Have you been getting a health insurance subsidy this year?

Some interesting things to know if you are one of the people who, like me, is buying their own insurance from the healthcare exchanges and receiving an advance subsidy from the government to help pay for it:

1. If you received a subsidy this year that was directly paid to your insurance company, you MUST have your return filed by April 15th. No extensions–not even if you are missing crucial information like K-1s from partnerships etc. Your preparer will have to make a good faith estimate, note the number under question in a statement attached to the return, and file an amended return if needed. The IRS needs the return in order to calculate whether you received too much subsidy and need to return the advance payments, or whether you received too little and get a refund.

2. This January (or actually, for 2015, February 2) and every year henceforward, you (EVERYONE, not just people buying care off the exchanges) will receive a new tax information form to be brought to your return preparer with information about your health insurance. Most of these forms are numbered 1095 with a letter indicating whether the insurance was purchased through your employer or from other sources. Your preparer cannot file your tax return until you have your information form, so tax season will be delayed and abbreviated this season. Expect very harried tax preparers especially as tax season progresses. Also because of the additional work required to reconcile the information, potentially up to an additional hour per return, especially if your insurance changed during the year or if you had a coverage gap during the year, expect tax return costs to go up this year. On the other hand, you are much more likely to be able to avoid or minimize penalties if you are using a qualified tax preparer–and especially if you have a tax planning meeting before year end–so the value provided in return for the fee only increases. But if you are focused only on the cost, it will probably go up more than usual this year.

3. If your income changed during the year in any substantial way from the way you estimated it last year when signing up on the exchange, you should have gone on to healthcare.gov or your state exchange and updated your information during the year. Especially if your income went up substantially, you could lose the subsidy and have to repay it–even if your modified AGI was just one dollar over the limit for your filing status.

4. If you chose to remain uninsured this year, you will owe a penalty. The MINIMUM penalties rates are relatively low this year (the $95 Single minimum penalty number has been much bandied about) and will rise steeply over the course of the next two years, but if your income was a middle class income and you went uninsured, your penalty could be quite steep–up to 1% of income this year (going up to 2.5% by 2016), and capped for this year at $9800 (the national average price of a bronze plan for a family). Some taxpayers are going to be in for a nasty surprise.

5. If you owe a penalty and have a balance due on your tax return, as opposed to a refund, if you don’t pay the amount that is due because of the penalty, they won’t actively come after your for it. What will happen is that interest and penalities will continue to accrue, and if or whenever you next have a refund due, the IRS will take it. Interest will accrue until the entire balance is paid.

6. The subsidies are now under Supreme Court challenge for those of us who receive the subsidy from Healthcare.gov, as opposed to from a state exchange. The Supreme Court on Friday accepted the King v. Burwell case, which challenges the legitimacy of subsidies received from the federal as opposed to the state exchange, since the governing law refers to “State” subsidies. Two different Circuit Courts decided differently on this issue, hence the Supreme Court acceptance of the challenge. TBD by June-yet another way the Right is trying to make the Affordable Care Act go away. Two-thirds of people would lose their subsidies if the word “State” is interpreted in the narrow rather than in the broad sense, making insurance unaffordable for them and effectively undermining the law.

About elissawurf

Elissa Wurf, Ph.D. (psychology), CPA
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