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The Massachusetts Health Care Reform Law requires that most residents over 18 who can afford health insurance have coverage for the entire year, or pay a penalty through their tax returns. Penalties add up for each month you don't comply, but there is a grace period that allows lapses in coverage of 3 or fewer consecutive months. You must be enrolled in health insurance plans that meet Minimum Creditable Coverage (MCC) requirements.
Most adults already have health insurance, perhaps through their employer or a government program, but if you don't, you or your employer can find the right health insurance plan online.
You may also buy plans through approved Massachusetts health insurance carriers. To learn more or buy a plan, contact the Health Connector at (877) 623-6765, TTY number at (877) 623-7773, or visit the website.
Whether you file or have to file a Massachusetts personal income tax return, anyone 18 years old or over must get and maintain creditable health insurance coverage as long as it's considered affordable under the schedule set by the Massachusetts Health Connector. This includes those who are exempt from filing taxes. This health care mandate applies to:
If you're a resident, or in some cases a part-year resident, file Schedule HC with your Form 1 or Form 1-NR/PY. If you don't, this will delay processing your return. Fill in the Health Care Information section on your Schedule HC to prove that you have health insurance that meets MCC requirements. (Note that when Schedule HC instructions for line 11 ask if "you applied for MassHealth or Commonwealth Care and were denied", "denied" means that you were denied because you weren't eligible for those government-subsidized insurances, not denied for administrative reasons such as failing to return the forms necessary for determining eligibility.)
If you have health insurance from more than 2 insurance carriers, fill out Schedule HC-CS as well. Report your 2 most recent insurance carriers first on Schedule HC first and then fill out Schedule HC-CS to report your additional insurance carriers.
If you turned 18 in the past tax year, the health care mandate applies to you beginning on the first day of the third full month following your birthday.
If a taxpayer dies during the year, the health care mandate applies to the deceased up until the last day of the last full month that they were alive.
Your health care premiums are tax-deductible if you're self-employed, so you can reduce your taxable income by your health insurance premium's cost. This is reported on Schedule Y of your Massachusetts income tax return. The Massachusetts Health Connector offers health plans on a pre-tax basis.
If you have an insured benefit plan that provides coverage for dependents, your child can stay on your health plan through the earlier of:
If your plan is a self-insured plan, check with your plan sponsor to find out how long dependents can stay on your plan. See here for more information on the personal income tax treatment of this benefit.
Carriers can't impose any limitations on eligibility for dependent coverage, other than limitations defining familial relationships under the policy (e.g., spouse and children, or spouse, children and parents) and any other limitations that may be allowed.
If you moved into Massachusetts during the year, the health care mandate applies to you beginning on the first day of the third full month following the month you became a Massachusetts resident.
If you moved out of Massachusetts during the year, the health care mandate applies to you up until the last day of the last full month you were a resident.
If you're a retired Massachusetts resident now living abroad, and you have full health insurance in the country you live in, you can complete your Schedule HC by either:
If you were living out of the state (a nonresident of Massachusetts), and thus filed your income tax return in the state you lived in before, you aren't subject to the mandate. However, to avoid penalties in the future, you should contact the Massachusetts Health Connector at (877) 623-6765, TTY number at (877) 623-7773, or visit them online.
Minimum Creditable Coverage (MCC) is the minimum level of benefits that you need to be considered insured and avoid tax penalties in Massachusetts. These benefits include:
If your plan doesn't meet the MCC requirements for the entire time that the mandate applied to you, fill in the "No MCC/None" oval in line 3 of the Schedule HC. You won't be penalized if we determine that you didn't have access to affordable insurance that met MCC.
Most plans meet the MCC standards. You'll know if your plan does because Massachusetts-licensed health insurance companies must put an MCC-compliance notice on their plans to indicate if it does or doesn't meet MCC.
If you receive a Form MA 1099-HC from your insurer, it will indicate whether your insurance meets MCC requirements. If you didn't receive one from your insurer and get health coverage through your job, you can call your insurer or your employer's human resources department or benefits administrator for help. If your insurer or your employer can't help you, please refer to list of benefits above to see if your policy meets these requirements. If your plan meets all of the requirements listed above, you may certify that you were enrolled in a plan that met the MCC requirements during that time period.
You automatically meet MCC if you're enrolled in:
For years before 2014, you automatically meet MCC if you were enrolled in:
Receiving services through the Health Safety Net Trust Fund (previously known as the "Uncompensated Care Pool" or "Free Care Pool") is not considered health insurance, and thus does not meet MCC requirements. If this is the only way in which your health care needs are paid, you must select the No MCC/None oval in line 3 of the Schedule HC.
If you were enrolled in an MCC plan for only part of a year, you should fill in the "Part-Year MCC" oval in line 3 of the Schedule HC. Next, provide your health insurance information for the MCC plan(s) you were enrolled in. Do not provide health insurance information for a plan that does not meet the MCC standards.
Massachusetts is keeping its individual mandate along with the federal mandate from the Affordable Care Act (ACA) while making sure that they work together in a way so no one is subject to "double penalties". Massachusetts will continue to apply the mandate only to adults, even though the federal mandate applies to children.
In some cases, coverage automatically meets MCC. MCC also outlines categories of benefits that must be covered by plans that don't automatically meet MCC, such as employer-sponsored plans or plans in the individual market. For example, a plan must cover doctor visits and prescription drugs to meet MCC.
You must have Minimum Essential Coverage (MEC) to satisfy the federal mandate. Instead of including specific types of benefits, it's generally defined as different types of coverage. These coverage categories include:
In almost all cases, plans that meet the state’s MCC requirements also meet the federal MEC requirements. You likely won't experience any changes while filing your taxes or be penalized.
If you don't have MCC compliant coverage, you'll pay whichever penalty is larger. If the federal penalty is greater than the state penalty, you'll pay the full federal penalty but won't pay anything to the state. If the federal penalty is less than the state penalty, you'll pay the full federal penalty to the federal government and the difference between the 2 penalties to the state.
This form contains information you need to complete your Schedule HC. Students who are dependents on a parent's insurance plan also need the information on the Form MA 1099-HC to complete their income tax returns.
Insurance carriers (including MassHealth, Commonwealth Care, or Commonwealth Care Bridge) and certain employers are legally required to issue Forms MA 1099-HC no later than January 31 of the following year.
You will receive a Form MA 1099-HC if:
If you receive more than 1 Form MA 1099-HC because you have more than 1 health insurance carrier for the year, you (and/or your spouse, if married filing jointly) must report each carrier that provided health insurance.
If you switched coverage or had more than 1 insurance carrier in the year, you'll receive a Form MA 1099-HC from each carrier showing detailed information about specific months of coverage. You need to report each instance of coverage you had as you complete Schedule HC.
Don't worry if you receive a Form MA 1099-HC that lists your middle initial incorrectly. There will be no problem, since you don't transcribe your name from the Form MA 1099-HC onto the Schedule HC. The important data is the information you carry over from the Form MA 1099-HC to the Schedule HC.
You won't receive a Form 1099-HC if:
You'll only be penalized for lacking insurance if you can afford to get health insurance but didn't. The penalties vary depending upon your income, age and family size. Penalties can be no more than half the lowest priced plan available to an individual through the ConnectorCare health insurance.
The individual mandate penalty applies only to adults who can afford health insurance. If, according to the state affordability schedule, you have no affordable options, you won't be penalized. There's no penalty if your income is at or below 150% of the federal poverty level because there is no premium and therefore no penalty. See the guidelines regarding the tax penalties for not having health insurance.
Your penalty amount will be calculated and entered on Form 1 or Form 1-NR/PY. If you owe more than you are getting back in refund, pay the amount of tax due on the tax return. We will send a bill if the amount of tax due is not paid with the return.
You can appeal the penalty if you were unable to get affordable insurance due to a hardship or other circumstances. If the Connector denies or dismisses your appeal, you'll receive a bill from DOR.
You can also base your appeal on other circumstances. For example, income changes or life circumstances might have affected your financial status during the year so that applying the affordability tables in Schedule HC was inequitable. You could have been unable to get government-subsidized insurance despite your income, or other circumstances that made you unable to buy insurance.
To appeal a penalty, you have to show that you experienced any of the following hardships during the tax year:
There is a grace period for people who have a gap in coverage. You can go up to 3 consecutive months without penalty, and multiple lapses are allowed within 1 calendar year. Therefore, if you lose your coverage but then resume coverage within 3 or fewer calendar months, you won't be penalized. We'll know how long you've had coverage because insurance carriers submit the same Form MA 1099-HC information to us as well.
If you go 4 or more consecutive months without insurance, you need to determine if you have access to affordable health insurance, either through an employer, the government, or on your own.
If you had insurance for 15 days or more in a month, it will be treated as a full month of coverage. Otherwise, coverage of 14 days or less will be counted as a month without coverage. This calculation will be reflected in the Form MA 1099-HC.
If you can't afford health insurance payments while you're unemployed (before your new health insurance becomes effective through your new employer), check with your previous employer's human resource department about possibly extending your coverage until your new insurance becomes effective. You may also want to speak to the Commonwealth Health Insurance Connector Authority or the Division of Unemployment Assistance about other options. However, if your waiting period is 3 or fewer consecutive months, you fall within the permitted grace period and won't be penalized.
If you recently lost your job but got coverage through COBRA, you won't be subject to penalties. Losing your job is considered a "qualifying event" in most cases, which means that you are temporarily entitled to the same health plan coverage you had while you were employed. As long as the insurance you had through your former employment met MCC standards, you won't be penalized as long as you maintain that coverage through COBRA.