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Affordable Care Act Confirmation Letter

The Affordable Care Act (ACA) was signed into law in 2010. One provision of the Act required that in 2014 all Americans must have qualified health insurance or face a "Shared Responsibility Payment." Additionally, the Act allowed insurance providers and large employers a one-year delay in reporting the coverage in 2014 to both the IRS and to the Taxpayer.

This delay effectively rendered the Health Care penalty a voluntary oral reporting item for 2014 in many cases. In order to remind you of the rules and to protect us both from future IRS liability in the event of an audit and or IRS inquiry, we require all individual taxpayers for 2014 to positively affirm the following items related to Health Care.

Click here to download the sample ACA Confirmation Letter wording

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Example ACA Confirmation Letter Language:

[Date]

[Client Name]
[Client Address]

Dear [Client Name]:

This letter is to confirm understanding of your qualified dependents under the Affordable Care Act (ACA).
Thank you for your attention to this matter, and please contact me with any questions that you may have.

Please initial each item and sign the bottom of the affirmation.

______    1. We have provided you with all copies of Forms 1095-A, 1095-B, and 1095-C we received.
______    2. We did not receive all Forms 1095-A because we have alternate government provided qualified health care insurance from Medicare, Medicaid, or Tri-Care that covers all members of our household who qualify as dependents. Enter N/A if not applicable.
______    3. We have qualified employer-provided health insurance for the entire year for all members of our household who qualify as dependents.
______    4. We have qualified other health insurance we purchased directly from state or federal exchange for the entire year which covers all members of our household who qualify as dependents.
______  5. We did not have coverage for all members of our household who qualify as dependents for part of the year. Enter N/A if not applicable.

______  6. We did not have coverage for all members of our household who qualify as dependents for the entire year. Enter N/A if not applicable.

Please complete the table below if items 5 or 6 apply.

Name Period of Coverage Insurer
     
     
     
     
     
     
     

In the event you do not have qualified health insurance for the entire year for all members of your household who qualify as dependents, we will calculate the penalty and include it with your return. Please attach any applicable exemption certificates for dependents to this form.

Signature 1: _______________________________ Signature 2*: ______________________________
Name (Printed): ____________________________ Name (Printed): ____________________________
Date: _____________________________________ Date: _____________________________________

 * If filing a joint return, both parties are required to sign the return.

Thank you for your attention to this matter, and please contact me with any questions that you may have.

Very truly yours,
[Firm Contact]
[Title]

ACCEPTED AND AGREED:

[Client Name] ______________________________________________________   [Date] _______________

By: [Name of Signatory] ____________________________ Its: [Title] _____________________________

This information is intended solely for general educational purposes. It is not intended for the purpose of providing specific legal, accounting, or other professional advice to any particular recipient or with respect to any particular jurisdiction. The author, publisher, and distributor of this document (1) make no representations, warranties, or guarantees as to its technical accuracy or compliance with any law ( federal, state, or local) or professional standard; and, (2) assume no responsibility to any recipient of this document to correct or update its contents for any reason, including changes in any law or professional standard. Before using any engagement letter in your practice, you should formally retain the counsel of an attorney knowledgeable as to the accounting industry, your practice, and the laws of any jurisdiction(s) within which you conduct your practice to ensure the documents maximum usefulness and compliance with applicable laws and professional standards. (3) The language contained herein is drafted with respect to the available information as of January 21, 2015 and is subject to change without notice.

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