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Health Insurance Marketplace | PA Employee Benefits

Abridged from www.irs.gov

Health care insurance purchased through the Marketplace

InterviewIf you purchased health care insurance through the Marketplace, you should receive a Form 1095-A, Health Insurance Marketplace Statement, at the beginning of the tax filing season. The information shown on Form 1095-A helps you complete your federal individual income tax return. If Form 1095-A shows coverage for you and everyone in your family for the entire year, check the full-year coverage box on your tax return. Among other things, Form 1095-A reports the total monthly health insurance premiums paid to the insurance company you selected through the Marketplace. It lists the amount of premium assistance you received in the form of advance payments of the premium tax credit that were paid directly to your insurance company, if any. If you received a Form 1095-A with incorrect information, see our Corrected, Incorrect or Voided Forms 1095-A for Tax Years 2014 and 2015 questions and answers to find out how it affects your taxes.

If you chose to have advance payments of the premium tax credit paid directly to your insurance company, you must file a federal income tax return, even if you are otherwise not required to file. You are required to reconcile — or compare — these payments to the premium tax credit you’ll compute for your tax return. Even if you did not choose to receive advance payments, you must file a federal income tax return to claim the premium tax credit. See below for more information regarding the effect of failing to reconcile advance payments of the premium tax credit.

If you purchased coverage through the federally facilitated Marketplace and you set-up a HealthCare.gov account, you can get a copy of Form 1095-A, Health Insurance Marketplace Statement online from your account. Visit your Marketplace’s website to find out the steps you need to follow to get a copy of your Form 1095-A online. You can use either the information from your online account, if it is available, or the Form 1095-A that is mailed to you to complete your tax return.

Failing to file tax returns will prevent advance payments in the next year

The IRS reminds taxpayers who received advance payments of the premium tax credit that they should file their tax return timely to ensure they can receive advance payments next year from their Marketplace.

If advance payments of the premium tax credit were paid on behalf of you or an individual in your family, and you do not file a tax return reconciling those payments, you will not be eligible for advance payments of the premium tax credit or cost-sharing reductions to help pay for your Marketplace health insurance coverage in the next year. This means you will be responsible for the full cost of your monthly premiums and all covered services. In addition, we may contact you to pay back some or all of the advance payments of the premium tax credit.

Marketplaces will determine eligibility for advance tax credit payments and cost-sharing reductions for the coverage year in the fall before the new coverage year starts. You will substantially increase your chances of avoiding a gap in receiving this help if you electronically file your tax return with Form 8962 by the due date of your return.

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