No rule from IRS that you have to get vetted by Covered CA - Publication 974 page 4
Publication 974 page 4
Flow Chart - Can you take the PTC Premium Tax Credit
Flow Chart – Can you take the PTC Premium Tax Credit – Click to enlarge
1095 Where no subsidies were requested
1095 Where no subsidies were requested Click to enlarge
Premium Tax Credit 8962
Premium Tax Credit 8962
Ambigious way to ask the question, but it's in the CON favor
Ambigious way to ask the question, but it’s in the CON favor

What if you don’t tell Covered CA in advance that you want the credit, can you still get the deduction when you file taxes, as long as you got your coverage though Covered CA?

Arguments – No

When a Covered CA  application is submitted, clients are asked if they want to see if they qualify for medi-cal or premium assistance.

If the question is answered “No” then the income and tax information will be skipped and no Premium assistance will be applied.  They can not claim any assistance regardless of where the income falls under the FPL when they file taxes.

If they want to be considered to get Premium assistance, the answer to that question needs to be “Yes.”

If clients want to pay the full amount but be considerer for  Premium assistance, they need to select “yes” on the help paying insurance question and then adjust the premium assitance to $0. When they do their taxes, if they should have been receiving premium assistance, they get a credit .  Response By Email (Argelia) (09/08/2016 11:56 AM)

Yes

  • Page 4 of publication 974 gives the rules for taking the credit, nowhere does it say you have to get permission from Covered CA first!
  • IRS.Gov FAQ’s # 3  When you apply for coverage in the Marketplace…If you do not opt for advance credit payments or the Marketplace determines that you were not eligible for advance payments at the time of enrollment, you may be eligible to claim the credit when you file your tax return for the year, which will either lower the amount of taxes owed on that return or increase your refund.
  • In bottom third of Publication 974 flow chart, it’s only an issue if your income winds up at less than 100% of poverty level.
  • Nowhere on Form 8962 Premium Tax Credit (PTC) does it ask if you told Covered CA or any Market Place that you wanted the APTC credit in advance.
  • Covered CA is mandated to give you a 1095 A, if nothing else so that you don’t have to pay the mandate penalty.  We are talking about PTC not APTC.
  • CFR 1.36 B-2 Eligibility for Premium Tax Credit

One should NEVER rely on anything Covered CA or any Insurance Company says!  Even if it’s in print!!!  Insure Me Kevin.com where Covered CA gave the wrong answer about Social Security counting for MAGI.

View the discussion InsureMeKevin.com  blog.

No

The original bill H.R. 2775 was introduced into the House of Representatives on July 22, 2013, and was called the No Subsidies Without Verification Act. It sought to declare that no premium tax credits or reductions in cost-sharing for the purchase of qualified health benefit plans under the Patient Protection and Affordable Care Act (PPACA, often informally referred to as “Obamacare”) shall be allowed before theSecretary of Health and Human Services (HHS) certifies to Congress that there is a program in place, consistent with PPACA requirements, that verifies the household income and coverage requirements of individuals applying for such credits and cost-sharing reduction.[2] The bill passed the House on September 12, 2013.  Wikipedia

42 U.S. Code § 18081 – Procedures for determining eligibility for Exchange participation, premium tax credits and reduced cost-sharing, and individual responsibility exemptions

(a)Establishment of program The Secretary shall establish a program meeting the requirements of this section for determining—

(1) whether an individual who is to be covered in the individual market by a qualified health plan offered through an Exchange, or who is claiming a premium tax credit or reduced cost-sharing, meets the requirements of sections 18032(f)(3),18071(e), and 18082(d) of this title and section 36B(e) of title 26 that the individual be a citizen or national of the United States or an alien lawfully present in the United States;
(2)in the case of an individual claiming a premium tax credit or reduced cost-sharing under section 36B of title 26 or section 18071 of this title
(A) whether the individual meets the income and coverage requirements of such sections; and

(B) the amount of the tax credit or reduced cost-sharing;

(3) whether an individual’s coverage under an employer-sponsored health benefits plan is treated as unaffordable under sections 36B(c)(2)(C) and 5000A(e)(2) of title 26; [1] and
(4) whether to grant a certification under section 18031(d)(4)(H) of this title attesting that, for purposes of the individual responsibility requirement under section 5000A of title 26, an individual is entitled to an exemption from either the individual responsibility requirement or the penalty imposed by such section. Read More 
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One comment on “Credit at tax time if not requested initially?

  1. I agree that the consumer should be able to reconcile the PTC on their taxes with Form 8962 regardless of whether they opted in for a subsidy or not. I think Covered California is pointing to condition 1b above that the person was not eligible for minimum essential coverage from the government. The only way to know that is to do an income test and see if the individual or family is deemed Medi-Cal.

    However, we all know some family’s may have low monthly incomes, but still have a MAGI that is over 138% of the FPL at tax time. So technically, they weren’t eligible for Medi-Cal from the IRS standpoint. But because Medi-Cal is based on monthly income, CC deems them eligible, and indirectly ineligible for PTC.

    It has not gone unnoticed by people at Covered California that a family that truly won’t have a final MAGI below 138% of the FPL is being forced to be creative on the income section of the application. Some people say they are being forced to lie about their income to avoid Medi-Cal. But in reality, they are not eligible for Medi-Cal.

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