Recalculate the creditConsider: ◦ 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 toMid-year job loss Subsidy may be too lowMid-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 tobenchmark 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
Vanessa is married… but separatedfrom her husband.She has 3 children.She has wages of$31k, but sellscosmetics on theside, earning anadditional $2,400. 10
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