Faq
What is a 1095-A form?
A 1095-A form is the document proving your Marketplace subsidies for the previous year. This document ensure that you had coverage and if you qualified for subsidies, that you received the correct amount of discounts. Those who did not receive enough of a discount will receive reimbursement in their tax return while those who received too much of a discount will be required to pay some or all of the subsidy back. This process is called reconciliation.
Where can I find my 1095-A tax form?
If anyone in your household was covered by a Marketplace plan in 2015, you should’ve received Form 1095-A, Health Insurance Marketplace Statement, in the mail by early February. If you have an online Marketplace account, it should be there also. It comes from the Marketplace, not the IRS.
What should I do if I get a notice saying the Marketplace needs more information (an “inconsistency” or “data-matching” issue)?
You got this notice because some information you provided on your application – like your income estimate, your citizenship or immigration status, or other data – doesn’t match our records. Learn more about what to do when the Marketplace asks for documents to verify your information.
To avoid health insurance issues, you must submit the documents by the deadline included in the notice. If you don’t, you could lose your coverage or savings. See the page above for instructions on how to resolve these inconsistencies.
Why did I receive more than one 1095-A?
If you got more than one 1095-A, it’s probably because one of these applies:
- You changed Marketplace plans during the year
- You updated your application with new information – like adding or subtracting a family member, or moving – that resulted in a new enrollment in your plan
- Different household members had different plans
- There are more than 5 people on the same plan
How can I get health coverage now that Open Enrollment is over?
Even though Open Enrollment is over, you can still get 2016 health insurance 2 ways:
With a Special Enrollment Period (SEP) – like if you have a baby, get married, lose job-based coverage, or have certain other life changes. You can apply for Medicaid and the Children’s Health Insurance Program (CHIP) any time and can enroll immediately if you’re eligible.
If you don’t qualify for either, Open Enrollment for 2017 Marketplace health coverage will begin in the fall. You can sign up to get reminders so you don’t miss any deadlines or other important information about next year’s Open Enrollment. You may also have an option to buy a short term medical plan if you need coverage to start sooner. These policies are not considered ACA compliant and you may still be responsible for a Health Insurance Tax when purchasing these types of plans.
How do I find out if I qualify for an exemption that keeps me from having to pay the fee for not having health insurance?
Most people must have qualifying health coverage or pay a fee for the months they don’t have insurance.But if you qualify for a health coverage exemption – from certain hardships or life events, health coverage or financial status, membership in some groups, and more – you don’t have to pay the fee that other uninsured people must pay. Check under Marketplace exemptions to see if you qualify.
Where can I find exemption application forms?
If you think you may qualify for an exemption that’ll keep you from having to pay the fee for not having a 2015 health plan, you may claim one when you file your tax returns.
- Find 2015 health coverage exemption forms and instructions.
- Find 2015 hardship exemption forms and instructions.
- Your Adjusted Gross Income (AGI) on your federal tax return
- Excluded foreign income
- Nontaxable Social Security benefits (including tier 1 railroad retirement benefits)
- Tax-exempt interest
- MAGI does not include Supplemental Security Income (SSI)
- Essential health benefits
- Pr-existing conditions, including pregnancy
- Preventive care
- Many states are expanding Medicaid to cover all households below certain incomes. See if your state is expanding and if your income is in range to qualify.
- Your children may qualify for CHIP even if you don’t qualify for Medicaid.
- Online
- By phone
- With in-person help
- With a paper application
- If you don’t have coverage in 2016, you’ll pay a penalty of either 2.5% of your income, or $695 per adult ($347.50 per child) — whichever is higher.
- In some cases, you might qualify for an exemption from the requirement to have health insurance.
How do I report changes to things like my income, family, or address outside Open Enrollment?
It’s really important to report any changes, like to your income, address, and household, as soon as possible. These changes may affect the coverage or savings you’re eligible for.
You can report changes to the Health Insurance Marketplace 3 ways: Online, by phone, or in person.
What counts as “income”?
Your Marketplace savings are based on your estimated income for 2016 – not last year’s income.
Your MAGI is the total of the following for each member of your household who’s required to file a tax return:
The below examples are types of income that you SHOULD consider as income when applying for Marketplace subsidies, for each member of your household:
<thstyle=”background-color: #cecece;”>Notes
Notes
| Income type | Include as income? | Notes |
|---|---|---|
| Federal Taxable Wages (from your job) | Yes | If your pay stub lists “federal taxable wages,” use that. If not, use “gross income” and subtract the amounts your employer takes out of your pay for child care, health insurance, and retirement plans. |
| Tips | Yes | |
| Self-employment income | Yes | Include “net self-employment income” you expect — what you’ll make from your business minus business expenses. Note: You’ll be asked to describe the type of work you do. If you have farming or fishing income, enter it as either “farming or fishing” income or “self-employment,” but not both. |
| Unemployment compensation | Yes | |
| Social Security | Yes | Include both taxable and non-taxable Social Security income. Enter the full amount before any deductions. |
| Social Security Disability Income (SSDI) | Yes | But do not include Supplemental Security Income (SSI). |
| Retirement or pension Income | Yes | Include most IRA and 401k withdrawals. (See details on retirement income in the instructions for IRS publication 1040). Note:Don’t include qualified distributions from a designated Roth account as income. |
| Alimony | Yes | |
| Capital gains | Yes | |
| Investment income | Yes | Include expected interest and dividends earned on investments, including tax-exempt interest. |
| Rental and royalty income | Yes | Use net rental and royalty income. |
| Excluded (untaxed) foreign income | Yes |
The below examples are types of income that you SHOULD NOT consider as income when applying for Marketplace subsidies, for each member of your household:
| Income type | Include as income? | Notes |
|---|---|---|
| Gifts | No | |
| Supplemental Security Income (SSI) | No | But do include Social Security Disability Income (SSDI). |
| Veterans’ disability payments | No | |
| Worker’s Compensation | No | |
| Proceeds from loans (like student loans, home equity loans, or bank loans) | No | |
| Child support | No |
Who is included in your household?
| Relationship | Include in household? | Notes |
|---|---|---|
| Dependent children, including adopted and foster children | Yes | Include any child you’ll claim as a tax dependent, regardless of age. |
| Children, shared custody | Sometimes | Include children whose custody you share onlyduring years you claim them as tax dependents. |
| Non-dependent child under 26 | Sometimes | Include them only if you want to cover them on your Marketplace plan. |
| Children under 21 you take care of | Yes | Include any child under 21 you take care of and who lives with you, even if not your tax dependent. |
| Unborn children | No | Don’t include a baby until it’s born. You have up to 60 days after the birth to enroll your baby. |
| Dependent parents | Yes | Include parents only if you’llclaim them as tax dependents. |
| Dependent siblings and other relatives | Yes | Include them only if you’llclaim them as tax dependents. |
| Spouse | Yes | Include your legally married spouse, whether opposite sex or same sex. In most cases, married couples must file taxes jointly to qualify for savings. |
| Relationship | Include in household? | Notes |
|---|---|---|
| Legally separated spouse | No | Don’t include a legally separated spouse, even if you live together. |
| Divorced spouse | No | Don’t include a former spouse, even if you live together. |
| Spouse, living apart | No | Include your spouse unless you’re legally separated or divorced. (See next row for an important exception.) |
| Spouse, if you’re a victim of domestic abuse, domestic violence, or spousal abandonment | Not required | In these cases, you don’t have to include your spouse. |
| Unmarried domestic partner | Sometimes | Include an unmarried domestic partner only if you have a child together or you’ll claim your partner as a tax dependent. |
| Roommate | No | Don’t include people you just live with — unless they’re a spouse, tax dependent, or covered by another exception in this chart. |
Obamacare Overview
The Health Insurance Marketplace is for people who don’t have health coverage. If you don’t have health insurance through a job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source that provides qualifying coverage, the Marketplace can help you get covered.
If you have job-based insurance: You can buy a plan through the Marketplace, but you’ll pay full price unless your employer’s insurance doesn’t meet certain standards or if the cost of coverage is not deemed “affordable” (monthly premium is greater than 9.5% of your monthly income). Most job-based plans do meet the standards
What you pay for insurance depends on your income – and you’ll probably save. Your savings depend on your estimate of your expected income for 2016, not your income for 2015. This year, about 8 in 10 of the uninsured who are eligible for Marketplace coverage qualify for financial assistance to lower the cost of their monthly premiums. Get a quick idea if your expected income is in the range to save.
Based on the income estimate you put on your application, we’ll tell you if you qualify for one of these:
A health insurance plan with savings. Most people who apply qualify for a premium tax credit that lowers their monthly insurance bill. Some also save on out-of-pocket costs like deductibles and co payments.
The plans are offered by private insurance companies with a range of prices and features. All plans cover:
Medicaid and the Children’s Health Insurance Program (CHIP)
Medicaid and CHIP provide free or low-cost coverage to millions of people and families with limited income, disabilities, and some other situations.
You can apply for coverage 4 ways
If you don’t have health insurance, you may have to pay a fee. Most people must have qualifying health coverage or pay a fee with their 2016 federal taxes.
