1095-A, 1095-B and 1095-C: What are they and what do I do with them?

En Espanol-  1095-A, 1095-B and 1095-C: ¿Qué son y qué debo hacer con ellos?

You may have recently received a form in the mail from DHHS, your employer or the Marketplace. The 1095 form is your "proof of health care coverage" for 2017.  Remember if you did not have health care coverage for more than 3 months, you are required to pay a shared responsibility payment (penalty).  

You will need this form when you go to file your taxes.  There are 3 types of 1095 forms--for Marketplace insurance, public insurance, and employer insurance. If your status changed during the year, or if you had multiple employers, you may get more than one type of 1095!

Form 1095-A

Form 1095-A

1095-A Health Insurance Marketplace Statement

If you had health care coverage through the Marketplace for any part of 2017,  you will receive a 1095-A.  If you selected electronic communications, you will receive an email notifying you that your 1095-A can be downloaded from your Marketplace account at healthcare.gov.  

Your marketplace statement will indicate your tax credit and this form is used to determine whether you may have to pay part of your tax credit back or whether you will receive more of a tax credit. 

Form 1095-A is used to fill out Form 8962 to reconcile the tax credits you received with your actual 2017 income.  (Read about Form 8962 in this blog post!)

Form 1095-B

Form 1095-B

1095-B Health Coverage

You will receive a 1095-B form if your health care was provided by your employer or was provided by the government through the Children's Health Insurance Program (CHIP, MIChild in Michigan), Medicaid, Medicare or a basic health plan.  These forms may not be mailed until after March 2.  The IRS states it is not necessary to file a 1095-B with your taxes. 

Form 1095-C

Form 1095-C

1095-C Employer-Provided Health Insurance Offer and Coverage

Employees will receive a 1095-C if you health care was sponsored by your employer.  

Want more details? The IRS has detailed information about the 1095 forms here.

 

Two More Tax Forms

You may also need to reconcile your tax credits with Form 8962 or claim a health coverage exemption with Form 8965.  (Read about Form 8962 in this blog post!)

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Get 'Em Now! Free Flu Shots Prevent Epidemics

A lot of people say ‘it’s just the flu.’ However, influenza is a serious respiratory illness. Nationally, it causes more hospitalizations and deaths than all other vaccine preventable diseases combined.
— Christina Zilke, Washtenaw County Health Department

What is the flu?

Symptoms of the flu can include fever, chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue or tiredness.  Some individuals will report vomiting and diarrhea but these symptoms are more common in children than for adults.  Symptoms can last anywhere from a few days to about two weeks. 

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Some individuals are at a higher-risk of developing flu complications like sinus and ear infections, pneumonia, and bronchitis.  Pregnant women, young children, people living with chronic medical conditions, or people over the age of 65 are all at a higher-risk of developing flu-related complications.  In some cases complications can become severe and result in hospitalizations and can be life-threatening.

Flu across the country is widespread now. In Washtenaw County, the most recent data looks like this: 

To date (1/27/2018), 181 people in our county have been hospitalized this season and 4 adults have died. 

To date (1/27/2018), 181 people in our county have been hospitalized this season and 4 adults have died. 

More people are being hospitalized. 

I'm Healthy, Why Do I Need A Shot?

The Center for Disease Control (CDC) recommends that everyone 6 months and older should receive a flu shot during the year’s flu season.  

It is important for you to get the flu shot because it keeps yourself and your family safer. If you do get flu, you may be less affected. You are also less likely to transmit the flu. Keep your loved ones healthy!

Some strains of flu are stronger than others. In 1918, the flu killed tens of millions of people around the world. Read more about that in this Washington Post article

In 1968, my entire family got the “Hong Kong” flu. We were all sick for weeks. I still remember it. My mom set up cots in my parents’ bedroom. My grandmother wouldn’t come take care of us because she didn’t want to get sick herself.
— WHP staff member

I Got a Shot Last Year…Why Do I Need Another This Year?

The viruses that carry the flu are always changing.  Flu vaccines are made specifically for each season. Even when they are not completely effective, they still provide some protection. The second reason we get flu shots every year is that the antibodies from previous vaccine viruses will decline over time and no longer protect you from flu viruses.

It's Free, Thanks To The Affordable Care Act! Don't Delay!

Under the Affordable Care Act vaccinations are FREE for those with insurance--and that includes Medicaid and Marketplace coverage, as well as Medicare and employer coverage. Flu shots are given out at pharmacies, doctors, and even your local health department!

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Greatest Hits! Our Top 5 Posts of All Time

Here's a look back--our top 5 blog posts of all time are worth a first look, and a second look too!

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1. The most sought-after blog post, getting twice as many hits as any other blog post, was the very first blog post that staff member Tonya South-Peterson wrote for us! It has resources for how to get eyeglasses if you have Medicaid. With Medicaid, eyeglasses are a covered benefit!

Need Eyeglasses? Medicaid Has You Covered

What's more, this blog post is also available in Spanish.

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2. The #2 blog post is about how to use Medicaid as secondary insurance. This post has more comments than any other blog post, perhaps because not much has been written for the general public about Medicaid as secondary insurance and it can be a bit complicated. (But not super complicated--it's not too different from having insurance from two employers.)

Good News: Medicaid Can Be Secondary Insurance

Find this blog post in Spanish as well. 

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3. The #3 blog post describes how to find a DHHS caseworker's email and/or phone number. In the coming year, DHHS is planning on moving to a "universal caseworker" system, and most people may not have caseworkers in the traditional sense. But whatever happens, we will keep you posted, and update this post as needed.

How To Find A DHHS Caseworker's Email Address (And Phone Number)

Read this in Spanish.

 

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4. The #4 post was the #1 post in 2016! Trying to figure out which Medicaid health plans to choose can be tricky.  In 2018 there will be some changes, particularly to the dental plan choices of the Medicaid health plans--but we will keep you updated as those changes get closer.

Choosing A Medicaid Health Plan (Updated)

This post is also in Spanish.

 

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5. Last but not least--the #5 blog post is a must read for people who have small businesses or do contract/consulting work. It's better to start early, tracking your income and expenses, than to start late. If the information is basically the same as last year's, you can use your taxes, but if you are just starting a new business, this may be what you need.

Help! How Do I Report Self-Employment Income For Medicaid Or The Marketplace?

Read this in Spanish.

 

Are you curious about what our top posts were in 2016?

There is some overlap. Read the Top Posts of 2016 here.

Want to see all of our Spanish posts? We have a page that holds all of our Spanish posts.

Do you have questions or ideas for other blog posts? Let us know in the comments.

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Last Two Weeks: Walk-In and Evening Hours! Spread the Word! Tell Your Friends!

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Open Enrollment ends December 15th. Don't miss this window of opportunity!

We have walk-in hours, Mon.-Fri. from 9 a.m. - 4 p.m., at 555 Towner in Ypsilanti, MI. You can also call for information or an appointment at 734-544-3030. 

EXTRA!!! SPECIAL EVENING HOURS!!! 12/13 until 8pm!

The WHP office will be open on Wednesday, December 13th until 8 p.m.!!!!

Map to WHP office or call (734)544-3030

HELP US!

Help your friends, clients and community! 

Download and distribute the flyer below.

Friends let friends know:

Dec. 15th is the deadline to sign up for 2018 healthcare on the Marketplace (healthcare.gov).

Here is the link to the poster.

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It's Thanksgiving. We're Thankful for the ACA!

President Obama signs the Affordable Care Act. Sitting to his right is former Rep. John Dingell, who represented much of Washtenaw County. 

President Obama signs the Affordable Care Act. Sitting to his right is former Rep. John Dingell, who represented much of Washtenaw County. 

#THANKSACA

The Affordable Care Act. The Patient Protection and Affordable Care Act. 

It's easy to remember some of the things the Affordable Care Act has done.

  • 20 MILLION more people in the U.S. have health insurance. 
  • In Michigan, over 600,000 people are enrolled in the Medicaid expansion, the Healthy Michigan Plan which includes medical, dental and vision benefits.
  • Vaccines are FREE.
  • Need help quitting smoking?  Nicotine patches and medications are FREE.
  • You cannot be denied health care because of a pre-existing condition. It doesn't matter if you have asthma, cancer, or depression--you can still get health insurance.
  • Young adults can stay on their parent's health insurance until they are 26
  • Your annual physical (wellness) appointment is FREE
  • For 2017, your out-of-pocket maximum can be no more than $7,150 for an individual plan and $14,300 for a family plan.
  • Women don't get charged extra for health insurance, and pregnancy is a covered benefit.
  • There are no annual or lifetime limits for insurance. 

#THANKSACA!

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It's Open Enrollment from now until December 15, 2017. Don't miss a chance to get Marketplace coverage! Have questions?  Know someone who needs health care?  

We Help People - Like You! 

Call the WHP at (734) 544-3030

Come see us Monday - Friday between 9am - 4pm.  555 Towner St. Ypsilanti, MI (Except Thanksgiving and the day after Thanksgiving--we're closed.)

Want to read more about the impact of the ACA? 

Kaiser Family Foundation: The Effects of Medicaid Expansion Under the ACA

Medical geek?  From the New England Journal of Medicine, The Affordable Care Act at 5 Years

Data Geeky?  Reform by the Numbers from the Robert Wood Johnson Foundation.

Concerned about efforts to repeal the Affordable Care Act? Here is a way to keep up to date

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Open Enrollment Tips, Part 4: "Other" Deductions To Know About

At some point in the Marketplace and Medicaid applications, you get asked if you pay alimony, student loan interest, or "other" deductions. Just what are those "other deductions?" If you have them, you can essentially lower the income that is counted as MAGI, or Modified Adjusted Gross Income

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The way that works is, if you have income of $20,000 and you pay $300 in student loan interest, your "counted" annual income is only $19,700. If you also paid $2,000 into an IRA, your "counted" annual income becomes $17,700.

When your Modified Adjusted Gross Income is lower, you may qualify for more tax credits, or even for cost-sharing

For the most part, the things that you would be able to deduct are things on the bottom half of the front page of your 1040 tax form. 

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Why "Other" can be a beautiful thing

Remember: the healthcare.gov enrollment application specifically asks you about alimony and student loan interest, but the "other" category may be both interesting and useful.

People who are self-employed, who are actively paying tuition, or who want to invest in retirement through an IRA or in a health savings account may find a path to higher tax credits and increased cost sharing with just a bit of attention to that "other" category.

If you need tax advice about what is deductible, contact your accountant or talk to a tax preparer. We can answer questions or give advice about general tax filing but are not accounts.  If you are low income, contact the United Way and ask about their VITA tax program or check out their free online tax help at MyFreeTaxes.

As always, if you have questions, leave us a comment or give us a call at (734) 544-3030. We Help People--LIKE YOU!

--R. Kraut

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Open Enrollment Tips, Part 3: Should I Choose A Dental Plan?

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After you choose a health insurance plan on the Marketplace (healthcare.gov), you generally will get a screen that says that dental insurance is not included. Would you like dental insurance?

If you answer yes, you will be directed to look at some of the dental insurance plans on the Marketplace.

How does individual dental insurance work?

In general, individual dental insurance is similar to individual health insurance in two ways:

  1. You pay a monthly premium.
  2. Preventive care (cleanings and x-rays) are covered 100% and are encouraged. Other procedures will be covered at different percentages (50%, 80%, 100%) depending on the procedure, the dental network, and the company. Just like with most health insurance, dental insurance works with a "network" of providers, and out of network providers may be covered at a much lower cost, or not at all.

Individual dental insurance is different from individual health insurance in two ways.

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  1. More significant procedures (fillings, crowns, extractions, root canals, bridges, dentures) often have a waiting period of 6 or 12 months before you can use the benefit. 
  2. Most individual dental insurance has a maximum dollar amount that can be spent on you in any year. This is the opposite of medical insurance, where once you hit a maximum out of pocket costs, everything is covered.  With dental insurance, if you need a couple of expensive procedures, you will likely hit the point where the dental insurance has maxed out.

 

Can you use tax credits for dental insurance on the Marketplace?

In general, no. Dental coverage is an essential benefit for children under the age of 18. If it is not included in their health plan then you can use tax credits (if you have any left over) toward their dental plan.  Adults cannot use tax credits to buy dental insurance.  Marketplace dental information.

Are there other options?

Yes, there are (at least) three other options.

1. Take employer-offered dental insurance. If you are buying health insurance on the Marketplace because your employer health insurance is unaffordable, their dental insurance may still be affordable--and may not have the waiting periods that individual dental insurance has. You can only choose this during employer open enrollment or a special enrollment period.

2. Buy off the Marketplace. Since you are not using tax credits, you should look around. You can work through an insurance broker or directly with companies that offer dental plans like Blue Cross, Delta, Golden, etcetera. You can only do this during Marketplace open enrollment or when you qualify for a special enrollment period.

3. Set money aside each month for dental expenses as if you were paying a dental premium. Call around to find a dentist you like and who is affordable. Dentists' rates vary. Pay out of pocket for cleanings, fillings, etcetera. [You can also use money from a health savings account or flexible spending account to cover dental expenses.] You can choose this any time of year.

Read more about dental care, insurance and coverage here.

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Open Enrollment Tips, Part 2: How Much Will I Pay? Best and Worst Case Scenarios

You know what you might pay for your health insurance premium--a fixed, monthly cost.  But what about the rest?  What will you actually pay for health care next year?  Will you pay just your Monthly Premium or will you pay your full Maximum Out Of Pocket Cost?  $1200, $5200, or something in between? 

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Best Case Scenario

One way to think about health insurance is to imagine the Best Case Scenario. Imagine that you have a year where you are healthy, and nothing goes wrong. 

In this scenario, you pay:

Your Premium: $100/month for a subsidized silver plan

Annual doctor's visit (preventive care, covered 100%): $0

Flu shot (preventive care, covered 100%): $0

Birth control pills (covered 100% under the ACA): $0

TOTAL COSTS FOR THE YEAR: $100/month premium x 12 months=$1200

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Worst Case Scenario

Now imagine that you have a year where everything goes wrong. You start out the year with appendicitis, then you fall and break your arm, you have a cancer scare, Lyme disease, and you are hospitalized for pneumonia. You might be wondering--if you have a year like that--what is it going to cost? What is the Worst Case Scenario--not for your health, but for your budget?

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Actually, it's not that hard to figure this out either--there is a mathematical formula for it. 

Start with the cost of your premium.

We'll use the same premium: $100/month for a subsidized silver plan. 

Your deductible is $2000, but that turns out to be more important (in a worst case scenario) for the pace at which you pay bills, and less important for the actual Worst Case Scenario.

What is important is the line marked Maximum Out Of Pocket Costs. We'll say, in this case the Maximum Out of Pocket number is $4,000. Once you spend that maximum number, you pay nothing more. 

TOTAL COSTS FOR THE YEAR= Total premium cost + Maximum out of pocket amount

In this scenario, you would pay: ($100/month)*12 + $4000 = $1200 + $4000 =$5200

So with this plan, under the best case scenario you would pay $1200 and under the worst case scenario you would play $5200. Try out these formulas on any plan. 

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Just one caveat: In some cases, the maximum out of pocket number applies only to in-network spending; or out-of-network spending may be subject to a higher maximum out of pocket number. Except for emergencies, try to stay in network. 

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Open Enrollment Tips, Part 1: An Educated Consumer Is Our Best Customer

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Some of you--of a certain age--may remember the Sy Syms commercial, with the tagline, "An Educated Consumer is Our Best Customer." Well, what's true for buying clothes is even more true (100 times more important, probably!) for choosing health insurance. 

So here are a few things to know, if you are shopping for health insurance. 

1. If you are very low income, you may be eligible for Medicaid. If you think you are eligible for Medicaid, do the MIBridges Medicaid application. Don't assume the Marketplace will send you there correctly--it is supposed to, but the two systems are not well-calibrated. (We help with those applications, too.)

2. If you had a plan last year, don't let it auto-renew. Spend the hour it requires to assess everything again. Provide revised income estimates, check your dependents, update your address. Most importantly, the plans have changed. In some cases, they have changed A LOT. 

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Make sure you are aware of which doctors or health systems are in-network or out of network for any plan that you choose. These networks can also change between plan years. 

Because costs are calibrated for tax credits based on the second-lowest cost silver plan, when the costs for that plan change (and this year they changed a lot!), the tax credits change a lot too. But if you were eligible for subsidies before, and your income is similar, you will pay the same or less--but you may need or want to change plans.

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3. If your income is a bit higher than Medicaid, but still under 200% of the poverty level ($24,120 for a single person, $49,200 for a family of 4) you will probably find the best deals with the Silver plans. (Probably. You may still want to compare the gold and bronze plans as well.)

4. If your income is between 200% and 400% of the poverty level ($24,120-$48,240 for a single person, $49,200-$98,400 for a family of 4), it is highly likely that you will find the gold and bronze plans more appealing. Gold plans, on average, will cover 80% of your medical costs and Bronze plans, on average, will cover 60% of your medical costs. 

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Explainer: The Trump administration made some last-minute changes removing cost-sharing subsidies, which are only applied to silver plans. Because of this, the cost of silver plans went up more than the cost of gold or bronze plans. But because tax credits are calculated based on silver plans, your tax credit will likely go further on the bronze or gold plans. If you want the details, read this

5. If your income is over 400% of the poverty level ($48,240 for a single person, $98,400 for a family of 4), you will not qualify for tax credits. But you might find better deals off of the Marketplace. Work with an in-person or online insurance broker, and make sure you are choosing from ACA-compliant plans. These should be marked as Bronze, Silver, Gold or Platinum. If they are ACA-compliant, they will have the same essential benefits, but the cost may be less expensive.

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Washtenaw Health Plan staff will answer your questions and help you figure it out.  It's complicated.  Different people in a family may get different coverage. Parents may qualify for the Marketplace, kids may qualify for Medicaid or MIChild.  An older couple might have Medicare, Medicaid and/or Marketplace.  No situation is too complex, no question should go unanswered.  We'll help sort it out.  

Call 734-544-3030 or walk-in to 555 Towner St. Ypsilanti from 9 am to 4 pm Monday through Friday.  

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Don't Be Scared, Healthcare Isn't Spooky! Instead, Get Ready!

If it's Halloween, then Open Enrollment on the Marketplace (healthcare.gov) is just around the corner!  It may also be time for your employer's open enrollment period! 

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Here's What You Need To Get Ready

1. Income information for everyone in your household

For Medicaid and MIChild, you need income information for  the current month/year. If you are applying on the Marketplace, you are trying to project your income and household information for next year (2018).  Income limits for Medicaid and MIChild can help you understand what you are applying for.

2016 Taxes: Your 1040 form (first page), as well as W-2s and  Schedule C or E if you are self-employed. 

Paystubs:  Bring 30 days of the most recent paystubs for anyone who is working.  If you don't have paper copies, make sure you can access your pay information online. 

Self-employment Information: Recent income and expense statement, Schedule C or E. 

Do you have a working teenager in your family?  Read more about whether or not their income counts at  Teens Who Work: Does Their Income Count?

2. Household composition

For the Marketplace, what matters is your tax household. For Medicaid and MIChild, both who is in your tax household and who is living in your house are important. For everyone in your house, you need certain documents. 

Who was in your household this year and who will be in it next year?  (Hint: Is your college senior graduating? Did you just have a baby?)

Social Security Numbers for everyone in the family who has them.

Immigration documents, such as permanent resident green cards, work permits, visas. (People who have DACA status cannot apply on the Marketplace and should contact the WHP for help.)

Home and/or mailing addresses for everyone in the household.

Dates of birth for everyone.

3. Employer coverage

Does your employer offer coverage?  What does it cost?

Your employer can fill out this form to help decide if your employer coverage is affordable and meets minimum coverage standards according to the Affordable Care Act:  Employer Coverage Tool.

In some cases, employer insurance may be affordable for the employee, but not for the rest of the family. Contact the WHP for help in that situation.

Open Enrollment Question: Do I Have To Take My Employer Healthcare Coverage? (Usually, Yes)

4. Log-ins and password

If you had Marketplace insurance, you already have an account.  Find your Marketplace account information sheet or make sure you have the password for your email account. (If you have multiple email accounts, you can usually identify the one with the active healthcare.gov account by searching for emails from healthcare.gov.)

Want Help? We are making appointments now, so call 734-544-3030.

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