First ACA exemption

[JenMO]

family of 6, 4 kids on Medicaid; father works approx. $30,000. I've worked thru several worksheets. When looking for the lowest cost Bronze plan, when entering family, do I include the kids even though they have Medicaid. Would that be the same if 1 parent had ins and the other didn't? do you always include whole family whether anyone has insurance or not?
Also, when you do the worksheets do you keep for records to prove? I can't find the worksheets in my software (maybe havent' found yet, not sure). I'm doing paper worksheets

[JenMO]

also this is MO and they did not expand Medicaid (as I understand) and their income is below poverty level. Which exemption should I use, A? or G? then is that all I fill out? I've spent all afternoon on this, and probably will be one of t he easier ones

[JenMO]

another exemption? filing threshold with 4 children--gross income is below filing threshold. Which one to use?

[TaxGuyBill]

They are not below the filing threshold. For a Married Filing Jointly return, the 2015 filing threshold is $20,300. Dependents don't change that.

Both A and G would work, but Code G is the easiest to prove (under 100% FPL and in a State that did not expand Medicaid), so I would do that.

For your original question, yes, you would include the kids for the Bronze plan number. You include everybody the is not eligible for employer insurance. Oddly enough, for the Second Lowest Silver Plan, you include everybody that is not eligible for employer insurance OR other Minimum Essential Coverage, such as Medicaid.

[JenMO]

ok, poverty level looks good. But on the bronze, whole family is included, but on silver comparison, only those who don't have insurance?

[TaxGuyBill]

The instructions don't say that, so there is a good chance I'm wrong about that. I'm researching it right now. I'm sorry if I'm wrong about that, but I'll post back if and when I find an answer.

[TaxGuyBill]

Sorry, I was wrong.


For the ACTUAL Premium Tax Credit, it is based on those that do not qualify for other Minimum Essential Coverage (in your situation, 2 people, assuming no employer insurance is available).

However, for this HYPOTHETICAL Premium Tax Credit to determine the Exemption, the calculation is different, and uses the family members that are (1) not exempt or (2) not eligible for EMPLOYER insurance (in your situation, 6 people, assuming no employer insurance is available).

Sorry about the confusion.

[JenMO]

Confusion? understatement. not your fault, the whole worksheet, bronze, silver crap. so bronze I would input whole family (even if kids on Medicaid) and silver would do the same?
So if poverty level they fall under the exemption that MO did not expand Medicaid?

[TaxGuyBill]

Yes, the entire family would be on the worksheet (if nobody had access to employer insurance).

However, because they are in a State the did not expand Medicaid and are under 138% of the FPL, don't waste your time on the worksheet. Just enter Code "G" for the exemption/hardship.

http://www.irs.gov/pub/irs-pdf/i8965.pdf#page=2

[TAX4US]

I wonder if there is somewhere out there that has a list of those states that did not expand the Medicaid. Would come handy I think?

[TaxGuyBill]

I wonder if there is somewhere out there that has a list of those states that did not expand the Medicaid. Would come handy I think?

Google is your friend.

http://familiesusa.org/product/50-state-look-medicaid-expansion

http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/

[Justataxguy]

Google is your friend.

http://familiesusa.org/product/50-state-look-medicaid-expansion

http://kff.org/health-reform/state-i...able-care-act/

There is also an ACA calculator at the kff site - http://kff.org/interactive/subsidy-calculator/

[TaxGuyBill]

I am revisiting this because my first answer was correct, and I got confused and incorrectly changed my mind to the wrong answer. The following is from the original statement and is CORRECT:

"For your original question, yes, you would include the kids for the Bronze plan number. You include everybody the is not eligible for employer insurance. Oddly enough, for the Second Lowest Silver Plan, you include everybody that is not eligible for employer insurance OR other Minimum Essential Coverage, such as Medicaid."



I just re-read the Instructions and the Regulations for this, and that is how it is. The Premium Tax Credit is based on the number of people that are not eligible for Minimum Essential Coverage. So somebody that is eligible for Medicaid are NOT counted for the Second Lowest Silver Plan. However, for the Bronze plan, you DO include those eligible for non-employer Minimum Essential Coverage.


It's seems weird, but that is how the Final Instructions and the Regulations seem to read.

Again, I'm sorry for even more confusion. :-)

[TaxGuyBill]

I just realized that part of my initial confusion was that the IRS just updated the 8965 instructions specifically on this point. The version before 1/21/15 read differently than the current version.