Premium Tax Credit

[peggysioux]

Taxpayer had insurance through employer for 2014 so all good there. However, she goes on to tell me that for 2015 she went through the Marketplace and is receiving a Premium Tax Credit. I asked her if she advised the representative that she was eligible for employer based insurance and she said yes she did. Her income is approx. $26,000 and she has one dependent who receives medical insurance through medicare. Her portion of the employer insurance was $144 per month. Based on my computation, her insurance through her employer would not be considered unaffordable being it is less than the 9.56% of her income and the employer insurance covers the minimum value requirements. I am unsure why the representative would advise the taxpayer that she was eligible (I know what you might be thinking....did the taxpayer truly tell the representative that she had medical insurance through her employer - and I do believe she did).

So, the difficult part is that the open enrollment period through her employer is now closed. I advised her that she would have to pay back the premium tax credit but it seems a little unfair that the representative set her up with insurance and now she has no chance to get set back up with employer insurance. Is there possibly something I am missing that does make taxpayer eligible? One would think that the insurance representatives would be very knowledgeable on this subject.

[BP.]

She can purchase through the Marketplace, but if employer coverage is affordable, then no APTC/PTC. Can she go back to the Marketplace to report a status change, or to have the APTC stopped? Can you confirm if she really is getting APTC?

[peggysioux]

Premium Tax Credit

She is supposed to bring her 2015 insurance with her at her next appointment for me to review. Her new premium is only $94 per month so she must be receiving the PTC. I just thought there might be something I am missing that might make her eligible.

[TaxGuyBill]

I agree, I don't think you are missing anything.


I've been hearing a lot of stories that the Marketplace representatives are giving out flat-out wrong information.

[Burke]

I've been hearing a lot of stories that the Marketplace representatives are giving out flat-out wrong information.

I agree. The next door benefits specialist (who signs these people up for insurance with firms as part of her business) called the Marketplace with her client on the phone, and asked several questions about the coverages under certain plans, and the MS gave her wrong answers regarding benefits offered. Sigh.... it is a learning curve for sure.

[CVTax]

Wouldn't a qualifying event, such as loss of other coverage, allow her to enroll on her employers plan? (or maybe that is just in my state)

[kathyc2]

Instead of the question being if the taxpayer is eligible for PTC, should the question be what, if any, responsibility as preparers we have to determine such? I'm not seeing anything on tax forms regarding if employer insurance is available. Is there a reason we should not rely on the 1095A being correct, similar to other tax forms client receives?

[peggysioux]

Premium Tax Credit

Instead of the question being if the taxpayer is eligible for PTC, should the question be what, if any, responsibility as preparers we have to determine such? I'm not seeing anything on tax forms regarding if employer insurance is available. Is there a reason we should not rely on the 1095A being correct, similar to other tax forms client receives?

Good point by Kathy - if taxpayer went through the Marketplace and was told she qualifies, and there is no question on the 8962 regarding receiving the PTC and was eligible for employer insurance, do we as the tax preparer file strictly from 1095-A?

[Burke]

I don't think we have any other choice. I have a client who has continued enrollment for 2015 with PTC, and the Marketplace wants proof of income for 2014. We don't have the info yet to do the return, and cannot estimate, so she is continuing to get PTC and may not be eligible.