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. o Consumer Assistance Program and HelpLine (1-800-965-7476) o Public Policy Research and Advocacy www.mainecahc.org 4
Our Activities www.mainecahc.org 5
CONGRATULATIONS! www.mainecahc.org 6
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 • King v. Burwell is a case that was argued before the Supreme Court on March 4 th • It is a case that threatens to eliminate tax credits to buy health insurance in ~ three dozen states, Maine included www.mainecahc.org 8
What do we say? 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 www.mainecahc.org 9
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. www.mainecahc.org 10
But what about ME? www.mainecahc.org 11
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 www.mainecahc.org 12
www.mainecahc.org 13
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
The Next Open Enrollment Period November 1, 2015 – January 31, 2016 www.mainecahc.org 16
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 15 th by midnight for coverage starting January 1 st . www.mainecahc.org 17
Are we there yet!?!? Not yet, but there’s still plenty to do! www.mainecahc.org 18
Special Enrollment Periods (SEPs) • Now that Open Enrollment has ended, only individuals who have been granted a special enrollment period may enroll. • Everyone else must wait until November 1 st . www.mainecahc.org 19
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! www.mainecahc.org 20
Special Enrollment Periods Triggering Event Plan Selection Date Coverage Effective Date Loss of minimum essential Any day of the First day of following coverage month month following (but not due to failure of payment) plan selection Marriage Any day of the First day of following month month following plan selection Birth, adoption, or placement in Any day of the Date of birth, foster care month adoption, or placement Change in status to become a Same rules as open Same rules as open citizen or lawfully present enrollment enrollment Enrolled or not enrolled due to Same rules as open Same rules as open error by exchange enrollment enrollment www.mainecahc.org 21
Special Enrollment Periods Triggering Event Plan Selection Date Coverage Effective Date Future loss of employer coverage Any day of the First day of the month (within next 60 days) month following the date of the loss of coverage Access to new QHP through a Same rules as open Same rules as open permanent move enrollment enrollment Certain Native Americans can Same rules as open Same rules as open enroll or change plans once a enrollment enrollment month Exceptional circumstances, Same rules as open Same rules as open including loss of eligibility for a enrollment enrollment hardship exemption www.mainecahc.org
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 on 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 15 th to April 30 th . 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
Speaking of Taxes… • 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! www.mainecahc.org 26
Our role as assisters: • 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… www.mainecahc.org 27
Taxes: What’s New? 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: www.mainecahc.org 28
Taxes, cont. 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 www.mainecahc.org 29
Taxes, cont. • About 20% of Form 1095-As that went out were incorrect o The Marketplace has called, mailed or emailed recipients of incorrect 1905-As • If someone received an incorrect 1095-A: o They should contact the Marketplace by calling 1-800-318-2596 to verify the mistake and request a corrected Form 1095-A o 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. www.mainecahc.org 30
Tax Reconciliation • 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 www.mainecahc.org 31
Tax Reconciliation www.mainecahc.org 32
What happens if your projected income is wrong? • You will reconcile the difference when you file your taxes o If you made more than you estimated – you may owe money o 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 www.mainecahc.org 33
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