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IRS Releases Draft Forms for Individuals, Businesses and Insurers to Report on Health Insurance in 2014

Updated: August 10, 2014

On July 24, 2014 the IRS released draft forms for the 2014 tax filing season (returns due April 15, 2015) for individuals, small businesses, large employers and insurance issuers to report on health insurance in accordance with the Affordable Care Act (ACA) requirements.

For individual taxpayers:

A draft of the new Individual Income Tax Return Form 1040 includes lines for listing calculated net premium tax credits for those who are either owed more in tax credits from purchasing insurance through an ACA marketplace or must pay back some of the tax credits they received in advance. The Premium Tax Credit Form 8962 form is used to calculate the taxpayer’s final premium tax credit amount for the tax filing year.

The 1040 also includes lines to report coverage for the year, as required by the ACA, by checking “full-year coverage” or listing a calculated shared responsibility payment (the penalty for not having coverage). The Health Coverage Exemptions Form 8965 allows individuals who were uninsured for all or part of the prior year to document any exemption from the penalty that they can claim.

For small businesses:

The Credit for Small Employer Health Insurance Premiums Form 8941 will allow small business who purchased health insurance for their employees on the ACA small business marketplace to calculate their health care tax credit.

For entities that provide health care coverage to individuals or employees:

The IRS released drafts of the forms that the ACA marketplaces (1095-A), insurance issuers (1095-B) and self-insuring large businesses (1095-C) will have to fill out for each of the individuals for whom they provide coverage. This information will be used to verify full-year coverage for all individuals filing income tax returns and to verify premium tax credit calculations.

The IRS has not yet released official instructions for filling out these forms and plans to do so in August 2014.

All draft tax forms can be found on the IRS website.

IRS Releases Average Cost of Bronze Level Plan For Determining Tax Penalties in 2014

Updated: August 10, 2014

The IRS has established the maximum amount taxpayers may have to pay if they or a family member is uninsured in 2014.  The 2014 tax filing year (returns due April 15, 2015) will be the first year for which tax penalties for not having health insurance will be required.

The maximum tax penalty for each family member who was uninsured in 2014 will be $204 per month, or $2,448 annually, up to a maximum of $12,240 per family.  $12,240 is the penalty for a family of five, but even if the family size is greater than five, a taxpayer will not pay more than this amount.

Under the Affordable Care Act (ACA), taxpayers have to pay a penalty (called a shared responsibility payment) for the months in which they, their spouse, or their tax dependents did not have coverage. 

The penalty cannot exceed the cost of purchasing coverage, so the maximum penalty is determined by calculating the average premium for bronze levels plans offered through all ACA marketplaces across the country. The IRS calculated the maximum penalty for 2014 by taking a weighted average of the average Bronze level plan offered in ACA marketplaces in each county or county equivalent for a 21 year old individual who does not smoke.

Read the regulations from the IRS here.

More on calculating the tax penalty on our site here.

Financial Aid for Hospital Services

Updated: August 10, 2014

Individuals and families that have income below 300% of the federal poverty level  and do not have insurance are eligible for discounts and financial assistance from hospitals in New York State.

All hospitals must provide financial assistance for New York State residents for emergency care. Each hospital must also provide financial assistance for residents in their primary service area. Details about primary service areas of individual hospitals can be found on the NY State Department of Health website.

Discounts and financial assistance are determined on a sliding scale based on an individual’s income. This means that those with lower incomes will receive larger discounts than those with higher incomes. Some hospitals extend discounts to individuals who are above 300% of the federal poverty level or who have health insurance but are not able to fully pay co-pays and deductibles.

Individuals who earn less than 100% of the federal poverty level cannot be charged for a child’s or pregnant woman’s clinic and emergency room visits, and cannot be charged more than $15 for an adult’s emergency room or clinic visit.

Hospitals cannot take an individual’s home, car, a retirement or college savings accounts cannot be taken into account when determining their income level. For example, a hospital may not foreclose on a patient’s home to collect a bill.

Hospitals must provide patients with information on the available financial assistance. Upon request, hospitals must provide application forms in accessible languages and provide patients with assistance in filling them out as necessary. Patients have 90-days from the date that the service was provided by the hospital to request an application and 20 days to file the application once they receive it.

Join Us at the South Hollis Library on July 10th to Find Out About Your Health Insurance Options

Last updated:  July 7, 2014

Come and join OCHIA at the South Hollis Library healthcare open house to find out what coverage you qualify for in the NY State of Health, the Official Health Plan Marketplace.

Where:   South Hollis Library in Queens
When:    Thursday, July 10th at 2:00 – 5:00pm

Trained navigators will be on site to help you enroll in Medicaid, Child Health Plus, or if you have qualifying, event private health insurance.

Preregistering at 718 465-6779 is suggested but not required. See Flyer

NYS Releases Health Insurance Marketplace Enrollment Report

Last Updated: June 25, 2014

On June 25, 2014, the NY State of Health (NYSOH)  released a report on who enrolled in the marketplace during the first open enrollment period,

This report, entitled NY State of Health: The Official Marketplace 2014 Open Enrollment Period,  provides information on the nearly 1 million people who enrolled through the NYSOH from October 1, 2013 to April 15, 2014, including how many people received financial assistance the which health plans they enrolled in.  The report also contains information on enrollment into the marketplace by small businesses and their employees.

In addition to the report, NYSOH released several infographics:

The following table summarizes NYSOH enrollment activity for public health insurance and private health insurance in NYC.






Medicaid 62,404 98,149 44,640 92,371 11,223 308,787
CHP    790 8,553 2,562 8,503 1,432 24,840
QHPs 16,419 53,219 38,413 50,386 6,879 165,316
All Programs 82,613
159,921 85,615 151,260 19,534 498,943
Enrollment in NY State of Health in NYC, by Program type, during Open Enrollment (October 1, 2013 - April 15, 2014)

Read more about the report in the state’s press release.

Data on Immigrants & Health Insurance Coverage in NYC 

Last updated:  June 25, 2014

The NYC Department of City Planning presented on the great diversity that is New York City at HRA OCHIA’s June 25th Partners’ Meeting.  In this presentation, Joel Alvarez and Adam Attar reviewed new data on immigrants in the City, where they live, where they come from, and what languages they speak.  They also presented on health insurance coverage among immigrants overall and different immigrant groups, including where many uninsured immigrants live in the City. 

Additionally, information on projections work that the Department does to forecast how the City will look in 2020 and 2040 was shared, as well as how to find a lot of useful data reports, maps and tools on their website.

Download their presentation, their latest report The Newest New Yorkers, or access data from the report using their online interactive map.

New Special Enrollment Period for Individuals Who Have COBRA

Date:  May 28, 2014

Individuals enrolled in COBRA have through July 1, 2014 to switch to a plan in the NY State of Health. To take advantage of this new, time-limited opportunity to enroll in Marketplace coverage (called a special enrollment period), you must call the NY State of Health at 1-855-355-5777. 

For some people, coverage through NY State of Health may cost less than their COBRA coverage. Eligible individuals can also receive tax credits and cost-sharing reductions to lower their costs through the NY State of Health. After July 1st, people who have COBRA must wait until November 15th, when the next open enrollment period starts, to change to a Marketplace plan. The Consolidated Omnibus Budget Reconciliation Act – or COBRA, for short – allows people losing job based coverage to continue it for a limited period of time. Learn more about COBRA on our website.

This special enrollment period for people who have COBRA was created by the federal government to address concerns that these individuals were not provided with clear enough information about their coverage options. Specifically, there was concern that the notices people received when they were losing their job-based coverage did not state clearly enough that instead of continuing their coverage under COBRA, they could enroll in Marketplace coverage. For persons already enrolled in COBRA, there was a concern that people did not know they could switch to Marketplace coverage during open enrollment. New York’s Marketplace is called NY State of Health.  More information about this special enrollment period is available from the federal notice and New York State of Health FAQs on Special Enrollment Addendum.

The federal government has also revised COBRA notices to make information about the Marketplace clearer.  View model language for the new COBRA general notice and election notice on the U.S. Department of Labor website.  

Department of Health & Human Services Posts Enrollment Data for New York’s First Open Enrollment Period

Date: May 5, 2014

The federal Department of Health & Human Services has published marketplace enrollment numbers for public and private coverage for the Affordable Care Act’s first open enrollment period (October 1, 2013 - March 31, 2014), including special enrollment period activity through April 19, 2014.

Similar to previous data, 31% of young adults age 18 to 34 enrolled in the marketplace for health insurance.  Additionally, 56% of individuals chose silver tier plans.  Consumers earning less than 250% had incentives to select silver plans.  Cost sharing reductions were only available to eligible residents if they enrolled in a silver plan.

This document (PDF) provides more detailed enrollment information for open enrollment.

Recently Had A Life Changing Event? NY State of Health issues FAQs on Special Enrollment Periods

Date: May 2, 2014

Recently had a life changing event? You may qualify for a special enrollment period. Some qualifying events including having a baby or gaining a dependent, getting married or divorced, losing your health coverage or permanently moving to New York State may allow you to purchase private coverage outside of open enrollment. The NY State of Health has compiled a list of Frequently Asked Questions (FAQs) on Special Enrollment (PDF to help consumers understand their options.

If you had a life changing event you must act to newly enroll in coverage or change your health plan within a 30 to 60 day window, depending upon the circumstance.

The NY State of Health is allowing individuals who experienced delays applying for coverage until April 15th to complete their application.

Updated: March 28, 2014

The NY State of Health announced that residents need to complete their application for private insurance by 11:59pm on Monday, March 31, 2014 to avoid a federal tax penalty. 

Residents who have taken steps to apply for coverage by March 31st, but who experienced delays through no fault of their own, may have until the end of the day on April 15th to complete their application.  This FAQ provides more information about obtaining an extension. 

After these deadlines, residents can only enroll in private health insurance if they experience a qualifying event that makes them eligible for a special enrollment period.  Qualifying events include such events as getting married, having a baby or adopting a child, moving permanently to New York State, or losing other health insurance.

Without a qualifying event, individuals must wait to enroll in private coverage until the next open enrollment period, which begins November 15th.

Adults eligible for Medicaid and Child Health Plus can use the NY State of Health to get coverage at any time during the year.

Small businesses can purchase a plan to cover their employees all year round.

New Federal Rules Help Married Domestic Violence Survivors’ Access Premium Tax Credits

Last updated:  March 28, 2014

On March 26, 2014, the federal government announced that married domestic violence survivors may qualify for premium tax credits using the ‘married filing separately’ federal tax status. 

These survivors of domestic violence may also be eligible for a special enrollment period that allows them to apply for coverage through May 31, 2014. Call the NY State of Health Customer Service Center at 1-855-355-5777 for more information and help applying.

Residents with incomes up to 400 percent of the federal poverty level (currently $45,960 for an individual) may be eligible for premium tax credits for health insurance policies offered through the NY State of Health.

Generally, married individuals must file taxes jointly to claim a premium tax credit.

This new tax filing rule allows married survivors of domestic violence who do not file taxes with their spouse to be eligible for tax credits.  To learn more about the rule change, read the IRS notice  or U.S. Treasury fact sheet.

NYC Urges Uninsured New Yorkers to Get Covered Before March 31st

Last updated:  March 10, 2014

"Get Covered!" is a citywide awareness campaign to motivate uninsured New Yorkers to sign up for health insurance before open enrollment ends on March 31, 2014.

With the deadline approaching to enroll in a health plan this year, a final push is on to get as many people signed up as soon as possible for health insurance through the state's online marketplace, NY State of Health, over the next three weeks. 

The NYC Health Department reports that nearly 20% of adults in the City are uninsured, and nearly 40% of adults who speak Spanish as their primary language at home do not have health insurance. 

The City’s media campaign includes ads in English  (PDF) and Spanish (PDF) that provide examples of New Yorkers who are now eligible for free or lower-cost coverage under the Affordable Care Act. 

Learn more about what the Affordable Care Act offers Immigrants, Young Adults, Sole Proprietors, and Small Businesses, including information on premium tax credits and cost-sharing reductions (in English).  Information is also available in Arabic, Bengali, Chinese, French, Haitian Creole, Korean, Russian, Spanish, and Urdu.

Federal Government Announces Changes to the Employer Mandate

Last updated:  February 4, 2014

Under the Affordable Care Act, employers with 50 or more full-time employees must offer affordable and adequate health benefits or pay fines.  This “employer shared responsibility” requirement (also called an employer mandate) was originally scheduled to go into effect this year (2014) but has already been postponed until 2015.

On February 10, 2014, the federal government announced that it would further delay and modify this requirement.  In its final regulations, medium size employers with 50 to 99 employees will now have until 2016 instead of 2015 to provide their workers health insurance.  

In addition, larger employers with 100 or more employees will have additional time to cover all of their full-time workers.  In 2015, they will have to cover 70% of full-time employees in order to avoid paying  a penalty.  In 2016 and beyond, they must offer insurance to 95% of full-time employees. 

To learn more, read the U.S. Treasury fact sheet or the IRS’s final regulations and questions and answers.


Making the Affordable Care Act Work for You!

On Wednesday, February 12, 2014, the Office of Citywide Health Insurance Access (OCHIA), the Small Business Administration, the New York State of Health (NYSOH) and Community Service Society will provide tips on how to navigate the new insurance landscape and determine the best health care coverage options for you and your employees under the Affordable Care Act. There will also be Navigators present who can answer your questions and help you apply for health insurance for yourself or your business. 

See our flyer for more information and register today!

Most people in NYC under age 65 must now apply for Medicaid through the NY State of Health

Last Updated:  January 10, 2014

As of January 1, 2014, most pregnant women, children, and non-elderly adults (under age 65) must apply for Medicaid coverage through NY State of Health.  The Human Resources Administration (HRA) will continue to accept applications for Medicaid for persons over 65, individuals who have Medicare, and people of any age who need Medicaid related to a disability or blindness. Learn more.

FAQs for Residents with Insurance through NY State of Health’s Individual (NYSOH) Marketplace

Last Updated: January 2, 2014

If you are newly insured through the NY State of Health, the Marketplace has published a new set of FAQs about using coverage that starts January 1, 2014.

It includes helpful tips and information on:

•    Finding out if your doctor is in your plan’s network
•    Prescription coverage and access
•    Procedures for obtaining emergency care
•    Health plan customer service

New Year's Greeting from OCHIA

Last Updated: December 31, 2013

Wishing all New Yorkers a Happy And Healthy Holiday Season And New Year. To view the animated card, open Internet Explorer then click here.

News & Tips for Using NY State of Health

Last Updated: December 20, 2013

As the new deadline of December 24, 2013 to enroll for coverage starting on January 1, 2014 looms, we’ve put together some News & Tips (pdf) to help you find the best health care plan for you as you explore your options on the New York State of Health (NYSOH).

Our News & Tips Sheet (pdf) links you to lots of helpful information – including videos that show you what to expect when you apply for coverage through NYSOH and where to find the Individual and Small business Tax Credit Calculators on NYSOH. There’s also resources for application assistors.

Don’t forget take advantage of the educational resources offered on our HI Link website

Get Health Insurance by March 31, 2014 to Avoid Paying a Penalty for Being Uninsured

Last updated:  October 31, 2013

The federal government recently clarified that if you enroll in health insurance during the initial open enrollment period – which runs from October 1, 2013 through March 31,2014 – you won’t have to pay a penalty for being uninsured before this coverage starts.  Read more here (pdf).

Even though you won’t pay a penalty if you wait to enroll, health insurance is important and with the new tax credits and financial assistance available in NY State of Health, most uninsured New Yorkers are expected to qualify for lower cost coverage.  If you sign up and pay for insurance before December 15th, 2013, your coverage can start by January 1, 2014. Visit to enroll today.

Remember the Affordable Care Act (ACA) requires nearly all residents get health insurance by January 1, 2014, or else pay a penalty when they file their taxes, unless they can claim an exemption.  To learn more about penalties and exemptions for individuals, including the exemption you can claim if you wait until the end of open enrollment to get coverage, click here .


NY State of Health, The Official Health Plan Marketplace, is now open

Last Updated: October 1, 2013

October 1st marks the opening of NY State of Health, an online marketplace where individuals, families, and small businesses can shop and sign up for private health insurance. Through this Marketplace, New Yorkers can find out if they can get tax credits to lower their health insurance costs. 

New Yorkers can choose from 4 different tiers of coverage--Platinum, Gold, Silver, and Bronze-- to find a plan that fits their budget and health care needs. You can read more about what NY State of Health offers residents and small businesses on our website by clicking here .

Visit the NY State of Health to get health insurance.


Find Out Where You Can Get Help Signing Up for Health Insurance

Last Updated: September 30, 2013

NY State of Health, the Official Health Plan Marketplace, has released a schedule of the times and locations where New Yorkers get help signing up for health insurance. Called in-Person Assistors (IPAs) or Navigators, these individuals are trained and certified by the state to help individuals, families, small businesses and their employees who apply for health insurance through the Marketplace. Click here to see the location and site schedule.


New York Announces Names of In-Person Assistors / Navigator Grantees

Last Updated: August 05, 2013


New York State has awarded grants to 50 organizations to serve as in-person assistors / navigators in New York City, To see a list of the organizations that have been awarded grants in your borough, click here.

In-person assistors / navigators will help residents get health insurance in the NY Health Benefit Exchange starting in October 2013. These assistors can help: 

• Individuals
• Families
• Small businesses and their employees.

In-person assistors and navigators must meet certain federal and state standards.  These standards include the successful completion of a training program and certification by the Exchange.  Additionally, when helping residents and businesses, assistors and navigators must provide fair and impartial information in a manner that is culturally and linguistically appropriate.

A total of 50 organizations have received grants statewide. At this point, all of these awards are conditional, pending successful completion of State prequalification and approval processes.


Healthy NY Program Is Ending For Individuals and Sole Proprietors

Last Updated: July 16, 2013


All Healthy NY individual and sole proprietor contracts will end on December 31, 2013.   If you currently have Healthy NY coverage on your own (not through an employer), you will need to enroll in a different health insurance plan before January 1, 2014 to avoid a gap in coverage.  To learn more about these changes, click here

Beginning October 1, 2013, you can look for health insurance through the NY Health Benefit Exchange.  To learn more about the Exchange, click here.

If you would like to enroll in Healthy NY for the remainder of 2013, you can still do so, but this coverage will end on December 31, 2013.   To learn more about the Healthy NY program and how to apply, click here .


Healthy NY Plans will Change for Small Businesses in 2014

Last Updated: July 15, 2013


Healthy NY, a state subsidized health plan for eligible small businesses, will have new benefits as of January 1, 2014.

• If you offer Healthy NY to your employees – your current Healthy NY plan will no longer be offered after January 1, 2014, but new Healthy NY plans will be available. These new plans will include additional benefits required under the Affordable Care Act.  You will be able to move to a new Healthy NY plan at the end of 2013.

• If you want to start offering insurance – eligible small businesses will still be able to purchase a Healthy NY plan outside of the NYS Health Benefit Exchange in 2014.

• To learn more about how Healthy NY plans will change for small businesses, click here .

Small businesses will also be able to access new coverage options on the New York State Health Benefit Exchange starting October 1, 2014.  In the Exchange, eligible small business can also receive a tax credit for up to 50 percent of their health insurance costs.

• For information about coverage options for small businesses available through the New York State Exchange click here .

Large Employers Won’t Face A Penalty For Not Offering Insurance in 2014

Last Updated: July 03, 2013


The Obama administration is delaying until 2015 the enforcement of the employer mandate. 

The Affordable Care Act requires businesses with 50 or more employees to provide their workers with health insurance coverage in 2014, or else pay a penalty.  Now, employers won’t pay a penalty for not covering their full-time workers in 2014.

According to the U.S. Treasury website, the delay is intended to give the government additional time to simplify reporting requirements and adapt health coverage and reporting systems.

This delay applies only to business penalties: 

 • Most individuals are still required to have health insurance or pay a fine starting in 2014. 

• Both individuals and small businesses with 50 or fewer employees will still be able to shop for and enroll in health insurance through the NY Health Benefit Exchange. 

• Employees who do not get coverage through their employers will continue to be eligible for tax subsidies to help pay for their own health insurance. 

• Eligible small businesses will continue to be eligible for the health care tax credit to help them pay for employee coverage.


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