Form 1095 and Filing Your U.S. Individual Income Tax Return. Are you ready?

Form 1095 and Filing Your U.S. Individual Income Tax Return. Are you ready?

If you haven’t completed your U.S. Individual Federal Income Tax return yet, you may run up against a question about the Form 1095, why it’s important and whether you can complete your tax return without it.

Form 1095 is a collection of Internal Revenue Service (IRS) tax forms in the United States which are used to determine whether an individual is required to pay the individual shared responsibility provision. Individuals can also use the health insurance information contained in the form/forms to help them fill out their tax returns. The individual forms are Form 1095-A “A Health Insurance Marketplace Statement”, Form 1095-B “Health Coverage”, and Form 1095-C “Employer-Provided Health Insurance Offer and Coverage”. Individuals may receive one or multiple versions of Form 1095.

The Affordable Care Act, or Obamacare, includes both the individual mandate and the employer mandate. The individual mandate requires that most Americans have qualifying healthcare coverage or potentially face a fine.[1] The employer mandate requires employers with 50 or more full-time equivalent employees to offer healthcare coverage to their full-time employees or potentially face a fine. Form 1095 determines whether the employee or the employer have to pay a fine for failing to meet the individual mandate and the employer mandate, respectively.

(the previous two paragraphs came from Wikipedia and described Form 1095 perfectly!)

Normally, Form 1095 is supposed to be delivered by January 31. However, over the past few years, the IRS has granted an extension for health plans and employer groups to deliver it later (presumably due to the onerous effort it may take to get ‘er done). This year the 1095 must be delivered by March 3.  Many employers were planning to deliver the 1095 as soon as possible before March because many people want to file their income tax returns sooner than later, especially if they are due a refund.

The 1095 may be mailed or downloaded from a website.  Your tax accountant or Turbo Tax prompt may ask you to answer a question related to whether you had health insurance in the tax year you’re filing for. The 1095 is meant to illustrate which months you and your tax dependents were covered by said health insurance.  Many people get stuck not completing their tax returns because they don’t have the 1095 in hand.

Good news:  You do not have to wait for either Form 1095-B or 1095-C from your coverage provider or employer to file your individual income tax return. You can use other forms of documentation, in lieu of the Form 1095 information returns to prepare your tax return. Other forms of documentation that would provide proof of your insurance coverage include:

  • insurance cards,
  • explanation of benefits
  • statements from your insurer,
  • W-2 or payroll statements reflecting health insurance deductions,
  • records of advance payments of the premium tax credit and
  • other statements indicating that you, or a member of your family, had health care coverage.

You will not need to send the IRS proof of your health coverage. However, you should keep any documentation with your other tax records. This includes records of your family’s employer-provided coverage, premiums paid, and type of coverage.

To learn more about Form 1095, visit the IRS website.

The information in this post is meant to be informational only, and not intended as legal advice for how to file your individual income tax return.  People who receive their health insurance through the Marketplace or employer or other group plan should check with their insurance provider, employer or group administrator for direction on obtaining their 1095, and also consult with a tax or legal consultant for any direction or advice on properly filling out your U.S. Individual Income Tax Return.

Preventive Healthcare: Are you getting your free screenings?

An ounce of prevention is worth a pound of cure.  Preventive healthcare is important, especially to identify and treat symptoms or diseases BEFORE they get turn into prolonged, expensive and potentially life-threatening situations.

Now is the time to schedule your annual preventive care visit with your doctor.  Employer and group insurance plans may not require a co-payment, co-insurance, or deductible to receive recommended preventive health services, such as screenings, vaccinations, and counseling.

For example, depending on your age, you may have access — at no cost — to preventive services such as:

Top things to know about preventive care and services:

  • Network providers: If your health plan uses a network of providers, be aware that health plans are required to provide these preventive services only through an in-network provider. Your health plan may allow you to receive these services from an out-of-network provider, but may charge you a fee where claims are subject to a deductible or coinsurance.
  • Office visit fees: Your doctor may provide a preventive service, such as a cholesterol screening test, as part of an office visit. Be aware that your plan can require you to pay some costs of the office visit, if the preventive service is not the primary purpose of the visit, or if your doctor bills you for the preventive services separately from the office visit.
  • Questions: If you have questions about whether you are covered for preventive services at no cost, contact your medical plan.  You can often find your list of covered benefits on the insurance website (i.e. http://www.mycigna.com or https://www.uhc.com/)
    • Contact your employer or group plan, or visit your employer/group intranet to locate the Summary of Benefits of Coverage (aka SBC) which is required by law to be provided to covered members. The SBC will identify what’s covered and how.
  • Talk to your health care provider: To know which covered preventive services are right for you — based on your age, gender, and health status — ask your health care provider.
  • Dental Care is important. Regular preventive dental exams can impact your your oral health by lowering your risk for developing tooth decay, gum disease, and more serious dental problems. We can all practice good oral hygiene habits, such as brushing your teeth at least twice a day and flossing.
  • Preventive health also incorporates self-care.  We can perform majority of preventive measures on our own to stay healthy like eating right, exercising, reducing stress, sleeping well and living a risk-free lifestyle.  Search the internet to find ways to incorporate self-care (here’s a post by Harvard Medical School)

Visit the Health and Human Services website to learn more about preventive care at https://www.hhs.gov/healthcare/about-the-aca/preventive-care/index.html

Top 5 Benefits Open Enrollment Must-Dos

The open enrollment benefits period is the one time of the year employers allow you to make changes to your benefit elections with very few questions asked.  Take advantage of it.

It’s not uncommon for our own benefit elections to run on auto pilot rolling over each year.  Take a few minutes to run an audit. You could save yourself money and heartache down the road.  Prepare yourself by reading the benefit communications your company prepared for open enrollment.  Learn what’s new, what may be going away next year and whether there are any significant changes that will impact you or a covered family member financially.

Review your current elections

Do you still need the same medical or dental plan?  You may have elected the higher cost dental plan last year when you needed that root canal, but now you’re only in need of periodic cleanings.  Downgrade to a lower payroll contribution plan.   Maybe your company is now offering a new cost-effective medical plan.   Take inventory of all benefit elections to confirm whether you still want or need them, or whether there are any other benefits you’re not enrolled in that would be of value to you.

Remove or add any dependents

Are you still carrying an ex-spouse or child over the age of 26 on your health plans?  While the age limitation to cover children may vary by state, you may need to actively drop that ineligible child (or ex-spouse) which could decrease your payroll contributions.   Unless you have a mid-year life event such as a marriage, divorce or birth, you can only add a dependent during the open enrollment period.

Change Recurring Contributions to Savings Accounts

Flexible spending accounts and health savings accounts usually start off as an annual goal election with periodic, consistent payroll contributions made over the course of the year.  Over time, funds accumulate in a special account that can only be used under specific conditions without tax implications or penalty.

Health care flexible spending account plans may allow for unused funds to carryover from one year to the next, but often there’s a limit to how much you can carry over. Check with your employer on what your plan rules are as they can vary.  If you no longer need to save pre-tax contributions for a rainy day, stop the election.

Health savings accounts allow you to rollover all of the unused funds, and even take them with you if you leave a company.  If you have extra cash to save, contributing up to the IRS maximum into your health savings account is always a safe bet.

Dependent care flexible spending accounts (earmarked for child care and adult care expenses) don’t allow for the carryover of unused funds from one year to the next. This is the epitome of the “use it or lose it” rule.  If you no longer have a child in day care, stop contributing.

Update Beneficiaries

Life insurance plans and health savings accounts enable you to designate a beneficiary which can ensure a smooth payout of any financial payout to whomever you wish such after you’re gone.  Priorities and situations change impacting who may be entitled to your assets.  Did you get divorced and forget to change your beneficiary?   Assigning a beneficiary ahead of time can eliminate the need to go through probate or any legal process.

Submit your open enrollment elections by the due date

Rules are rules. However, many companies may offer a silent or change window for up to several weeks after the initial open enrollment period.  Technically, the law is a bit fuzzy on this, but an employer can allow you to make a change to your benefit elections for the next calendar year as long as the elections are submitted by December 31 of that year. If you missed the official window, make the case to your employer and stress any financial hardship to persuade them.  Companies need to be seen as behaving fairly and equitably to all employees.