patient protection and affordable care act current impact lawrence zimbler, mst, ea © 2013,...

Patient Protection and Affordable Care Act Current Impact

Lawrence Zimbler, MST, EA

© 2013, Lawrence Zimbler MST EA

PPACA

• This session is a very brief overview of some of the items within the PPACA that have taken effect in 2013, or are about to take effect.

• Additional detail on PPACA impact will be covered in the NATP Essential 1040 classes and in our Michigan Chapter’s January “Last Chance” seminar on 1/10/14.


PPACA

• What we’re covering today:– 0.9% Medicare tax on earned income– 3.8% Medicare tax on investment income– Employer Notice to Employees– Opening of Exchanges 10/1/13 (?)– Health Insurance Navigators & Tax Preparers as

Navigators– Premium Assistance Tax Credit and reconciling

the Premium Assistance Subsidy.– Changes to the Small Employer Health

Insurance Credit.– Fees on Insurers and Plan Sponsors


0.9% Medicare Tax

• Taxpayers whose earned incomeearned income exceeds the threshold amounts below, based on filing status will pay an additional 0.9% Medicare tax on their earned income in excess of that threshold amount.– Single / HoH: $200,000– MFJ / QW: $250,000– MFS $125,000


0.9% Medicare Tax

• There is no separate reporting of this additional Medicare tax on the employee's Form W-2.

• Computation of the tax and will rely on the total amount of Medicare tax withheld shown in Form W-2, Box 6. (2013

instructions to Form W-2, page 15)

• Draft Form 8959 has been released by the IRS.


0.9% Medicare Tax• The obligation to withhold this additional

0.9% Medicare tax begins in the pay period that causes an employee to exceed $200,000 of wages for the calendar year -- it is not prorated

• Because of filing status, and actual earned income, the employer's withholding at this level may be sufficient, insufficient or excessive.

• Employees will compute the correct amount of the surtax on their income tax returns and are responsible for having an adequate amount of tax paid either through withholding or by payments of estimated tax.


• If additional Medicare tax is due, the amount is carried from Form 8959 to line 60 of Form 1040, page 2.

• If too much additional Medicare tax was withheld, the excess will be added to other federal income tax withheld on line 62 of page 2 of Form 1040.


0.9% Medicare Tax

Draft 2013 Form 1040, page 2

http://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Questions-and-Answers-for-the-Additional-Medicare-Tax


3.8% Medicare Tax on NII

• New IRC §1411(a) imposes on individuals and non-charitable trusts a tax of 3.8% on the lesserlesser of – the taxpayer's net investment income, or – the amount by which MAGI exceeds the following

threshold, based on filing status:– Single/HoH: $200,000– MFJ/QW: $250,000– MFS $125,000

• MAGI is defined as AGI without regard to the Foreign Earned Income Exclusion. [IRC 1411(d)]



• What is Investment Income:– To the extent not derived from an active

trade or business:• Interest

• Dividends

• Annuities

• Royalties

• Rents

• Net gain from disposition of property

• Income from passive activities

• Income as a “trader” in securities© 2013, Lawrence Zimbler MST EA


• What is Investment Income:– Any of the above generated from the

investment of working capital within an active trade or business

• SUBTRACT– All deductions properly allocable to the

investment income (don’t forget state income tax…)

• To obtain NET INVESTMENT INCOME (NII)



• Distributions from a qualified plan (IRA, SEP, SIMPLE, 401(k), 403(b), etc) are not included. Neither are any amounts subject to FICA or Self-Employment tax.

• A special rule applies to the gain or loss from the disposition of an interest in a partnership or S-Corporation limiting that gain or loss to the amount that would have been recognized had the entity liquidated at FMV.


• IRS Website has lenghthy Q&A section on the NIIT.

• Also Regs. §1.1411-1 through §1.1411-11


3.8% Medicare Tax on NII• Taxpayer, a single filer, has $180,000 of

wages. Taxpayer also received $90,000 from a passive partnership interest, which is considered Net Investment Income. Taxpayer’s modified adjusted gross income is $270,000. Taxpayer’s modified adjusted gross income exceeds the threshold of $200,000 for single taxpayers by $70,000. Taxpayer’s Net Investment Income is $90,000.

• The Net Investment Income Tax is based on the lesser of $70,000 (the amount that Taxpayer’s modified adjusted gross income exceeds the $200,000 threshold) or $90,000 (Taxpayer’s Net Investment Income). Taxpayer owes NIIT of $2,660 ($70,000 x 3.8%).



• What about my principal residence?

• NIIT does not apply to gain that is excluded from tax by IRC §121

• Gain not excluded flows through the normal computation.


3.8% Medicare Tax on NII• A, a single filer, earns $210,000 in wages and

sells his principal residence that he has owned and resided in for the last 10 years for $420,000. A’s cost basis in the home is $200,000. A’s realized gain on the sale is $220,000. Under IRC section 121, A may exclude up to $250,000 of gain on the sale. Because this gain is excluded for regular income tax purposes, it is also excluded for purposes of determining Net Investment Income. In this example, the Net Investment Income Tax does not apply to the gain from the sale of A’s home.


3.8% Medicare Tax on NII• B and C, a married couple filing jointly, sell their principal

residence that they have owned and resided in for the last 10 years for $1.3 million. B and C’s cost basis in the home is $700,000. B and C’s realized gain on the sale is $600,000. The recognized gain subject to regular income taxes is $100,000 ($600,000 realized gain less the $500,000 IRC section 121 exclusion). B and C have $125,000 of other Net Investment Income, which brings B and C’s total Net Investment Income to $225,000. B and C’s modified adjusted gross income is $300,000 and exceeds the threshold amount of $250,000 by $50,000. B and C are subject to NIIT on the lesser of $225,000 (B’s Net Investment Income) or $50,000 (the amount B and C’s modified adjusted gross income exceeds the $200,000 single threshold). B and C owe Net Investment Income Tax of $1,900 ($50,000 X 3.8%).



• D, a single filer, earns $45,000 in wages and sells her principal residence that she has owned and resided in for the last 10 years for $1 million. D’s cost basis in the home is $600,000. D’s realized gain on the sale is $400,000. The recognized gain subject to regular income taxes is $150,000 ($400,000 realized gain less the $250,000 IRC section 121 exclusion), which is also Net Investment Income. D’s modified adjusted gross income is $195,000. Since D’s modified adjusted gross income is below the threshold amount of $200,000, D does not owe any Net Investment Income Tax.



• The amounts of Net Investment Income that are included on your Form 1040 by reason of Form 8814 are included in calculating your Net Investment Income.


Employer Notice to Employees

• Section 18B of the Fair Labor Standards Act requires that every employer subject to FLSA (regardless of the number of employees) must provide written notice to every employee of the availability of health insurance through an Exchange.

• Pretty much EVERY business with gross receipts > $500,000 will be subject to this rule.



• Employers are required to provide the notice to each new employee at the time of hiring beginning October 1, 2013.

• For 2014, the Department will consider a notice to be provided at the time of hiring if the notice is provided within 14 days of an employee’s start date.



• The Department of Labor has issued model notices on their websitehttp://www.dol.gov/ebsa/healthreform/– Two model notices are provided:– One for employers who currently offer health

insurance and– One for employers who do not currrently

offer health insurance.

• Also see the DOL technical release 2013-02 (May 8, 2013) for more details


http://www.dol.gov/ebsa/healthreform/

Employer Notice to Employees• The Department of Labor website added the

following Q&A on 09/11/2013:– ”Q: Can an employer be fined for failing to

provide employees with notice about the Affordable Care Act's new Health Insurance Marketplace?

– A: No. If your company is covered by the Fair Labor Standards Act, it should provide a written notice to its employees about the Health Insurance Marketplace by October 1, 2013, but there is no fine or penalty under the law for failing to provide the notice.”

http://www.dol.gov/ebsa/faqs/faq-noticeofcoverageoptions.html© 2013, Lawrence Zimbler MST EA

Exchanges• States across the country have received grants

to establish a new marketplace. States can create and operate their own marketplace (State-based Exchange) or a hybrid called a State Partnership Exchange in which the state runs certain functions. A Partnership Exchange allows states to make key decisions and tailor the marketplace to local needs and market conditions. The Federal government will establish and operate a marketplace in those states that do not establish their own. All marketplaces will launch open enrollment in October 2013


Exchanges

• Exchanges will sell insurance plans according to tiers as follows:– Platinum Plan – expected to cover 90% of

expected medical costs – Gold Plan – expected to cover 80% of

expected medical costs– Silver Plan – expected to cover 70% of

expected medical costs– Bronze Plan – expected to cover 60% of

expected medical costs


Exchanges

• Exchange plans may provide coverage for self-only, two adult, family coverage or adult plus n children

• The premium tax credit is based on the second-lowest cost Silver Plan; and any additional cost-sharing help is available only for purchasers of silver level plans.


Exchanges

• 27 states have opted to default to the federal exchange and not offer their own state exchange

• MICHIGAN will offer a partnership exchange, opening for enrollment October 1, 2013http://www.healthinsurance.org/michigan-state-health-insurance-exchange/


http://www.healthinsurance.org/michigan-state-health-insurance-exchange/

http://www.healthinsurance.org/michigan-state-health-insurance-exchange/

Exchanges

• The Michigan website indicates that 14 different insurors will offer policies through the Exchange.


Navigators

• Section 1311 of PL 111-148 (the Patient Protection and Affordable Care Act (ACA)) establishes health insurance exchanges.

• At §1311(i) a new position is invented called a “Navigator.”

• Navigators are appointed by each insurance exchange.


Navigators

• Navigators must…– conduct public education activities to raise

awareness of the availability of qualified health plans;

– distribute fair and impartial information concerning enrollment in qualified health plans, and the availability of premium tax credits under section 36B of the Internal Revenue Code of 1986 and cost-sharing reductions under section 1402;

– facilitate enrollment in qualified health plans;


Navigators

• Navigators must…

– provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under section 2793 of the Public Health Service Act, or any other appropriate State agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and

– provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange or Exchanges.


Navigators• Navigators must…

– provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under section 2793 of the Public Health Service Act, or any other appropriate State agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and

– provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange or Exchanges.

– Legitimate Navigators do not have special ID or credentials to distinguish them from scams.


Navigators• To be a Navigator, an entity shall

demonstrate to the Exchange involved that:– the entity has existing relationships, or

could readily establish relationships, with• employers and employees, • consumers (including uninsured and

underinsured consumers), or • self-employed individuals likely to be

qualified to enroll in a qualified health plan

• Sounds like a tax preparer to me… © 2013, Lawrence Zimbler MST EA

Navigators

• IRS has issued new Q&A’s on the co-existence of the ACA and IRC §7216 for tax return preparers.


Navigators• For tax return preparers, will taxpayer consent be

required to use contact information to provide clients general educational information about the Affordable Care Act and health insurance available through the new health insurance marketplaces?

• A. No. The §7216 regulations permit tax return preparers to use a list of client names, addresses, email addresses, phone numbers and each client’s income tax form number to provide clients general educational information, including general educational information related to the Affordable Care Act. For example, a tax return preparer may mail general educational information to all clients regarding health care enrollment options available through the new health insurance marketplaces without obtaining consent. © 2013, Lawrence Zimbler MST EA

Navigators

• Q3. Will taxpayer consent be required to solicit and facilitate client enrollment in health insurance available through the new health insurance marketplaces?

• A. Yes. Tax return preparers who use tax return information to solicit and facilitate health care enrollment services must first obtain taxpayer consent to do so.


Navigators• Example: Return Preparer Z is also a health care

‘navigator’ who would like to use tax return information, as defined in Treas. Reg. § 301.7216-1(b)(3), to solicit and facilitate enrollment of eligible clients into qualified health plans available through the new health insurance marketplaces.

• Z must obtain taxpayer consent following the rules specified in Treasury Regulation §301.7216-3 prior to using the tax return information in assisting taxpayers in connection with the solicitation and facilitation of the enrollment of Z’s eligible clients into qualified health care plans.

• See Rev. Proc. 2013-14 (I.R.B. 2013-3, Jan.4, 2013), as modified by Rev. Proc. 2013-19 (I.R.B. 2013-10, March 4, 2013), for requirements for consents from taxpayers who file a return in the Form 1040 series.


Premium Assistance

• IRC §36B provides for a refundable tax credit for tax years beginning in 2014 available to eligible individuals who purchase health insurance from an Exchange.

• When purchasing from an Exchange, an individual who qualifies has the opportunity to receive the credit in the form of a premium subsidy.


Premium Assistance• Eligible individuals will:

– Not be eligible for minimum essential coverage from an employer or another source (e.g.: Medicare or Medicaid, CHIP, TRICARE or Veterans health care);

– Be eligible for coverage through an employer but either: • that coverage is deemed to be unaffordable.

Unaffordable coverage in this case exceeds 9.5% of the individual’s household income, or

• the employer plan fails a minimum value requirement to provide at least 60% coverage for an employee’s total allowed cost.

– an individual is treated as eligible for employer-sponsored minimum essential coverage if the individual actually enrolls in an eligible employer-sponsored plan, even if the coverage does not meet the affordability and minimum value requirements.


Premium Assistance• Eligible individuals will:

– Purchase health insurance from an Exchange– Be lawfully present in the United States – not be an

illegal alien. A legal alien with household income below the federal poverty level but who is ineligible for Medicaid coverage is an eligible individual for this credit.

– Not be incarcerated• The criteria above are determined on a monthly

basis; below are determined annually– Have household income between 100% and 400%

of the federal poverty level based on the individual’s family size

– If married, file a joint tax return. – Not be a dependent of another taxpayer.


Premium Assistance

• Eligibility for the premium subsidy for individuals who sign up during 2013 is based on their 2012 income tax return.

• When these individuals file their 2014 tax return they must reconcile the actual premium credit they’re allowed, based on their 2014 income, filing status, family size, etc.

• If their subsidy was higher then their 2014 computed eligibility they must repay some or all of the excess.– Repayment limits apply in certain circumstances


Premium Assistance

• Individuals (or couples) who experience a change in marital status or other household circumstance, experience a decrease in income of more than 20 percent, or receive unemployment insurance, may update eligibility information or request a redetermination of their tax credit eligibility.”

[Committee Reports of the Joint Committee on Taxation 18-10, P.L.111-148 p.12]


Premium Assistance

• Eligibility is based on family size and income between 100% and 400% of federal poverty guidelines.

• The table below is the 2013 federal poverty guidelines.


Premium Assistance

Family Members Poverty Guideline400% of Poverty

Guideline

1 $11,490 $45,960

2 15,510 62,040

3 19,530 78,120

4 23,550 94,200

5 27,570 110,280

6 31,590 126,360

7 35,610 142,440

8 39,630 158,520

For families/households with more than 8 persons, add $4,020

for each additional person. ($16,080 @ 400%)

http://aspe.hhs.gov/poverty/13poverty.cfm© 2013, Lawrence Zimbler MST EA

Premium Assistance

• Whether your premiums are affordable is determined by a percentage of your household income from the table below.

• This percentage of household income is compared to the benchmark premium for your state’s exchange and your type of coverage.

• The benchmark is the appropriate premium for the second lowest cost silver plan offered in the exchange.


Premium AssistanceIn the case of household

income (expressed as a percent of poverty line) within the following income tier:

The initial premium percentage is-

The final premium percentage is-

Up to 133% 2% 2%

133% up to 150% 3% 4%

150% up to 200% 4% 6.3%

200% up to 250% 6.3% 8.05%

250% up to 300% 8.05% 9.5%

300% up to 400% 9.5% 9.5%


Premium Assistance

• Notice that, at 300% of FPL, your insurance premium is affordable if it is at or less than 9.5% of your household income.

• If your household income is >400% of FPL, you are not entitled to a credit or a subsidy.– Repayment limits will not apply if you receive a

subsidy based on 2 year old qualifying data, but actual income exceeds 400% of FPL

• The regulations specify the manner in which a subsidy received must be divided when filing status or family situations change.


Premium Assistance

• On September 12, 2013, IRS Issued multiple Questions and Answers specifically on the premium tax credit and premium subsidy.

• Look on http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-the-Premium-Tax-Credit

• Inside sources report today via WSJ that computer glitches affecting 36 exchanges run by federal government are still not computing premiums and subsidies correctly – expect initial glitches.


Small Employer Health Care Credit

• This credit has been around since 2010, and provides a refundable credit even to tax-exempt employers.

• The credit rules change in 2014 so that:– Insurance must be secured from an

exchange AND– It is available for only 2 years from the first

year that insurance is obtained from an exchange.


Fees on Plan Sponsors

• Section 6301(e)(2)(A) of the ACA added new IRC §4375 imposing a fee on the issuers of health insurance policies.

• The fee begins with policy years ending after September 30, 2012 and continues through the policy year ending on and before September 30, 2019 (calendar year plans ending 12/31/2018)



• Employer sponsored Health Reimbursement Arrangements (HRA) including popular plans offered to many small businesses through BASE (http://www.baseonline.com/) are self-insured plans that are subject to this per capita fee. Many small employers received notice of the need to file Form 720 by July 31, 2013 with only a $1 or $2 payment.

• Perhaps these employers can find comfort in the fact that it will cost the government upwards of $50 to process these paper Forms 720 and $1 checks.


patient protection and affordable care act current impact lawrence zimbler, mst, ea © 2013,...

Documents

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