Although open enrollment for the Affordable Care Act's Health Insurance Marketplace ended on January 31, members of federally recognized tribes and Alaska Native Claims Settlement Act Corporation shareholders can enroll in Marketplace coverage any time of the year.
The Indian Health Service is still actively engaging in outreach and enrollment events across Indian Country, but now we're shifting the focus to tax season and what tribal members need to know. The tax forms can be confusing and sometimes a little frustrating, but it's important to file the correct forms with the correct information about your health care coverage.
If you had coverage through the Health Insurance Marketplace in 2015 and used premium tax credits to lower the monthly payments, you must file a federal income tax return for 2015. Here are some helpful tips:
- The Marketplace will send you Form 1095-A , Health Insurance Marketplace Statement, by early February.
- Use the information on the 1095-A Form to complete Form 8962 , Premium Tax Credit.
- Form 8962 will figure out if you used the right amount of tax credit during the year.
If you had employer-based insurance or any other type of coverage outside of the Marketplace, you will not receive a 1095-A form, but may get a 1095-B or 1095-C or no form at all.
If you didn't have any coverage in 2015, you must pay a penalty or claim an exemption. The penalty for 2015 is $325 per adult or 2 percent of your household income, whichever is higher.
However, members of federally recognized tribes or those eligible to receive services from an Indian Health Service, tribal or urban Indian health program may claim an exemption from the penalty . The exemption should be claimed on a federal income tax return using IRS Form 8965 [PDF - 82 KB].
If you already applied for and received an Exemption Certificate Number (ECN), then use this number to complete Part I of IRS Form 8965. If you did not already obtain an ECN you can still claim the exemption using IRS Form 8965 by entering code "E" in Part III of the form.
You will need to submit this form every year that you file a federal income tax return and are requesting an exemption, even if you have an ECN. You don't need to apply for an exemption if you are not filing a federal income tax return.
Please know there are trained assisters in every state to help you at no cost. You should never be asked to pay for services or help to apply for Marketplace coverage. You can find help at your local Indian Health Service, tribal or urban Indian health program or you can find a free, trained local assister through the Marketplace .
Be wary of scams. Remember to never give your financial information, like banking, credit card or account numbers to someone who calls or comes to your home uninvited, even if they say they are from the Marketplace. Double check any information that is confusing or sounds suspicious. Check out HealthCare.gov to verify information or call the Marketplace at 1-800-318-2596.
For more information, visit the IHS Affordable Care Act website or the Marketplace Tribal Resources website .
Raho Ortiz is the Director of the Division of Business Enhancement in the Office of Resource Access and Partnerships with the Indian Health Service. He provides national oversight and guidance for IHS business offices and provides the IHS with advice regarding reimbursement policy and procedures for Medicare, Medicaid and Marketplace health plans. He is Navajo and Acoma Pueblo.