Tax Filing Information

Summary

If you and/or an individual you claim as a tax dependent was enrolled in minimum essential coverage (MEC) during 2016, you will receive a Tax Form 1095-A or 1095-B. This form contains proof you had qualifying health insurance and important tax information you’ll need to complete your household’s federal income tax filing for 2016.
 

Form 1095-A: 

The 1095-A form will be mailed by Covered California to individuals enrolled in an L.A. Care Covered™ (subsidized or unsubsidized) plan except for individuals enrolled in the Minimum Coverage (Catastrophic) Plan.
 

Form 1095-B:

The 1095-B form will be mailed by L.A. Care to individuals enrolled in the following plans: L.A. Care Covered Minimum Coverage (Catastrophic), L.A. Care Covered Direct and the PASC-SEIU Plan.
 

Frequently Asked Questions

1. What is a tax penalty?

The federal Affordable Care Act (ACA) has a requirement that took effect on January 1, 2014, that may affect you. All taxpayers must confirm that they had minimum essential health coverage or that they were granted an exemption, otherwise they will be required to pay a tax penalty. The tax penalty for 2016 is 2.5% of your yearly household income or $695 per person ($347.50 for individuals under age 18) capped at $2,085 per family, whichever amount is greater. The monthly penalty is 1⁄12 of the annual penalty for each month that you do not have qualifying coverage. If you were uninsured for 1 or 2 months during the year, you will not pay a penalty. The tax penalty for 2016 is capped at the national average of the cost of a bronze level health plan available through the marketplace ($2,676 per year ($223 per month) for an individual and $13,380 per year ($1,115 per month) for a family with five or more members).

2. What is minimum essential coverage?

Minimum essential coverage is the type of health coverage an individual needs to meet the ACA individual responsibility requirement. This includes individual policies, job-based coverage, a state Children’s Health Insurance Program (CHIP), TRICARE (healthcare program for service members and families), and other types of ACA-compliant coverage.

3. Who can qualify for an exemption to avoid the tax penalty?

Individuals can apply for an exemption from paying the tax penalty if their income is below the minimum threshold for filing a tax return, if they are incarcerated, or experienced a hardship, among other reasons. Learn more about whether you qualify for an exemption,

Exemption applications are now available from the federal government. For more information and links to the applications, visit www.healthcare.gov/exemptions. If you have questions about exemptions from the tax penalty, you can call the Federal Marketplace at (800) 318-2596.

If you were granted an exemption, you will need your exemption certificate number and you will have to complete IRS Form 8965. Some exemptions can be claimed on your tax return even if you didn’t apply for one through the Federal Marketplace. IRS Form 8965 will help you determine if you qualify for one of the exemptions that are available at tax time.

You must submit an IRS Form 8965 Health Coverage Exemptions, to the IRS to report a coverage exemption you have already received from the Federal Marketplace or to claim a coverage exemption retroactively.

4. What is Form 1095-A?

Your Form 1095-A shows what, if any, the Internal Revenue Service (IRS) paid to your health insurance company in 2016 to help you with the cost of your health coverage. Any amount paid – also known as the advance premium tax credit (APTC) – was based on the income information and household size you provided. If your income changed, you may have paid too much or too little for your health coverage. Form 1095-A will also be used to make sure the subsidy paid to your plan is correct based on your income as reported to the IRS for 2016. Subsidies go up and down with your income. Form 1095-A helps ensure the amount you received in 2016 is just right.

5. What do I do with my Form 1095-A?

Save this form — you will need it when you prepare your taxes for 2016. Similar to a W-2, a 1095-A is one of the things that will determine the amount of taxes you will pay or the refund you receive. You’ll use it to fill out IRS Form 8962 to report any APTC received in advance or claim the premium tax credit. However, do not file Form 1095-A with the IRS.

For help with your taxes, consult a tax preparer. Most tax preparers are ready to assist you with this form and the tax requirements. You may be able to get free help filing your taxes, including free software programs or in-person assistance. Go to www.irs.gov/freefile or www.irs.gov/VITA.

If you have any questions regarding your Form 1095-A, please contact Covered California™ at 1-800-300-1506 (TTY: 888-889-4500).  You can also find more information by visiting the IRS website.

6. What is the IRS Form 8962 Premium Tax Credit?

IRS Form 8962 is used to calculate the amount of your premium tax credit and “reconcile” the APTC amount you received based on your estimated income with the amount of the premium tax credit you qualify for based on your actual income reported on your federal tax return. The IRS Form 8962 has sections for:

  • Annual and Monthly Contribution Amount
  • Premium Tax Credit Claim and Reconciliation of Advance Payment of Premium Tax Credit
  • Repayment of Excess Advance Payment of the Premium Tax Credit
  • Shared Policy Allocation
  • Alternative Calculation for Year of Marriage

If you are using tax software when filing your federal income tax, the IRS Form 8962 should be built into that software. You’ll need to complete the software form and file your completed tax documents electronically or by mail.

You can download the form and instructions at www.irs.gov to fill out the IRS Form 8962 manually. Type in “8962” in the search bar or select the Forms & Pubs tab.

If a professional tax preparer helps you, they can file or get the form in the same way mentioned above. View specific instructions on how to understand the form and the information needed to complete it.

7. Why am I receiving these forms?

As a result of the ACA, most Americans are required to have health insurance or pay a penalty. This form tells the government when you had health coverage during the calendar year.

8. How do I obtain a copy of my Form 1095-A?

You can obtain an electronic copy of your Form 1095-A by logging into your Covered California account in or after January 2017. Covered California mailed the forms out starting on January 9, 2017. Allow 14 days for it to arrive by mail. If you did not receive a 1095-A form, complete the 1095-A dispute form.

9. What if the amount on Form 1095-A is incorrect?

The amount on your 1095-A reflects how much the IRS paid to your health insurance company to help with the cost of your health coverage. If you feel the amount shown on your 1095-A is not correct, contact Covered California™ at (800) 300-1506 or complete the 1095-A dispute form.

10. May I request a copy of my billing history?

Yes, L.A. Care Covered™ and L.A. Care Covered Direct™ members can complete the Annual Billing Summary Statement Request Form. Please complete the form, sign, and mail or fax, the form back as instructed on the form.

If you do not have access to a computer and printer, you can call Member Services at 1-855-270-2327 (TTY/TDD 711)  to have a form mailed to you.

11. How do I obtain an Annual Billing Summary Statement Request Form?

You can download an Annual Billing Summary Statement Request Form. If you do not have access to a computer or printer, please call Member Services at 1-855-270-2327 (TTY/TDD 711)  and request to have the form mailed to you. You may also request to have a form e-mailed to you. An Annual Billing Summary Statement will be securely emailed to you upon your request.

12. Where do I send the completed Annual Billing Summary Statement Request Form?

You have two (2) options for returning the form:

  1. By Mail: L.A. Care Health Plan
    Attn: Medical Payments Systems and Services
    1055 W 7th Street, 10th Floor
    Los Angeles, CA 90017

     
  2. By Fax: L.A. Care Health Plan
    Attn: Medical Payments Systems and Services
    RE: Annual Billing Summary Statement Request Form

    (213) 438-6105
13. When will I receive a response regarding my Annual Billing Request Form?

You should receive a response within five (5) business days from the receipt of a signed and completed Annual Billing Summary Statement Request Form.

14. What is Form 1095-B?

The Form 1095-B will report the number of months an individual had minimum essential coverage while enrolled with an L.A. Care Covered™ Minimum Coverage Plan Member or L.A. Care Covered Direct™ or PASC-SEIU during the calendar year. Individuals should use Form 1095-B as proof to report health coverage while filing their federal income taxes with the IRS. You do not need to send IRS Form 1095-B to the IRS. However, keep this form with you when filing your federal income tax return to verify months of coverage.

15. How do I obtain a copy of my Form 1095-B?

If you are an L.A. Care Covered™ Minimum Coverage Plan or L.A. Care Covered Direct™ or PASC-SEIU IHSS member, you will receive a copy in the mail by March 2, 2017. If you did not receive a copy of your Form 1095-B, you can download the Request or Dispute Form 1095-B form or call Member Services to request the form. Please complete the form, sign, and return the form by mail or fax as instructed on the form.

  • L.A. Care Covered™ Minimum Coverage Plan and L.A. Care Covered Direct™ members can call 1-855-270-2327 (TTY/TDD 711) ). 
  • PASC-SEIU IHSS can call 1-844-854-7272 (TTY 711).
16. Who do I contact if the information on my 1095-B is incorrect?

If you are an L.A. Care member, you can download the Request or Dispute Form 1095-B form or call Member Services to request the form. Please complete the form, sign, and return the form by mail or fax as instructed on the form.

  • L.A. Care Covered™ Minimum Coverage Plan and L.A. Care Covered Direct™ members can call 1-855-270-2327 (TTY/TDD 711) . 
  • PASC-SEIU IHSS can call 1-844-854-7272 (TTY 711). 
17. How do I obtain the Request or Dispute Form 1095-B?

You can download a Request or Dispute Form 1095-B. If you do not have access to a computer or printer, please call Member Services and request to have the form mailed to you. You may also request to have a form e-mailed to you. A Request or Dispute From 1095-B will be securely emailed to you upon your request.

  • L.A. Care Covered™ Minimum Coverage Plan and L.A. Care Covered Direct™ members can call 1-855-270-2327 (TTY/TDD 711) . 
  • PASC-SEIU IHSS can call 1-844-854-7272 (TTY 711) .
18. Where do I send the completed Request or Dispute Form 1095-B?

You have two (2) options for returning the form:

  1. By Mail: L.A. Care Health Plan
    Attn: Medical Payments Systems and Services
    1055 W 7th Street, 10th Floor
    Los Angeles, CA 90017

     
  2. By Fax: L.A. Care Health Plan
    Attn: Medical Payments Systems and Services
    RE: Request or Dispute Form 1095-B

    (213) 438-6105
19. How long will it take to receive a response regarding my 1095-B Dispute Form?

You should receive a response within five (5) business days from the receipt of a signed and completed Request or Dispute Form 1095-B.

20. I have not received an IRS Form 1095 A or B. What should I do?

You may call L.A. Care Health Plan to request Annual Billing Summary Statement Request Form or download the form here. Please refer to questions #11-13 to learn how you can request an Annual Billing Summary Statement.

21. Where can I go to get more information?

Please click on the following links for more information:

Please note this information does not constitute tax advice and consultation with your tax professional is recommended as individual circumstances will vary.