The Internal Revenue Service (IRS) has given the new public health insurance exchanges rules for reporting on the private health coverage they have sold.
In a new batch of final regulations, “Information Reporting for Affordable Insurance Exchanges,” IRS officials explain how the exchanges will communicate whether they have enrolled consumers in individual “qualified health plans” (QHPs).
The exchanges will report the information every month on Form 1095-A.
The IRS could set the due date for the first reports on or after June 15, 2014, but no earlier than that, officials say.
Government agencies, exchanges, health plans and QHP enrollees will use the information on the form in connection with the new premium subsidy tax credit program created by the Patient Protection and Affordable Care Act (PPACA).
Consumers can use the PPACA tax credit to pay for coverage while the tax year is still under way, a year or more before they actually file their tax forms.
In 2015, when the consumers file their 2014 tax forms, the IRS is supposed to use the Form 1095-A information to reconcile the amount of the advance tax credits paid to the consumers’ QHP issuers with the amount of tax credits the consumers were actually supposed to get.
If the IRS paid more in tax credits to the QHP issuers than the consumers were supposed to get, many consumers are supposed to find the cash to pay back the excess credits.
The IRS is preparing to publish the final regulations Wednesday.
The agency based the final version on a draft published in July.
In a discussion of changes in the final version, officials note that, in the original version, they used the term “taxpayer” to refer to an individual who enrolls a family in exchange-sold QHP coverage and asks for advance tax credit payments, and “responsible adult” to refer to QHP users to who do not ask for advance credit payments.
A commenter suggested that use of the term “responsible adult” failed to accommodate nontraditional family structures, because the terminology assumed that the individual who claimed a dependent also enrolled the dependent in coverage.
The IRS kept the term “responsible adult” but is now using the term “tax filer” to refer to QHP users who ask for advance tax credit payments.
The new regulations apply only to individual QHP coverage.
The U.S. Department of Health and Human Services (HHS) is in charge of setting the rules for Small Business Health Options Program (SHOP) QHP reports, officials say.