Using The marketplace Financial Application Checklist When applying, it will help to have these things at hand Social Security Numbers (or document #’s for legal immigrants) of everyone who will be covered under the plan. Birth dates of everyone covered under the plan Pay-stubs, W-2 forms, or Wage & Tax Statements Policy Numbers for any current Health Insurance Policies Information about any health insurance available from a job
Financial Application Medicaid Denial Tax Credit Shop/ Compare Financial Assistance Process Tax Credit (estimate) from ConnectForHealthCo.com Financial Application has an accurate Tax Credit Amount.
Plans must provide “Preventive Care” at no cost Specific details may vary by plan, but in general, you will NOT have to pay a copayment, co-insurance, or deductible to receive certain preventive health care, such as:copaymentco-insurancedeductible Blood pressure, diabetes (Type II) and cholesterol tests Many cancer screenings, including mammograms and colonoscopies Counseling on such topics as quitting smoking, losing weight, eating healthfully, treating depression and reducing alcohol use Regular well-baby and well-child visits, from birth to age 21 Routine vaccinations for children against diseases such as measles, polio or meningitis Counseling and screenings to ensure healthy pregnancies Women’s wellness and pre-natal visits Flu and pneumonia shots
Women’s Preventive Services Preventive Services 100% Covered (No Co-Pays, Co-insurance or Deductibles) 1.Annual Well-woman visits 2.Screening for Gestational Diabetes 3.Testing for Human Papillomavirus or HPV 4.Counseling and screening for HIV 5.Contraception methods and counseling 6.Breastfeeding support, supplies, and counseling 7.Screening and counseling for domestic and interpersonal violence
The right level of care? REMEMBER: your out-of-pocket costs can vary significantly by the place of service, be sure to check your Health Plan details for coverages. Doctor’s Office Your doctor should be your first call when you’re sick. Your doctor not only knows you, but has all of your medical records in one place. Because of this, he or she can make an informed decision about the care you need. Retail Clinic Put simply, these clinics make life easier when you need routine healthcare services for common illnesses – like colds, flu, or sore throats – as well as vaccinations. They usually cost less than an emergency room. Urgent Care Go to an urgent care center when your doctor isn’t available. Infections, injuries, cuts, sprains, flu, fever, allergies, asthma, and rash is when you should consider going to an urgent care center instead of an Emergency Room. When you think you’re having an emergency, Trust Your Instincts… and go directly to the ER, or call an ambulance. Emergency Room Use the “ER” for emergencies only. If you’re facing a serious situation – like uncontrolled bleeding, chest pain, heart attack, difficulty breathing, possible stroke, or any threat to life or limb – head straight to the ER. NOTE: the emergency room is not an appropriate place for non-emergencies.
1.Young Adults. Not need to be enrolled in school Regardless of Marital Status Not need to live with their parents or be financially dependent. 2.Kids under age 19 The Law provides that they can get coverage regardless of pre-existing conditions. Young Adults can stay on their parents plan until the 26 th birthday
1095-A Tax Form Educational Meeting January 14, 2015
What is Form 1095-A? 1095-A is a tax form containing information regarding customers’ health insurance status and any financial assistance they may have received within the Connect for Health Colorado Marketplace. The purpose of this form is to help customers fill out Form 8962 when they file their taxes.
What is form 8962? Form 8962 is the form tax filers will need to submit in order to claim their premium tax credit, or to reconcile the advance premium tax credits (APTC) that was paid to the carrier on their behalf.
Who will receive Form 1095-A? All individual customers who enrolled in health insurance through Connect for Health Colorado in 2014 will receive Form 1095-A, even if you did not receive financial assistance. This form is also proof that the individual customer purchased insurance for 2014.
How does Financial Assistance Affect Tax Filing? If customers qualify for financial assistance, they must file an income tax return. These customers can no longer file any version of the short forms, such as the 1040 EZ. The customers have to file one of the longer forms, such as Form 1040 or 1040A. Customers must also file IRS Form 8962 with their income tax return.
What is Reconciliation? Once customers file their taxes with the financial assistance amount from their 1095-A Form, the IRS will take three actions which, together, are called “reconciliation.” The IRS will check to see if the income that was reported is the same as the income reported on the tax return. The IRS will also check to see if the customer’s tax household size is the same as when they applied for coverage. The IRS will then compare the financial assistance already paid to the customer’s health plan with the financial assistance that they qualify for.
What If the Amounts Don’t Match? If the household income on the tax return is lower than the income on the Connect for Health application, the customer may receive credits to lower their owed taxes, or even receive a refund. If the household income on the tax return is higher than the income on the Connect for Health application, the IRS may have paid too much financial assistance and the customer may have to pay some or all of the premium assistance back.
Limitations on Repayments FPL Household Income (Individual) Limit on repayment for Filing Single Limit on repayment for all other filing statuses Less than 200%Less than $22,978$300$600 200% - 300%$22, 979-$34,469$750$1,500 301% - 400%$34,470 - $45,959$1,250$2,500 401% or moreMore than $45,960No limit
Forms 1095-B and 1095-C Form 1095-B is sent if someone in the household was on Medicare, Medicaid, VA or other health insurance outside of Connect for Health Colorado. Form 1095-C is sent if someone in the household received health insurance through their job. These forms are not required to be sent by these other entities until next year. Customers should consult their tax advisors.
When will Individuals Receive their Form 1095-A? Everyone who purchased health insurance through Connect for Health Colorado will be mailed Form 1095-A on January 30 th, with a cover letter, and they will receive it the first week of February, whether or not they received financial assistance. An electronic copy of Form 1095-A is available in the My Documents section of their Connect for Health Colorado online account. An email will be sent on January 21 st to customers to explain the upcoming form.
What if the Customer Doesn’t Agree with the Amounts listed on the 1095-A Form? If the customer thinks that there is a mistake on Form 1095-A, they should call Connect for Health Colorado right away at 1-855- PLANS-4-YOU (855-752-6749). We may be able to send a corrected Form 1095-A. If the “CORRECTED” box on the top of the customers Form 1095-A is checked, this means we made a change to the information we originally provided.
Reporting Life Changing Events The following are ‘Life Change Events’ which are circumstances that may affect a customer’s health plan, And should be reported to the Marketplace.
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