other Dependents The tax law changes that take effect in tax year 2018 make significant changes to many individuals. As a result, new withholding tables went into effect in February. These are some of the changes most likely to affect an individual. I won’t go into detail, but here are the high points: [go over bullets]. And there is the breaking news that taxpayers can claim a hardship exemption on the tax return, but I don’t have much information about that yet. The new higher standard deduction MIGHT mean that some low income taxpayers will now have income below the filing requirement, and would qualify for an exemption of they need one. The other ones I am just mentioning for awareness – they don’t really impact the ACA provisions of the tax law.

43 PayCheck Checkup on irs.gov
Since every individual will be affected differently, it’s important that taxpayers check their withholding before too much more of the year goes by. https: // Here’s how you do it – from the irs.gov home page, click on the Paycheck Checkup link. This will take us to the irs.gov Withholding Calculator.

44 FREE Volunteer Income Tax Preparation
TaxAide and VITA volunteer sites Free return preparation by trained volunteers Free e-file and direct deposit Call for volunteer site locations and hours Visit (keyword VITA or TAXAIDE) or This slide is telling you how you can find out about the free sites. Not every community has free tax prep, but most of the larger ones do. In larger communities, free tax prep. is typically provided by AARP’s TaxAide program – I want to emphasize that they prepare taxes for low- and middle-income taxpayers of all ages. The volunteers are often retired – but you don’t have to be retired or a senior to use their services. In the villages, tax prep. is provided by ABDC (Alaska Business Development Center). They bring University students and other volunteers into the villages each year. Your local tribal office or village administration will have those details. People can call for a list of free tax sites and their hours of operation. It’s a toll-free statewide number operated by United Way and some community partners. This list is also available on the web at

45 Free tax help is available
Contact Alaska Business Development Center at for volunteer help in these regions: * Aleutians * Bristol Bay * Copper Valley * Interior * Kodiak * North Slope * Pribilofs * Southeast * Western Alaska * Yukon Delta Schedule available at

46 Free On-Line Filing www.MyFreeTaxes.com
Free for returns with AGI < $66,000 On line from any computer Help available by phone and chat Computer labs available at most Job Centers and Anchorage Gateway Learning Center Another option is to do your taxes yourself. If you do your own taxes, and want to figure out if you’re eligible for the EITC and the Child Tax Credit, you need to walk through the instructions and forms for those two tax credits. They’re available from the IRS. If you want to get your refund quickly, you can file electronically through the IRS website. Through special agreements with a number of software companies, the IRS offers free on-line filing.

47 ACA Web Resources IRS.gov/ACA HealthCare.gov
These are the primary ACA web resources for the Affordable Care Act. IRS.gov/ACA contains the latest information on the tax provisions included in the Act. HealthCare.gov contains information health care coverage enrollment through the Health Insurance Marketplaces, and how to get the appropriate financial assistance, including advance payments of the premium tax credit.

48 Working together to help consumers
Consider setting up an information table at your local tax site! Tax clients can find out about coverage options Marketplace clients can get tax help Tax clients who are already Marketplace consumers can get a tune-up if needed The assistor in Girdwood did this last year, on the days volunteers visited the library. The tax volunteers really liked having her there, and at least one taxpayer was able to get a question answered on the spot. The assistor told the site coordinator that she thought it was a good outreach opportunity for her, as well.

49 ACA Tax Resources IRS.gov/aca pages include: MEC chart,
Exemption chart, and Q&A section Electronic Publications 5156 and 5172 Health Care Tax Tips and legal guidance HealthCare.gov or state Marketplace website for Marketplace information Pub 5172, Facts about Health Coverage Exemptions Pub 5156, Facts about the Individual Shared Responsibility Provision

50 Questions? These are questions that have come up in past presentations.: If a person’s Permanent Fund Dividend was garnished, is it still included in household income? Yes. It must be reported on the tax return, and will be included in household income. This is also true for people who donate part of their PFD through Pick-Click-Give or who put half of their PFD in the Alaska College Savings Plan. All income that is “constructively received” must be reported on the income tax return, and will be included in HHI What if I have applied for an exemption through the Marketplace but I don’t have the number? If you were granted a coverage exemption from the Marketplace, but did not receive an ECN, or do not know your ECN, contact the Marketplace to obtain your ECN. If the Marketplace has not processed your application before you file, enter “pending.”

51 Thanks for having me!


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