Got a notice about a healthcare coverage related issue recently and not sure what to do with it?
With both the IRS and the Healthcare Marketplace sending healthcare notices out each year, you might be confused. We hope the information below will help you sort out why you received this message and what you need to do to respond.
IRS Healthcare Related Notices
Premium Tax Credit Letter 12C
This letter is sent if healthcare coverage related documents, like the Form 1095A, Health Insurance Marketplace Statement, shows that advance payments of the premium tax credit were elected at enrollment, but those amounts were not reported on your federal tax return or were reported incorrectly.
To resolve: Please visit IRS.gov’ s Understanding Your Letter 0012C page, then either reply in writing explaining any error with the information reported or complete and submit the required forms, such as Form 8962, Premium Tax Credit.
Other general letters
These request that you file your 2014 or 2015 federal tax return with Form 8962, Premium Tax Credit, as soon as possible to protect your eligibility for assistance with paying for you or your family's Marketplace health insurance coverage for the following calendar year, because records show that you claimed advance payments of the Premium Tax Credit when you enrolled in your insurance policy.
To resolve: If you agree with the information in the letter, file your tax return with Form 8962 as soon as possible, even if you don’t normally have to file. Use the Form 1095-A that you received from your Marketplace to complete Form 8962. If you need a copy of your Form 1095-A, log in to your HealthCare.gov or state Marketplace account or call your Marketplace call center.
This letter sent to let you know that it appears that you may have reported owing too much Health Care Shared Responsibility Payment (SRP) on your 2014 income tax return. See Understanding Your Letter 5600C. Please be aware that a new version of this letter will start being sent shortly for 2015 tax returns, but the resolution actions are the same.
To resolve: Please review the situation to see if you agree with the information in the letter. Check to see if you might be eligible for an exemption that you weren’t aware of. If you need to change the amount claimed on the return, file a Form 1040X, Amended U.S. Individual Income Tax Return. Attach Form 8965, Health Coverage Exemptions, if you qualify.
Note: The IRS, as of this article’s publication date, has not begun issuing letters or notices with regard to an employer’s status or liability under the employer shared responsibility provisions.
Periodic Data Matching Notices
These are sent to certain taxpayers if someone in their tax household is enrolled in both a Marketplace health plan with advance payments of the premium tax credit and Medicaid or the Children’s Health Insurance Program. In general, no one should be enrolled in both types of plans, so corrections to one or both of those plans may need to be made.
To resolve: Please go to HealthCare.gov, or call the Marketplace Call Center at 1-800-318-2596 and follow the instructions in the letter.
Failure to Reconcile Warning Notices
These are sent to certain taxpayers if anyone in their tax household attested on their 2016 Health Insurance Marketplace application that they filed a tax year 2014 federal tax return with Form 8962, Premium Tax Credit, and reconciled their 2014 advance payments of the premium tax credit (APTC), but who appear to have not yet filed. The law requires everyone who claimed advanced PTC at the time of enrollment must file a tax return. If one isn’t filed timely, you may be denied the option to get those advanced payment when you enroll for a future year.
To resolve: Use the Get Transcript process if you need to provide information to the Marketplace. Please file an amended return with the IRS, if APTC was not reported on the original return. If no return was filed, please file an original return using Form 1095-A data from the Marketplace with the IRS.
2016 Employer Notice
This notice is being issued to 300,000 employers, regardless of size, to inform the employers that an employee has enrolled in Marketplace coverage with financial assistance and that he or she claimed they: didn't receive an offer of health care coverage from your company; did have an offer of health coverage, but it wasn't affordable or didn't provide minimum value; or were in a waiting period and
unable to enroll in the offered employer health care coverage.
To resolve: Employers should visit the Healthcare.gov Employer Appeals page and file an appeal, with a copy of your notice, to the Marketplace if you believe there's been a mistake regarding the employee's eligibility or if you believe your employee was incorrectly determined eligible for their health plan because you offered the employee affordable, minimum value health coverage.
Employers can check IRS.gov’ s Affordable Care Act Tax Provisions for Employers for more information about the employer shared responsibility provisions and how to determine if you are considered and ALE or not. You can also use our Employer Shared Responsibility Provision Estimator to help you determine the company’s status.
Since both agencies administer different parts of the Affordable Care Act laws, you may get a notice from both agencies with regard to the same topic, but looking for slightly different information for different reasons. We encourage you to read through any notice or letter first and identify the agency that actually sent the letter. If you need help figuring out how to respond, check the agency website first for further guidance, then if needed; contact that agency directly for further assistance.
For IRS: visit IRS.gov/aca or call 1-800-829-1040.
Healthcare Marketplace: Please visit HealthCare.gov to see your online account, visit The Health Insurance Marketplace page for state contact information or call 1-800-318-2596.
If your IRS notice or letter is not listed above, please visit Understanding Your IRS Notice or Letter for more listings and information on what to do. Basic information may help you understand more about the Form 1095-A, Health Insurance Marketplace Statement, and how to fix issues related to that form.