A ruling by the Internal Revenue Service (IRS) creates a significant obstacle to a new type of health care network that the Obama administration has promoted as a way to provide better care at lower cost, at least according industry lawyers and providers. Health care markets are rapidly changing as independent doctors and hospitals race to form networks, otherwise known as accountable care organizations, in which they coordinate care for patients. The doctors and hospitals have financial incentives to keep patients healthy and to control costs, and they can share in the savings if they meet performance goals. The new entities, which now cover more than 28 million people, according to Leavitt Partners, help manage care for Medicare beneficiaries, people with employer-sponsored insurance, and consumers who buy coverage through online marketplaces under the Affordable Care Act.
Archive for Affordable Healthcare Act
In a recent “tax tip,” the IRS pushed out on the 1095 forms, anitem for Form 1095-C issued by “applicable large employers” to their full-time employees, caught my attention (again). One of the ways the IRS tells a recipient of Form 1095-C to use it follows: Read more
I think it is correct to say that all taxpayers are affected by the Affordable Care Act in some way. Certainly individuals living in the US. All must answer a question on the 1040 as to whether everyone in the “shared responsibility family” (basically those listed on the return), had health coverage for all months of the year. If there are any uncovered months, the next step is to see if an exemption applies for that month. If no exemption for any month, a penalty is computed and reported on the 1040. Read more
1. Employers subject to the heath care mandate.
All companies with 50 or more fulltime equivalent employees are required to offer health care benefits to fulltime employees and their dependents. If not provided, they are subject to a fine (see below). The insurance plan must provide “minimum value” (plan pays at least 60% of the cost of covered health benefits and provide substantial coverage of inpatient hospital and doctors services).
2. Fines for non compliance: The amount is the lesser of:
(a) $3,000 times the number of fulltime employees, in excess of 30, who buy a federally subsidized policy through a state exchange and receive a premium assistance tax credit. To avoid this tax, the employer must pay at least 60% of benefit costs. The share of the premium paid by a worker can’t be more than 9.5% of earned income, based on the prior year=s W2. Since large employers are ineligible to buy group coverage on an exchange for two or three years, they should buy coverage through their present insurance brokers. Read more
To be eligible for the Premium Tax Credit under the Affordable Care Act, all of the following must apply:
• Your income must be between 100% and 400% of Federal Poverty Line (see below) for a given family size.
• You cannot be claimed as a dependent.
• If married, you must file a joint return (although some exceptions may apply).
• You must be enrolled in a qualified health plan through Marketplace.
• Cannot be eligible for other minimum essential coverage.
• Premiums must be paid.
Under the Affordable Care Act, the IRS will be implementing a number of new forms. One such form is the 1095-C form, which will be completed by employers, and which will become mandatory for tax year 2015.
Employers with 50 or more full-time employees are required to file Form 1095-C, both with the employee and with the IRS.
This form includes information about whether the employer offered qualifying health coverage to the employee, spouse and dependents, for some or all months during the year.
Form 1095-C provides the following information:
• Employee’s name, SSN, address. Read more
The Premium Tax Credit, under the Affordable Care Act, is a refundable tax credit that helps eligible people with moderate incomes afford health insurance purchased through the Health Insurance Marketplace.
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 on your behalf directly to your insurance company, to lower what you pay out-of-pocket for your monthly premiums during 2015. These payments are called advance payments of the premium tax credit.
• Get it later: Wait to get the credit when you file your 2015 tax return in 2016. This means, then, that no Read more
Under the Affordable Care Act, the law requires you and each member of your family to have qualifying health insurance, called minimum essential coverage, otherwise you will be subject to a penalty when you file your federal income tax return.
It is important to note that you may be exempt from the requirement to maintain minimum essential coverage, if certain conditions are met, and thus will NOT have to make a shared responsibility payment (penalty) when you file your federal income tax return.
You can obtain some exemptions only from the marketplace, others only from the IRS, and yet others from either the Marketplace or the IRS.
You can obtain Affordable Care Act exemptions under the ACA if any of the following apply to you for 2015 tax year: Read more
When applying for insurance through a state or the federal health insurance marketplace, you will be asked to provide an estimate of your household income for 2016. Your household income is a key factor in determining if you are qualified for an insurance subsidy called the premium tax credit (PTC). Any premium tax credit that you are entitled to will be computed on your 2016 tax return when it is filed in 2017. However, the insurance marketplace will allow you to reduce your insurance premiums during the year by applying this credit in advance based upon the estimate of your household income you provided when applying for the insurance. This advance is referred to as the advanced premium tax credit (APTC).
It is very important to remember that the PTC is based on the actual family income when your tax return is filed in Read more
A tweet from an Indiana resident by the name of Benjamin Miller, including a picture of the IRS notice he received advising him that he owes $2,344 as a penalty for not having health insurance, has gone viral and ignited a firestorm.
Mr. Miller stated in his post that he didn’t buy health insurance because his premiums jumped by over $1,000 to $1,400 per month. Of course the increase in Mr. Miller’s insurance premiums were most likely due to the mandatory provisions included in the health plan that were needed to meet the minimum essential coverage requirements of the Affordable Care Act (ACA).
Presidential candidate Clinton has called for repeal one of the numerous parts of the Affordable Care Act (aka Obamacare). Reuters reports that on September 29, 2015, she called for repeal of the “Cadillac tax” provision that goes into effect starting in 2018 (“Clinton calls for repeal of ‘Cadillac tax’ on healthcare plans,” by John Whitesides, Reuters, 9/29/15).
A few observations on this:
• What happens when one piece of the complete healthcare reform plan is removed? The Cadillac tax raises revenue by imposing an excise tax on certain expensive plans offered to employees (see IRC Section 4980I). Likely it also is an incentive not to offer these Read more
The Affordable Care Act requires you and each member of your family to have qualifying health care coverage, qualify for an exemption from the responsibility to have minimum essential coverage, or make an individual shared responsibility payment when you file your federal income tax return. For purposes of ACA, qualifying health care coverage is also known as minimum essential coverage.
Minimum essential coverage includes:
• Health plans offered in the individual market – plans offered by a health insurance issuer licensed by a state, including a qualified health plan offered through the federally-facilitated or a state-based Health Insurance Marketplace. Read more