Making The Premium Tax Credits Work

Tara Straw

Health Action 2012January 19, 2012

Do you know what Do you know what your tax credit is?your tax credit is?

Recalculate the credit

Consider:◦ Your family (& your tax family & your coverage family)

◦ Income (all sources)◦ Other sources of coverage◦ Your benchmark premium◦ Your advance credit

The credit for 2014 was calculated based on your 2012 tax return.

Since then …◦ Your marital status has changed◦ Your family has changed◦ Your job has changed◦ Your insurance coverage has changed

Taxpayers who marry during the year◦ Problem: 1+ 1 = 3◦ Recommendation: Account for lower incomes while people are single.

Taxpayers who divorce Taxpayers who are separated◦ Problem: No tax credit if you file separately from your spouse!

◦ Recommendation: Exceptions for abandoned spouses, domestic abuse, and other circumstances.

Changes in family composition

People on your insurance, but not on your taxes

People on your taxes, but not on your insurance

* May not reflect your actual family.

What to report When to report Who to report to

Mid-year job loss Subsidy may be too low

Mid-year job gain Subsidy may be high

More types of coverage = more complications◦ Did the Exchange get it right?◦ Did I get it right?◦ Trapped between Medicaid and the Exchange?◦ Premium stacking

Is your employer-sponsored coverage affordable?

Repayment or additional credit (up to benchmark premium)

Income Maximum Repayment

(Single/Family)<200% FPL $300/$600

200%-300% FPL $750/$1,500

300%-400% FPL $1,250/$2,500

>400% FPL No Cap

10

Vanessa is married … but separated from her husband.

She has 3 children.

She has wages of $31k, but sells cosmetics on the side, earning an additional $2,400.

Medicaid eligibility◦ $33,400 for a family of 4 is 143% FPL◦ Kids look to be Medicaid or CHIP eligible

Marital status◦ Is she eligible for credits or excluded by filing separately from her husband?

Benchmark◦ Second-lowest cost silver self-only plan (~$4,300)

Vanessa’s share of premium is 3.6% ($155/yr)◦ Vanessa’s credit is $4,142

Change the employer affordability test

Ease family transitions

Mandate the use of forms that simplify consumer decisionmaking and end-of-year reconciliation

Prepare for comprehensive training of enrollment staff and volunteers

Clear rules and uniformity on reporting◦ Exchange duties:

Makes advance credit determination* Collect names and employer ID of each employer with one or more employees determined eligible for the tax credit

Determination that employer did not provide minimum essential coverage, plan didn’t meet 60% AV, or plan was unaffordable

Identify◦ Who is eligible for credits? ◦ Who will find them?

Simplify◦ Don’t require people to remember/calculate/estimate – Tell them what they need to know!

Demystify◦ Customer service◦ No black box on information◦ Make sure consumers have tools to make educated decisions in exchange and ESI

◦ Give consumers tools to understand reconciliation