Roundtables: Taxes, Outreach and Stories! Eric Covey, Consumer - - PowerPoint PPT Presentation

Assister Regional Roundtables:

Taxes, Outreach and Stories!

Eric Covey, Consumer Assistance Program Manager NAME

Consumers for Affordable Health Care

Agenda

• Open Enrollment 2 Celebration!
• Local and National Updates: What’s Going On?
• Open Enrollment and Special Enrollment Periods
• Taxes, taxes, taxes!
• Round Table Discussion
• COBRA, Health Insurance and Story Collecting!

www.mainecahc.org 2

Our Mission

To advocate the right to quality, affordable health care for every man, woman and child in Maine.

www.mainecahc.org 3

About Consumers for Affordable Health Care

• Non-profit, non-partisan mission-driven

research and advocacy organization based in Augusta (founded in 1988)

• Mission: To advocate the right to quality,

affordable health care for every man, woman, and child in Maine.

• Consumer Assistance Program and

HelpLine (1-800-965-7476)

• Public Policy Research and Advocacy

www.mainecahc.org 4

Our Activities

www.mainecahc.org 5

www.mainecahc.org 6

CONGRATULATIONS!

Enrollment Update

Maine:74,805

• 90% qualified for financial assistance, and paid an

average of $93/month. Nationally: Nearly 11.7 MILLION

• More than half are new enrollees!

www.mainecahc.org 7

• King v. Burwell is a case that was argued

before the Supreme Court on March 4th

• It is a case that threatens to eliminate tax

credits to buy health insurance in ~ three dozen states, Maine included

King v. Burwell

www.mainecahc.org 8

What do we say?

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• 1. Any financial assistance you have

already received will not be taken away

• 2. Thanks to the ACA, nearly 75,000 people

in Maine now have quality, affordable coverage

• 3. This case is a part of an effort to

dismantle the ACA

• 4. While the court considers the case, there

are no risks to your tax credits

What do we say? (cont.)

• 4. There is no legal basis for the Supreme

Court to take away health coverage from millions

• 5. Tax credits have made it possible for

millions of Americans, and nearly 75,000 in Maine, to have this coverage The Supreme Court will issue a decision on this case, likely in late June or early July.

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But what about ME?

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The “Coverage Gap”

• Remember, only people with incomes

between 100-400% FPL qualify for Marketplace subsidies

• Since Maine has not accepted federal

funds to cover adults below 138% in MaineCare, those below 100% have no assistance to buy coverage in the Marketplace

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The Coverage Gap: What this means for Mainers

• Anyone whose income is over 100% FPL

may qualify for tax credits

• For those with income under 100% FPL
• Parents & children: May qualify for MaineCare
• People with disabilities: May qualify for

MaineCare

• Everyone else: Catastrophic coverage, hospital

free care, or other safety net programs

www.mainecahc.org

Maine’s Safety Net Programs

• Hospital Free Care
• Sliding Scale Clinics, Free Clinics
• Prescription Assistance Programs
• MedAccess
• CarePartners
• Other local programs?

www.mainecahc.org

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The Next Open Enrollment Period

November 1, 2015 – January 31, 2016

Open Enrollment III

• For coverage starting in 2016 the Open

Enrollment Period is November 1, 2015 until January 31, 2016.

• Individuals must enroll on or before

December 15th by midnight for coverage starting January 1st.

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Are we there yet!?!?

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Not yet, but there’s still plenty to do!

• Now that Open Enrollment has ended,
• nly individuals who have been granted a

special enrollment period may enroll.

• Everyone else must wait until November

1st.

Special Enrollment Periods (SEPs)

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Qualifying Life Events

• Getting married
• Having a baby, adopting, or placing a child for adoption or foster

care

• Becoming pregnant does not open up an SEP
• Moving to a new area with different plan options
• Includes moving out of jail
• Losing other health coverage (deciding not to pay your premium or

voluntarily dropping COBRA does not count)

• Gaining citizenship or lawful presence in the U.S.
• Change in income makes you eligible for different tax credits or

cost-sharing reductions, but only if already enrolled in a Marketplace plan

• Loss of eligibility for a hardship exemption
• Remember – change of income on its own is NOT a

qualifying event!

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Special Enrollment Periods

Triggering Event Plan Selection Date Coverage Effective Date Loss of minimum essential coverage

(but not due to failure of payment)

Any day of the month First day of following month following plan selection Marriage Any day of the month First day of following month following plan selection Birth, adoption, or placement in foster care Any day of the month Date of birth, adoption, or placement Change in status to become a citizen or lawfully present Same rules as open enrollment Same rules as open enrollment Enrolled or not enrolled due to error by exchange Same rules as open enrollment Same rules as open enrollment

Special Enrollment Periods

www.mainecahc.org

Triggering Event Plan Selection Date Coverage Effective Date Future loss of employer coverage (within next 60 days) Any day of the month First day of the month following the date of the loss of coverage Access to new QHP through a permanent move Same rules as open enrollment Same rules as open enrollment Certain Native Americans can enroll or change plans once a month Same rules as open enrollment Same rules as open enrollment Exceptional circumstances, including loss of eligibility for a hardship exemption Same rules as open enrollment Same rules as open enrollment

Taxes, taxes, taxes!

• The bad news: many individuals who did

not have coverage in 2014 will have to pay a penalty at tax time.

• The good news: if they haven’t enrolled in

a Qualified Health Plan (QHP) for 2015 they will get an SEP!

www.mainecahc.org

Tax Time SEP

People may qualify for an SEP if they certify:

• They didn't know until after Open Enrollment ended
• n February 15, 2015 that they would have to pay a

penalty

• They owe the fee for not having coverage in 2014
• They aren’t already enrolled in 2015 coverage

through the Health Insurance Marketplace

The SEP will be open from March 15th to April 30th.

www.mainecahc.org

Tax Time SEP

• To get the SEP an individual must be

subject to the penalty for being uninsured in 2014

• They will still have to pay a prorated

portion of the penalty for the amount of time they were uninsured for 2015

www.mainecahc.org

• This year is the first year that individuals

will have to report on their health coverage when they file their taxes.

• These forms are complicated and people

will need help filling them out.

• As the local neighborhood

healthcare expert, people will turn to you!

Speaking of Taxes…

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• We ARE NOT tax professionals!
• We can help answer some questions

though.

• And we know who people can get tax help

from!

• But we ARE NOT tax professionals!
• …or accountants…

Our role as assisters:

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For most people, not a lot.

• Those who had health care coverage through an

employer, MaineCare, Medicare, etc. won’t have to do much.

• IRS Form 1040:

Taxes: What’s New?

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Individuals who received advance premium tax credits on health plans through the Marketplace will be mailed Form 1095-A from the Marketplace, which will give them the information that they need to file Form 8962 with their federal tax return to report on their health insurance for 2014 to the IRS.

• Form 1095-A will include:
• How many months the individual has had health insurance

through the Marketplace

• How much they paid in monthly premiums
• The amount that was paid in advance to the individual’s health

plan

• The second lowest cost silver plan available in their region
• Which members of the household were enrolled in the health

plan

Taxes, cont.

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• About 20% of Form 1095-As that

went out were incorrect

• The Marketplace has called, mailed or emailed recipients of incorrect

1905-As

• If someone received an incorrect 1095-A:
• They should contact the Marketplace by calling 1-800-318-2596 to

verify the mistake and request a corrected Form 1095-A

• Get a corrected 1095-A from their Marketplace account
• If someone has ALREADY FILED with an

incorrect 1095-A they DO NOT need to refile.

Taxes, cont.

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• Form 1095-A will be used to

reconcile how much somebody was eligible for in tax credits, and how much they received

• This will be calculated on Form

8962 which people will file with their taxes

Tax Reconciliation

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Tax Reconciliation

What happens if your projected income is wrong?

• You will reconcile the difference when you

file your taxes

• If you made more than you estimated – you

may owe money

• If you made less than you estimated – you

may get money

• If you know your income is different –

report it to the Marketplace so they can adjust

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• Peter, Mary, and their two children

estimate that their income in 2014 will be $52,988. The Marketplace determines that they are eligible for a premium tax credit of $11,198 for the year.

• Peter and Mary decide to take the credit in

advance, and the credit is sent directly to the insurer.

Example – Income is Higher than Projected

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• When Peter and Mary file their 2014 taxes in February

2015, it turns out that their income was a little bit higher than they estimated because Peter received a $2,000 bonus at the end of the year.

• The family’s final credit amount is $223 less than the

advance payments they received — $10,975 compared to $11,198. This means that at tax time, if the family was due to receive a refund, the refund would be reduced by $223. If they were not getting a refund, they would have to pay $223 to the IRS. Example from http://www.healthreformbeyondthebasics.org/premium- tax-credits-answers-to-frequently-asked-questions/

Higher than Projected

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• Peter and Mary’s actual income for 2014 was

$2,000 lower than they estimated, so their final credit amount would be $11,503.

• This means the family received $305 less in

advance payments than they were eligible for.

• At tax time, the family would either receive an

additional $305 in refunds, or if they owed taxes the amount they owe would be reduced by $305.

Example from http://www.healthreformbeyondthebasics.org/premium- tax-credits-answers-to-frequently-asked-questions/

Example – Income is Lower than Projected

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Repayment Caps

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From Kaiser Family Foundation (kff.org)

• Remind people that their tax credit was

based on the income that they projected

• If they didn’t update their income they

were receiving more in financial assistance than they were eligible for

Repayment Messaging

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Update your account with any changes in income

• r family size!

For some it might make sense to not take the whole APTC!

The Tax Penalty

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• Also known as the individual

shared responsibility payment

• Individuals who went 3 or more

months without minimum essential coverage will have to pay a penalty

The Tax Penalty

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• For 2014 the penalty is $95 per adult,
• r 1% of household income –

whichever is GREATER

• For 2015 the penalty will be $325 per

adult, or 2% of household income, whichever is GREATER

How much?

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Individuals may qualify for an exemption if they:

• Lowest cost coverage available would cost more than

8% of their household income

• Had a gap in coverage for less than 3 consecutive

months during the year

• Won’t file a tax return because income is below the tax

filing threshold (In 2014 the tax filing threshold is $10,150 for individuals and $20,300 for married persons filing a joint return)

Exemptions

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• Under 138% of the FPL and are unable to qualify for

Medicaid because your state has chosen not to expand the program

• Participate in a health care sharing ministry or are a

member of a recognized religious sect with objections to health insurance*

• Are not a U.S. citizen, a U.S. national, or a resident alien

lawfully present in the U.S.

• Are a member of a federally recognized Indian tribe
• Are incarcerated

Exemptions, cont.

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Additionally the Marketplace issues some exemptions directly based on hardship.

• These Hardship Exemptions generally cover the month
• f the hardship, and the month before and after
• For 2014 it is too late to apply for an exemption directly

from the Marketplace

• Individuals can apply for these exemptions directly from

the Marketplace for 2015

Exemptions, cont.

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• You were homeless
• You were evicted in the past 6 months or were facing eviction or foreclosure
• You received a shut-off notice from a utility company
• You recently experienced domestic violence
• You recently experienced the death of a close family member
• You experienced a fire, flood, or other natural or human-caused

disaster that caused substantial damage to your property

• You filed for bankruptcy in the last 6 months
• You had medical expenses you couldn’t pay in the last 24 months that

resulted in substantial debt

Hardship Exemptions

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• You experienced unexpected increases in necessary expenses due

to caring for an ill, disabled, or aging family member

• You expect to claim a child as a tax dependent who’s been denied

coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you don't have the pay the penalty for the child.

• As a result of an eligibility appeals decision, you’re eligible for

enrollment, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled through the Marketplace

• You were determined ineligible for Medicaid because your state

didn’t expand eligibility for Medicaid under the Affordable Care Act*

*Automatic on taxes this year: no guarantee on future years

Hardship Exemptions

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• Individuals will use Form 8965 to file for
• ne of these exemptions
• If they had applied and received a hardship

exemption from the Marketplace they should have an Exemption Certificate Number (ECN)

• REMINDER: An individual MUST PAY the

penalty for 2014 to get the Special Enrollment Period!

How to get an exemption

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Q: Normally I don’t have to file taxes. If I received advance premium tax credits for my 2014 health insurance plan will I have to file taxes?

Common Scenarios and FAQs

48

Q: My income fell below 100% of the Federal Poverty Level but I did not report this change to the Marketplace and continued to receive tax credits. Will I have to repay the tax credits I received?

Common Scenarios and FAQs

49

Q: I paid for the full cost of my plan through the

Marketplace because I was not eligible for tax credits when I submitted my 2014 Marketplace application, but my income for the year ended up being less than 400% of the Federal Poverty Level, so I should have qualified. Can I still get that money?

Common Scenarios and FAQs

50

Local Help!

CA$H Sites Individuals and families with a household income of $53,000 or less qualify for free tax preparation help at any of the CA$H sites below. Individuals can also visit http://www.cashmaine.org/find.

AARP Tax Aide Sites To find an AARP Tax Aide site, individuals can call 1-888-227-7669 or visit www.aarp.org/taxaide. Individuals do not need to be AARP members to access this help.

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Aroostook County ~ 764-5197 Capital Area (Augusta) ~ 621-3430 Central Maine (Waterville area)~ 873-7700 Eastern Maine (Bangor area and Penobscot, Piscataquis, Washington, & Hancock counties) ~ 973-3500 Calais (Washington County) ~ 255-9399 Lubec (Washington County) ~ 733-2491 Machias (Washington County) ~ 255-9399 Milbridge (Washington County) ~ 664-2424 Greater Portland ~ 699-0753 Lewiston/Auburn ~ 513-3160 Midcoast Maine ~ 321-8375 Wabanaki ~ 866-6545 Western Maine ~ 778-7954 York County ~ 324-5762, ext. 2718

Local Help!

• Maine Society of Certified Public Accountants

https://www.mecpa.org/ The Maine Society of Certified Public Accountants site features a search where individuals can locate CPAs in their geographic area.

• H&R Block

http://www.hrblock.com/tax-offices/local/maine-tax-preparation H&R Block has tax offices located throughout Maine. This site features a locator by City or Town where people can find the closest H&R Block locations to them.

• Jackson Hewitt

http://www.jacksonhewitt.com/OfficeLocator/Search- Results/?stateCode=ME Jackson Hewitt has tax offices located throughout Maine. The site above lists all locations where individuals can access help from certified tax preparers.

• And Consumers for Affordable Health Care!

1-800-965-7476

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• Form 1040: http://www.irs.gov/pub/irs-pdf/f1040.pdf
• Instructions: http://www.irs.gov/pub/irs-pdf/i1040gi.pdf
• Form 8962: http://www.irs.gov/pub/irs-pdf/f8962.pdf
• Instructions: http://www.irs.gov/pub/irs-pdf/i8962.pdf
• Form 8965: http://www.irs.gov/pub/irs-pdf/f8965.pdf
• Instructions: http://www.irs.gov/pub/irs-pdf/i8965.pdf

Questions?

Tax Form Links

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Q & A and Thank You!

Consumers for Affordable Health Care HelpLine: 1-800-965-7476

Web: http://www.mainecahc.org YouTube: http://www.youtube.com/user/mainecahcchannel “Like” us on Facebook: http://www.facebook.com/MECAHC Follow us on Twitter: @MAINECAHC

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• Marketplace plans may be a good option

for people who are eligible for COBRA

• Employees need help understanding their
• ptions, and when different options are

available

Marketplace and COBRA

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• Most people are only able to sign up for a

plan on the Marketplace during Open Enrollment

• For 2015: November 15, 2014 – February 15, 2015
• Some people qualify for Special Enrollment

Periods outside of Open Enrollment if they have certain life events happen to them

• Losing another kind of coverage qualifies you for a

SEP

Timing Matters!

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• When someone loses their employer-

based coverage, they can choose COBRA

• r the Marketplace

COBRA or Marketplace?

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• If they choose COBRA:
• They can’t switch to Marketplace until the next

Open Enrollment period

• They can switch during Open Enrollment
• When COBRA expires, they can get a Special

Enrollment Period and sign up on the Marketplace

COBRA or Marketplace?

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• If they choose the Marketplace and forego

COBRA:

• They have 60 days from when coverage will

end to enroll in a Marketplace plan through a Special Enrollment Period

• Depending on income, they may be able to

get financial help on the Marketplace

COBRA or Marketplace?

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• Differences between plans, including:
• Cost
• Total out-of-pocket expenses
• Provider networks
• Timing – when is each option available?
• Marketplace eligibility – can they get

financial help?

• Other coverage available
• Projected income

Helping Employees Understand Their Options

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• It is a glitch in the law
• If someone is offered coverage through a

spouse or parent/guardian’s employer the Marketplace ONLY looks at affordability for the employee

• The calculation to determine affordability

for an exemption is based on the actual cost to cover the individual

Understanding the Family Glitch

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• Via kff.org

Health Insurance Explained

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• We need to continue to demonstrate the

experience that consumers are having to improve health care coverage

• We do this by telling our stories!

Story Collection

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• Hanging by a Thread
• Losing the Farm
• It Saved Our Lives

Via Maine People’s Alliance

Our Stories are Powerful!

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• No Matter What Happens, I’m Going to Be

Covered

• Getting Covered Was One of the Most

Relieving Things Ever

Our Stories Matter!

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• Not everyone wants to share their story!
• For many it’s an empowering experience
• We can help!

Story Collecting Tips

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