The extra $3,000 is clearly stated on the 1095-A. I have seen it. The question is, “What did Kaiser do with the extra $3,000 and how did they not figure out that they were receiving no consumer premium to attach to the monthly subsidy?”
Advance Premium Tax Credit
Posts related to the Advance Premium Tax Credit health insurance subsidy from Covered California.
When the Byrd’s put all their information into the application, it calculates that they should pay no more than 7.30% of their income toward health insurance ($3,352 per year), and subtracts that from the annual cost of the Second Lowest Cost Silver Plan ($16,368 – $3,352 = $13,014.12) The exchange then divides the annual $13,014 of the subsidy by 12 months to get a monthly subsidy of $1,084.50.
For most tax payers, the income they estimated on their application for health insurance will not be exactly the same amount as their final Modified Adjusted Gross Income (MAGI) on their 2019 federal tax return. Part II of form 8962 compares the subsidy you received (column f) to the amount of subsidy you are entitled to (column e) from data supplied by the market place exchange on form 1095-A.
The family continued to wait, not paying any of the invoices they received because they figured that Covered California was working to resolve the issue. The health insurance plan was terminated by the health plan for lack of payment. If the consumer does not pay the all the premiums after 90 days, the consumer loses the right to make all the back-premium payments and reinstate the health plan. This is what happened to the family.
The 1095-A is almost as important as filing taxes. Even if you did not owe taxes in 2017, but still received the APTC, you have to file a tax return. Covered California has been notified by the IRS if a current household, receiving the subsidy, has not filed a 2017 tax return. Covered California is sending out letters to consumers that their current monthly APTC subsidy will be terminated if they do not resolve the issue.
On the old 1040 tax forms you report any repayment of excess Premium Tax Credit on line 46, and any additional PTC owed to you on line 69. For 2018, repayment of the PTC subsidy is reported on Schedule 2 Tax (line 46) and additional subsidy tax credit is listed on Schedule 5 (line 70) Other Payments and Refundable Credits. It’s important to know where to find these numbers if you are trying to forecast for the next year and are using the past figures as a guide.
The Covered California agent service representative said I was about the fifth agent he worked with to identify the missing dependent tax status question. He could see the question in his system, but I couldn’t see the question on my client application. When he indicated that Debbie was to be claimed as a dependent of Susan, the APTC monthly subsidy was awarded.
Some individuals and families who purchased their health insurance through a government exchange like Healthcare.gov or Covered California may be subject to the Penalty for Underpayment of Estimated Tax. The underpayment penalty is triggered when the federal income tax due is less than 90% of the previous year’s tax liability. If a tax household received thousands of dollars of the monthly Advance Premium Tax Credit (APTC) subsidy to lower their health insurance premiums, but earned too much taxable income to actually qualify for the Premium Tax Credit, the tax payer has to repay the entire subsidy. This repayment amount could easily trigger the underpayment penalty.
The formula for determining how much premium assistance, also known as the Affordable Care Act premium tax credits (PTC), to lower your monthly health bill is complicated. At its core the formula uses the inputs of your age, MAGI, a special contribution percentage and the annual cost of the Second Lowest Cost Silver Plan. Plugged into the formula, these inputs determine if any Advance Premium Tax Credits (APTC) will be awarded to reduce your health insurance premium. Some people are surprised to learn they don’t qualify for any APTC even though their MAGI is below 400% of the federal poverty level.
Covered California is cancelling the Advance Premium Tax Credit subsidy that lowers a household’s monthly health insurance premium for 2016 for some consumers. Through Covered California’s automatic renewal process I’ve seen several families’ tax credits disappear for 2016. Without intervention or explanation, many families who had their health insurance automatically renewed may receive a bill for the full premium amount because the tax credit subsidy was eliminated by Covered California.