1. Connect for Health Colorado Marketplace Update
September 2014

2. Connect for Health Colorado Marketplace Update
APTC Reconciliation/Shared Responsibility
Insurance Options for Immigrant Elders
Complex Household Enrollment Strategies

3. Shared Responsibility Provision of the ACA
What is the individual shared responsibility provision?
Under the ACA, the federal government, state governments, insurers, employers and individuals are given shared responsibility to reform and improve the availability, quality and affordability of health insurance coverage in the United States. Starting in 2014, the individual shared responsibility provision calls for each individual to:
Have minimum essential health coverage, or
Qualify for an exemption, or
Make a payment when filing his or her federal income tax return.

4. Shared Responsibility Provision of the ACA
Who is subject to the individual shared responsibility provision?
The provision applies to individuals of all ages, including children. The adult or married couple who can claim a child or another individual as a dependent for federal income tax purposes is responsible for making the payment if the dependent does not have coverage or an exemption.

5. Shared Responsibility Provision of the ACA
How do you report having minimum essential coverage, exemptions?
The individual shared responsibility provision went into effect in You won’t need to report minimum essential coverage or exemptions or make any individual shared responsibility payment until you file your 2014 federal income tax return in Information will be made available later about how to report your coverage or exemption (or make a payment) on your 2014 income tax return. Insurers will be required to provide everyone that they cover each year with information that will help them demonstrate they had coverage beginning with the 2015 tax year.

6. Shared Responsibility Provision of the ACA
How do you make payment?
If you or any of your dependents don’t have minimum essential coverage and don’t have an exemption, you will need to make an individual shared responsibility payment on your tax return. It is important to remember that choosing to make the individual shared responsibility payment instead of purchasing minimum essential coverage means you will also have to pay the entire cost of all your medical care. You won't be protected from the kind of very high medical bills that can sometimes lead to bankruptcy.

7. Shared Responsibility Provision of the ACA
How much is the payment?
If you must make an individual shared responsibility payment, the annual payment amount is the greater of a percentage of your household income or a flat dollar amount. You will owe 1/12th of the annual payment for each month you or your dependent(s) don’t have either coverage or an exemption.

8. Shared Responsibility Provision of the ACA
Specifically, how much is the payment?
For 2014, the annual payment amount is:
The greater of:
1 percent of your household income that is above the tax return filing threshold for your filing status, or
Your family's flat dollar amount, which is $95 per adult and $47.50 per child, limited to a family maximum of $285.
For the 1% rule, capped at the cost of the national average premium for a bronze level health plan available through the Marketplace in For 2014, that equals $204/individual/month.

9. Shared Responsibility Provision of the ACA
What about the payment in future years?
The percentages and flat dollar amounts increase over the first three years. In 2015, the income percentage increases to 2 percent of household income and the flat dollar amount increases to $325 per adult ($ per child under 18). In 2016, these figures increase to 2.5 percent of household income and $695 per adult ($ per child under 18). After 2016, these figures increase with inflation. 

10. Shared Responsibility Provision of the ACA
What happens if I can’t afford my payment?
The IRS routinely works with taxpayers who owe amounts they cannot afford to pay. The law prohibits the IRS from using liens or levies to collect any individual shared responsibility payment. However, if you owe a shared responsibility payment, the IRS may offset that liability against any tax refund that may be due to you.

11. Premium Tax Credit What is the premium tax credit?
The premium tax credit is an advanceable, refundable tax credit designed to help eligible individuals and families with low or moderate income afford health insurance purchased through Connect for Health Colorado, also known as the Marketplace, beginning in You can choose to:
have the credit paid in advance to your insurance company to lower what you pay for your monthly premiums (APTC), or
claim all of the credit when you file your tax return for the year, or
Some of both a) and b)
If you choose to have the credit paid in advance, you will reconcile the amount paid in advance with the actual credit you compute when you file your tax return.

12. Premium Tax Credit
What happens if my income or family size changes during the year?
The actual premium tax credit for the year will differ from the advance credit amount estimated by the Marketplace if your family size and household income as estimated at the time of enrollment are different from the family size and household income you report on your return. The more your family size or household income differs from the Marketplace estimates used to compute your advance credit payments, the more significant the difference will be between your advance credit payments and your actual credit.

13. Premium Tax Credit
What happens if my income or family size changes during the year?
Notifying the Marketplace about changes in circumstances will allow the Marketplace to update the information used to determine your expected amount of the premium tax credit and adjust your advance payment amount. This adjustment will decrease the likelihood of a significant difference between your advance credit payments and your actual premium tax credit.

14. Premium Tax Credit
Will I have to file a federal income tax return to get the premium tax credit?
For any tax year, if you receive advance credit payments in any amount or if you plan to claim the premium tax credit, you must file a federal income tax return for that year. If you receive any advance credit payments, you will use your return to reconcile the difference between the advance credit payments made on your behalf and the actual amount of the credit that you may claim. This filing requirement applies whether or not you would otherwise be required to file a return.

15. Premium Tax Credit
How will I know what to report on my federal tax return?
The Marketplace will send you an information statement showing the amount of your premiums and advance credit payments by January 31 of the year following the year of coverage. For example, you will receive the 2014 information statement by Jan. 31, 2015, and can use this information to compute your premium tax credit on your 2014 tax return and to reconcile the advance credit payments made on your behalf with the amount of the actual premium tax credit.

16. Premium Tax Credit
How is the amount of the premium tax credit reconciled?
The premium tax credit is a refundable tax credit. This means that if the amount of the credit is more than the amount of your tax liability, you will receive the difference as a refund. If you owe no tax, you can get the full amount of the credit as a refund. However, if you receive advance payments of the credit, you will reconcile the advance payments with the amount of the actual premium tax credit that you calculate on your tax return. If your actual allowable credit on your return is less than your advance credit payments, the difference, subject to certain caps, will be subtracted from your refund or added to your balance due. If your actual allowable credit is more than your advance credit payments, the difference will be added to your refund or subtracted from your balance due.

17. Sponsor Deeming and Marketplace (from NILC)
Who gets Sponsored?
Most Immigrants applying for Green card
How long does sponsoring last? (from NILC)
Becomes a U.S. citizen; or
Earns credit for 40 quarters (about 10 years) of work
Leaves the U.S. permanently
APTC eligibility is not affected by Sponsor Deemed income/assets
If immigrant is a tax dependent, the tax household’s income is used for determination

18. APTC Eligibility for Immigrants with Sponsors
Sponsor Deemed Over 65
Not eligible for MAGI Medicaid based on age
Under 5 Years Present (Not Eligible for Medicare at all)
Tax Household % FPL: Eligible for APTC based on income
Tax Household <100% FPL: Eligible for APTC based on immigration status exception (5 year bar)
Over 5 Years Present
Not eligible for Premium Free Medicare Part A
Must have 10 SSA quarters (would no longer need sponsor)
Tax Household <100% FPL: Eligible for Medicare Savings Program or Old Age Pension
If Sponsor Income/Assets prevent OAP or Medicare Savings Program (Buy In)
Eligible for APTC based on immigration status exception
Sponsor Deemed Under 65
More than 5 years Residence
Eligible for MAGI Medicaid based on tax household income
Less than 5 Years Residence
Immigration Status prevents MAGI Medicaid
Eligible for APTC based on tax household income

19. Complex Household Enrollments
One tax household, different insurance needs
Each Insurance Policy must have unique C4HCO account
Answer APTC questions and indicate who is applying for insurance on this policy
Only the amount of APTC for those eligible on the application is used for each account
When is this beneficial?
Only some of the members are eligible for Catastrophic or AI/AN coverage and that is the policy the eligible members want
Different levels of coverage are wanted
Different provider networks are wanted
Different coverage needs (formulary/cost sharing for certain services, etc..)

20. Complex Household Enrollments
One Family Enrollment, Two PTC eligible tax households
Family with children who file and are between %
Only one tax household can have APTC applied to family policy
Other tax filer will get PTC at time of filing
When could this be beneficial?
Family deductible/out of pocket max likely to be met
Family wants one policy to keep straight for whole family
Tax filers under 18, only charged for 3 children

21. Complex Household Enrollments
Adult Children on Family policy or Individual?
Children can remain on family policy until age 26
Could be tax dependents or filing on own
Only eligible for APTC on the account if tax dependent of account holder
Can live in other states/service areas
Would only want to use a policy that met all family members needs with provider availability
When is Individual Policy Beneficial?
Independent tax filer can use APTC
Policy needs specific to Individual
Family can still pay net premium
When is Family Policy Beneficial?
Adult Children are tax dependents and APTC is available
Family deductible/out of pocket max likely to be met
Family wants to control insurance buying decision
Tax Dependent-responsible for Shared Responsibility

23. Connect for Health Colorado Marketplace Update
Questions?

24. Connect for Health Colorado Marketplace Update
Kevin Finder, CAC Program Coordinator
Phone: (720)
Heather Taber, Assistance Network Manager
Phone: (720) 12