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With the conclusion of 2016 open enrollment, 2015 tax season is now upon us. If you thought it was safe to stop thinking about health insurance for a while, you may want to think again.
When the Affordable Care Act’s individual shared responsibility provision and premium tax credit took effect in 2014, the tax landscape changed along with the healthcare landscape. Now:
The second bullet point is what we are going to focus on in this post. Here’s where taxpayers can run to surprises and possibly owe the IRS money. Here’s why:
You see, after you apply for and select an advanced premium tax credit and enroll in a health insurance plan through your state-based or federally facilitated exchange, the subsidy amount for which you are eligible may not be the same from year—or even month to month. It could be that you could lose your eligibility altogether.
How is this possible?
At enrollment time, advanced premium tax credits are based on estimated income and household size for the year ahead, not the year prior. If these things change throughout the year, so will the subsidy amount for which you are eligible.
You must report changes in circumstances to ensure you receive the proper subsidy amount. It is your responsibility to report changes in life circumstances to your state-based or federally facilitated exchange at the time they occur throughout the year. Examples of such changes include increases or decreases in income and household size as well as moving to a different address or gaining or losing eligibility for government-sponsored or employer-sponsored healthcare coverage.
You must report these changes whether they happen once, three times, ten times or any number of times beyond or in between.
Now, let’s get back to that second bullet point—and to the question posed in this post’s headline: What happens if you miscalculated your advanced premium tax credit or, rather, neglected to report changes that impact your eligibility?
Failure to report changes in circumstances throughout the year will become evident when you file taxes for that year. At tax time, when you claim the subsidy and reconcile the amount you received with the amount for which you were actually eligible, you could find:
Sure, it may be too late to go back and report changes for 2015, but you can stay on top of them for 2016. If you are enrolled in an Obamacare plan and receiving advanced premium tax credits, make sure you report changes in life circumstances as soon as possible.
When you enroll in a state-based or federally facilitated health insurance exchange plan, you have the option to either apply for the premium tax credit and receive it in advance, which lowers your monthly payments throughout the year; or, you can claim the entire credit at once when you file your tax return.
Waiting until tax time to claim the credit can be a desirable option if you are likely to see frequent changes in circumstances throughout the year—for example, you are a freelancer or contract worker whose income changes from month to month.
While you can use online subsidy calculators to estimate your tax credit, the tax credit you ultimately receive will be determined at tax time.
One more thing: It is important to understand that whether you choose to receive advanced premium tax credits or wait and claim a premium tax credit at tax time, you must purchase your Obamacare plan from a state-based or federally facilitated exchange. Off-exchange plans are not eligible for subsidies.
Avoid subsidy mistakes and filing errors. From health insurance exemptions to subsidies, if you have questions about the Affordable Care Act and its impact on your taxes, be sure to consult a tax professional.
 Internal Revenue Service. “Affordable Care Act Tax Provisions for Individuals and Families.” IRS.gov. Last reviewed or updated Dec. 31, 2015. https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families
 Internal Revenue Service. “Premium Tax Credit: Claiming the Credit and Reconciling Advance Credit Payments.” IRS.gov. Last reviewed or updated Jan. 14, 2016. https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/Premium-Tax-Credit:-Claiming-the-Credit-and-Reconciling-Advance-Credit-Payments
This document is for general informational purposes only. While we have attempted to provide current and accurate information, this information is provided "as is" and we makes no representations or warranties regarding its accuracy or completeness. The information provided should not be construed as legal or tax advice or as a recommendation of any kind. External users should seek professional advice from their own attorneys and tax and benefit plan advisers with respect to their individual circumstances and needs.
About The IHC Group
The IHC Group is an organization of insurance carriers and marketing and administrative affiliates that has been providing life, health, disability, medical stop-loss and specialty insurance solutions to groups and individuals for over30 years. Members of The IHC Group include Independence Holding Company (NYSE:IHC), American IndependenceCorp. (NASDAQ: AMIC), Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company. Each insurance carrier in The IHC Group has a financial strength rating of A- (Excellent) from A.M. Best Company, Inc., a widely recognized rating agency that rates insurance companies on their relative financial strength and ability to meet policyholder obligations. (An A++ rating from A.M. Best is its highest rating.) Collectively, the companies in The IHC Group provide insurance coverage to more than one million individuals and groups. For more information about The IHC Group, visit www.ihcgroup.com.
About IHC Specialty Benefits, Inc.
IHC Specialty Benefits, doing business as Health eDeals Insurance Solutions is a full-service marketing and distribution company that focuses on small employer, individual and consumer products. Health eDeals markets products through general agents online, telebrokerage, advisor centers, private label and directly to consumers. For more information about Health eDeals visit www.HealtheDeals.com.