ADVANCED PREMIUM TAX CREDIT (APTC) Flashcards
ADVANCED PREMIUM TAX CREDIT (APTC)
1095 - form
Each January, the martketplace will furnish 1095-A tax forms to Qualified Health Plan enrollees who were enrolled in Platinum, gold, Silver, and Bronze plans the prior year.
The 1095-A form is used to complete IRS Tax Form 8962, which enables Qualified Health Plan enrollees to reconcile the amount of APTC they received or to claim PTC.
The form includes the consumer’s share of the Qualified Health Plan and Stand Alone Dental Plan (SADP) premiums attributed to Essential Health Benefits (EHBs) and if applicable, their SLCSP and the amount of APTC used.
COST SHARING REDUCTIONS (CSR)
Cost Sharing Reductions (CSRs) reduce the out-of-pocket costs (co-pays, co-insurance and deductibles) for health care services at the point-of-care.
Individuals with income greater than 200% and up to 250% of the FPL, who enroll in a Silver Plan, may be eligible to receive additional assistance to lower their out-of-pocket costs when they receive care and lower their maximum out-of-pocket costs.
Cost-sharing reductions do not impact the monthly premium cost of an insurance plan.
- CSR is only available for Silver plans. If a CSR-eligible individual chooses a non-Silver plan, they will not get the CSR benefit.
- Unlike APTC, CSR is not reconciled. As long as you stay within the same CSR plan each year, an individual’s CSR benefit will not change or be reconciled within that year.
- Attest to filing taxes in the up coming year.
COST SHARING REDUCTIONS (CSR) SILVER PLAN
If a CSR-eligible individual with FPL between 200-250% enrolls in a Silver Plan, they will enroll in a CSR version of their plan that will let them see what their out-of-pocket expenses would be. In the standard Silver Qualified Health Plan, the annual deductible for a sing person policy is $1,300; in the Silver CSR Qualified Health Plan, the Annual deductible will increase to $1,600 for a single person policy.
CHILD HEALTH PLUS?
Child Health Plus is a subsidized insurance program for uninsured New York State children under the age of 19, who are not Medicaid eligible and do not have access to a state benefit plan.
QUALIFIED HEALTH PLANS (QHPs)?
Qualified Health Plans (QHPs) are licensed commercial health plans that have been approved by the NY State of Health Marketplace to provide comprehensive coverage, follow limits on out-of-pocket expenses 9such as deductibles, co-payments, and out-of-pocket maximums), and meet other requirements.
ADVANCED PREMIUM TAX CREDITS (APTCs)
APTCs can be used to reduce monthly premiums for Platinum, gold, Siler or Bronze Plans. APTCs cannot be used for catastrophic plans
COST SHARING REDUCTION SUMMARY
CSRs reduce the out-of-pocket costs (co-pays, co-insurance and deductibles) for health care services at the point-of-care.
