Last Updated
March 21, 2016
Frequently Asked Questions:
Taxes and Health Insurance
The following is intended to provide basic guidance to health coverage Navigators and Assistors as they
field questions from consumers on what to expect at tax time. For more detailed information, Assisters
and Consumers may contact Consumers for Affordable Health Care at 1-800-965-7476, or refer to the
end of this guide for a list of certified tax professionals.
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Normally, I don’t have to file taxes. If I received advance premium tax credits for
my 2015 health insurance plan, will I have to file taxes?
Yes. Any individual who received premium tax credits in 2015 must file a federal tax return, even if they
have never filed before or don’t meet other IRS requirements to file. All individuals who have received
premium tax credits will have to file a federal tax return.
I didn’t have insurance for 2015. Will I have to pay a penalty?
Generally, individuals who went three or more months in 2015 without health insurance coverage that
meets minimum essential coverage requirements will be required to pay a penalty. However, they may
qualify for an exemption from paying this penalty. Individuals may qualify for an exemption if they:
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Cannot afford coverage, defined as those who would pay more than 8 percent of their
household income for the lowest cost bronze plan available to them through the Marketplace.
Had a gap in coverage for less than 3 consecutive months during the year.
Won’t file a tax return because income is below the tax filing threshold. In 2015 the tax filing
threshold is $10,150 for individuals and $20,300 for married persons filing a joint return.
Are unable to qualify for Medicaid because your state has chosen not to expand the program.
Participate in a health care sharing ministry or are a member of a recognized religious sect with
objections to health insurance.*
Are not a U.S. citizen, a U.S. national, or a resident alien lawfully present in the U.S.
Are a member of a federally recognized Indian tribe.
Are incarcerated.
Additionally individuals who do not qualify for one of the exemptions above but who have experienced a
hardship that made it difficult to purchase insurance may have received a hardship exemption through
the health insurance Marketplace.
* For a sect to qualify for the religious exemption, it must fall within the definitions of section 1402(g) of the Internal Revenue Code of 1986.
That section requires a sect to have been in constant existence since at least Dec. 31, 1950, and requires the sect to reject not only insurance
but also have sworn off receiving all benefits from the U.S. Social Security system.
Maine did not expand Medicaid (MaineCare), but I didn’t file for a hardship
exemption directly with the Marketplace. Will I still be able to get this
exemption from paying the penalty?
Yes. Individuals who reside in states like Maine that have not accepted federal funds to expand Medicaid
can now claim this exemption directly on their federal tax return. Individuals can receive this exemption
for the whole year if at any time in 2015 they were a resident of a state that did not expand Medicaid if
their income is below 138% of the Federal Poverty Level. While individuals can get this exemption
directly at tax time this year, it may not be automatic in future years. So individuals should be
encouraged to apply for an exemption or submit a Marketplace application.
I lost my health insurance coverage on July 15th and didn’t get covered again
until August 1st. Does this mean I am considered to have been without coverage
for a month because I lacked coverage for part of the month?
No, individuals who have coverage for any one day in a month are considered to have coverage for that
month.
I don’t qualify for an exemption. How much will my tax penalty be?
For 2015 the tax penalty will be $325 per uninsured adult and $162.50 per uninsured child, or 2% of
total household income, whichever is greater. For 2016 the penalty will go up to $695 per uninsured
adult and $347.50 per uninsured child or 2.5% of household income, whichever is greater.
How will I show the IRS that I had insurance?
Individuals who received advance premium tax credits on health plans through the Marketplace will be
mailed Form 1095-A from the Marketplace. Form 1095-A will give them the information they need to
file Form 8962 with their federal tax return to report on their health insurance for 2015 to the IRS.
Form 1095-A will include:
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How many months the individual has had health insurance through the Marketplace
How much they paid in monthly premiums
The amount that was paid in advance to the individual’s health plan
The second lowest cost silver plan available in their region
Which members of the household were enrolled in the health plan
People who had coverage through Medicaid, Medicare, an employer, or a source other than the
Marketplace will not have to fill out a Form 8962. They will check a box on Line 61 of their Form 1040 to
show that they and all members of their family had health coverage. Individuals with these other kinds
of coverage will receive either a form 1095-B or 1095-C with information about which members of their
household had coverage, and when. They do not need to file these forms with their taxes, but should
keep them as records.
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What other information will I need to report to the IRS?
In addition to information normally required to file taxes, individuals will also need specific information
to fill out IRS Form 8962 to report on their premium tax credit.
Form 8962 requires:
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Family size
Household income
Their family’s income level as a percentage of the Federal Poverty Level. An IRS chart helps
individuals figure this out, but many may need your help.
The second lowest silver plan available in the individual’s region. Form 1095-A will provide this.
The amount of tax credits paid to their health plan provider each month during 2014. Form
1095-A will provide this.
If an individual has received premium tax credits, it is important to know that they cannot file using the
1040EZ form. They will have to file either the 1040 or 1040A form, as well as filing Form 8962 to request
premium tax credits or report on premium tax credits they have received.
I received Form 1095-A from the Marketplace but I believe that the information
on it is wrong. What should I do?
Individuals should contact the Marketplace by calling 1-800-318-2596 to verify the mistake and request
a corrected Form 1095-A. The information on Form 1095-A is also reported to the IRS so it is important
that individuals do this before they file their 2014 tax return.
My income changed during the year. Will I have to pay any of my tax credit
back?
If an individual’s income went up during the year and they did not report that change in income to the
Marketplace to adjust the amount of tax credit they were getting, they must reconcile the amount of tax
credit that they wrongly got when they file their taxes. There are caps on the amount that individuals
will have to repay. If an individual is receiving a tax return, this amount will be deducted from the
amount that they will get back, or will be added to the amount that they owe.
(From Kaiser Family Foundation – http://kff.org/)
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If an individual’s income has gone down during the year, they may be able to get some money back. This
amount will be added to their return if they are getting one, or will lower the amount that they owe if
they owe money on their federal tax return.
My income fell below 100% of the Federal Poverty Level but I did not report this
change to the Marketplace and continued to receive tax credits. Will I have to
repay the tax credits I received?
The IRS has issued guidance that individuals whose income fell below 100% of the Federal Poverty Level
WILL NOT have to repay the amount that they received in premium tax credits. However, it may impact
their future Marketplace applications by requiring them to submit proof of projected income for
eligibility in future years.
How do I know if I received tax credits?
If an individual gets premium tax credits to help pay for the cost of their health insurance, the amount
they get will be listed on the statement from their health insurance company. They can also contact
their health insurance company directly to ask. For 2015, only Anthem, Harvard Pilgrim and Maine
Community Health Options were providing plans through the Marketplace. Individuals who received
premium tax credits will be mailed form 1095-A with information on their tax credit to submit when
they file their 2015 federal tax return.
I paid the full cost of my plan through the Marketplace because I was not
eligible for tax credits when I submitted my 2015 Marketplace application. But
my income for the year ended up being less than 400% of the Federal Poverty
Level, so I should have qualified. Can I still get that money?
Yes, individuals can get this money by filing a 2015 federal tax return including Form 8962. Form 8962
will help individuals figure out the amount of tax credit that they should receive, and they will get this
amount as a tax refund when they file their taxes.
My spouse and I received premium tax credits this year but usually file our taxes
as married, filing separately. What will happen when we file our taxes this year?
The Marketplace requires that married individuals file their taxes jointly to receive premium tax credits
unless they meet certain criteria in section 1.36B-2T(b)(2) of the Temporary Income Tax Regulations.
This allows certain victims of spousal abandonment or domestic abuse to receive a premium tax credit
while filing taxes as Married Filing Separately status. If individuals do not meet these criteria, and choose
to file as Married Filing Separately, they may have to repay the amount that they have received in
premium tax credits. The amount that must be repaid will be split evenly between each spouse. It’ll be
subject to the same income based repayment limits that apply to individuals or families who got excess
advance premium tax credits for other reasons.
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My spouse and I are separated but not divorced. How does this affect my taxes
and my ability to get tax credits?
If an individual is married and has lived apart from their spouse for the last 6 months of the year, pays
more than half the costs of keeping up the household, and claims a child as a dependent, then they
might be able to file as head of household, instead of married filing separately. For someone who is
separated, if they are able to file as head of household instead of married filing separately, they will still
be eligible to receive premium tax credits without having to include their spouse on their taxes or their
Marketplace application. Individuals should speak with a tax professional to figure out if they can file as
head of household.
My regular income did not change during the year from what I put on my
Marketplace application, but I inherited money from a relative. Will that affect
whether or not I have to pay back my subsidies?
Most inheritances will not count in determining eligibility to receive premium tax credits. This is because
most are not factored into modified adjusted gross income to determine reconciliation of tax credits
received. But this depends on the tax structure of the inheritance. Individuals should check with an
accountant to determine whether or not their inheritance will be included as taxable income.
I think that I have been scammed by phone or email regarding my health
insurance and taxes. What should I do?
If you think an individual has been the victim of a scam or given misinformation about their coverage by
an insurance agent or broker, then you should help them file a complaint with the Bureau of Insurance.
The Bureau will investigate every claim that they receive, but a complaint needs to be filed in order for
an investigation to begin. Filing a complaint is quick and simple and can be done electronically or
through the mail. For more information, to file a complaint online, or print out a complaint form to send
through the mail, visit: http://www.maine.gov/pfr/insurance/complaint.htm or call 1-800-300-5000. If
you have any questions or need assistance, you can also call our Assister Line, 1-800-838-0388 ext. 1.
For scams involving taxes, or other common scams, individuals should file a complaint with Maine’s
Attorney General at 1-800-436-2131 and with the Federal Trade Commission by calling 1-877-382-4357.
More information on common scams can be found at http://maine.gov/ag/consumer/scams.shtml.
You helped me sign up for this insurance; doesn’t that mean you have to help
me with my taxes to report on it?
No, Navigators and Certified Application Counselors (CACs) are not required to help individuals prepare
taxes. Additionally, Navigators and CACs do not have the training or expertise that tax assistance
professionals and accountants have to best assist an individual with their taxes. However, as a trusted
community resource you can provide valuable information to your clients using this guide!
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Where can I get help filing my taxes?
Individuals can get free help filing their federal tax returns at many locations in Maine through CA$H
sites which offer tax help through IRS trained tax preparation volunteers or at an AARP Tax Aide site.
CA$H Sites
Individuals and families with a household income of $54,000 or less qualify for free tax preparation help
at any of the CA$H sites below. Individuals can also visit http://www.cashmaine.org/find.
Aroostook County ~ 764-5197
Capital Area (Augusta) ~ 621-3430
Central Maine (Waterville area)~ 873-7700
Eastern Maine (Bangor area and Penobscot,
Piscataquis, Washington, & Hancock
counties) ~ 973-3500
Calais (Washington County) ~ 255-9399
Lubec (Washington County) ~ 733-2491
Machias (Washington County) ~ 255-9399
Milbridge (Washington County) ~ 664-2424
Greater Portland ~ 699-0753
Lewiston/Auburn ~ 513-3160
Midcoast Maine ~ 321-8375
Wabanaki ~ 866-6545
Western Maine ~ 778-7954
York County ~ 324-5762, ext. 2718
AARP Tax Aide Sites
To find an AARP Tax Aide site, individuals can call 1-888-227-7669 or visit www.aarp.org/taxaide.
Individuals do not need to be AARP members to access this help.
Additionally, people can seek help filing their taxes from local, certified public accountants (CPAs) or
through other for profit tax services providers.
Maine Society of Certified Public Accountants
https://www.mecpa.org/
The Maine Society of Certified Public Accountants site features a search where individuals can
locate CPAs in their geographic area.
H&R Block
http://www.hrblock.com/tax-offices/local/maine-tax-preparation
H&R Block has tax offices located throughout Maine. This site features a locator by City or Town
where people can find the closest H&R Block locations to them.
Jackson Hewitt
http://www.jacksonhewitt.com/OfficeLocator/Search-Results/?stateCode=ME
Jackson Hewitt has tax offices located throughout Maine. The site above lists all locations where
individuals can access help from certified tax preparers.
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Sources:
Kaiser Family Foundation (http://kff.org/health-reform/faq/health-reform-frequently-asked-questions)
Consumers Union (http://consumersunion.org/wp-content/uploads/2014/11/Health_Ins_tax_credits.pdf)
IRS (http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/The-Premium-Tax-Credit)
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