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Get IRS 1095-A Form in PDF

The IRS 1095-A form is a crucial document that provides information about your health insurance coverage obtained through the Health Insurance Marketplace. This form details the months you were covered, the premiums paid, and any premium tax credits you may have received. Understanding the 1095-A is essential for accurately filing your tax return and ensuring compliance with health care laws.

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The IRS 1095-A form plays a crucial role in the health insurance landscape, particularly for those who have obtained coverage through the Health Insurance Marketplace. This form provides essential information that helps individuals and families understand their health insurance status and the tax implications associated with it. It includes details such as the months of coverage, the premium amounts, and the specific coverage provided. Importantly, the 1095-A is used to determine eligibility for premium tax credits, which can significantly reduce the cost of health insurance premiums. For many, this form is not just a piece of paperwork; it is a vital document that can impact their financial situation. Understanding its components is key to ensuring compliance with tax regulations and maximizing potential benefits. As tax season approaches, having a clear grasp of the 1095-A form can alleviate confusion and help individuals navigate their responsibilities with greater ease.

Dos and Don'ts

When completing the IRS 1095-A form, it is essential to follow specific guidelines to ensure accuracy and compliance. Below are six important dos and don'ts to consider.

Do provide accurate information regarding your health insurance coverage.
Do ensure that all names and Social Security numbers are correct.
Do check the coverage start and end dates for accuracy.
Do keep a copy of the completed form for your records.
Don't leave any sections blank; fill out all required fields.
Don't submit the form without reviewing it for errors.

Following these guidelines will help prevent delays and issues with your tax filing process.

Document Attributes

Fact Name	Description
Purpose	The IRS 1095-A form is used to report information about health insurance coverage obtained through the Health Insurance Marketplace.
Who Receives It	Individuals who enrolled in a qualified health plan through the Marketplace will receive this form.
Filing Requirement	Taxpayers must use the information on Form 1095-A to complete Form 8962, which determines eligibility for the Premium Tax Credit.
Deadline	The form is typically sent out by January 31 of the year following the coverage year.
State-Specific Forms	Some states, like California and Massachusetts, have their own versions of the 1095-A, governed by state-specific laws.
Information Included	The form includes details such as the names of covered individuals, the months of coverage, and the premium amounts.
Corrections	If there are errors on the form, taxpayers should contact the Marketplace for corrections, as the IRS requires accurate information.
Importance for Tax Filing	Accurate completion of the 1095-A is crucial for ensuring correct tax filings and avoiding penalties.

Key takeaways

The IRS 1095-A form is essential for individuals who have health insurance coverage through the Health Insurance Marketplace. Here are some key takeaways about filling out and using this form:

The form provides information about your health coverage, including the months you were covered and the premium amounts.
It is necessary for completing your federal tax return, especially if you received premium tax credits.
Ensure that all information on the form is accurate, as errors can lead to delays in processing your tax return.
Keep a copy of the 1095-A form with your tax records for future reference and verification.
If you do not receive your 1095-A form by mid-February, contact the Health Insurance Marketplace for assistance.

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Example - IRS 1095-A Form

CAUTION: NOT FOR FILING

Form 1095-A is provided here for informational purposes only.

Health Insurance Marketplaces use Form 1095-A to report information on enrollments in a qualified health plan in the individual market through the Marketplace. As the form is to be completed by the Marketplaces, individuals cannot complete and use Form 1095-A available on IRS.gov. Individuals receiving a completed Form 1095-A from the Health Insurance Marketplace will use the information received on the form and the guidance in the instructions to assist them in filing an accurate tax return.

Form 1095-A

Department of the Treasury Internal Revenue Service

Health Insurance Marketplace Statement

▶ Do not attach to your tax return. Keep for your records.

▶Go to www.irs.gov/Form1095A for instructions and the latest information.

VOID

CORRECTED

OMB No. 1545-2232

2021

		Recipient Information
Part I		Recipient Information

1	Marketplace identifier		2	Marketplace-assigned policy number	3	Policy issuer’s name

4	Recipient’s name				5	Recipient’s SSN	6	Recipient’s date of birth

7	Recipient’s spouse’s name				8	Recipient’s spouse’s SSN	9	Recipient’s spouse’s date of birth

10	Policy start date		11	Policy termination date	12	Street address (including apartment no.)

13	City or town		14	State or province	15	Country and ZIP or foreign postal code

Covered Individuals

Part II

A. Covered individual name

B. Covered individual SSN

C. Covered individual

D. Coverage start date

E. Coverage termination date

date of birth

Coverage Information

Part III

Month

A. Monthly enrollment premiums

B. Monthly second lowest cost silver

C. Monthly advance payment of

plan (SLCSP) premium

premium tax credit

January

February

March

April

May

June

July

August

September

October

November

December

Annual Totals

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 60703Q

Form 1095-A (2021)

Page 2

Instructions for Recipient

You received this Form 1095-A because you or a family member enrolled in health insurance coverage through the Health Insurance Marketplace. This Form 1095-A provides information you need to complete Form 8962, Premium Tax Credit (PTC). You must complete

Form 8962 and file it with your tax return (Form 1040, Form

1040-SR, or Form 1040-NR) if any amount other than zero is shown in Part III, column C, of this Form 1095-A (meaning that you received premium assistance through advance payments of the premium tax credit (also called advance credit payments)) or if you want to take the premium tax credit. The filing requirement applies whether or not you’re otherwise required to file a tax return. If you are filing Form 8962, you cannot file Form 1040-NR-EZ, Form

1040-SS, or Form 1040-PR. The Marketplace has also reported the information on this form to the IRS. If you or your family members enrolled at the Marketplace in more than one qualified health plan policy, you will receive a Form 1095-A for each policy. Check the information on this form carefully. Please contact your Marketplace if you have questions concerning its accuracy. If you or your family members were enrolled in a Marketplace catastrophic health plan or separate dental policy, you aren’t entitled to take a premium tax credit for this coverage when you file your return, even if you received a Form 1095-A for this coverage. For additional information related to Form 1095-A, go to www.irs.gov/Affordable-Care-Act/Individuals-and- Families/Health-Insurance-Marketplace-Statements.

Additional information. For additional information about the tax provisions of the Affordable Care Act (ACA), including the premium tax credit, see www.irs.gov/Affordable-Care-Act/Individuals-and-Families or call the IRS Healthcare Hotline for ACA questions (800-919-0452).

VOID box. If the “VOID” box is checked at the top of the form, you previously received a Form 1095-A for the policy described in Part I. That Form 1095-A was sent in error. You shouldn’t have received a Form 1095-A for this policy. Don’t use the information on this or the previously received Form 1095-A to figure your premium tax credit on Form 8962.

CORRECTED box. If the “CORRECTED” box is checked at the top of the form, use the information on this Form 1095-A to figure the premium tax credit and reconcile any advance credit payments on Form 8962. Don’t use the information on the original Form 1095-A you received for this policy.

Part I. Recipient Information, lines 1–15. Part I reports information about you, the insurance company that issued your policy, and the Marketplace where you enrolled in the coverage.

Line 1. This line identifies the state where you enrolled in coverage through the Marketplace.

Line 2. This line is the policy number assigned by the Marketplace to identify the policy in which you enrolled. If you are completing Part IV of Form 8962, enter this number on line 30, 31, 32, or 33, box a.

Line 3. This is the name of the insurance company that issued your policy.

Line 4. You are the recipient because you are the person the Marketplace identified at enrollment who is expected to file a tax return and who, if qualified, would take the premium tax credit for the year of coverage.

Line 5. This is your social security number (SSN). For your protection, this form may show only the last four digits. However, the Marketplace has reported your complete SSN to the IRS.

Line 6. A date of birth will be entered if there is no SSN on line 5.

Lines 7, 8, and 9. Information about your spouse will be entered only if advance credit payments were made for your coverage. The date of birth will be entered on line 9 only if line 8 is blank.

Lines 10 and 11. These are the starting and ending dates of the policy. Lines 12 through 15. Your address is entered on these lines.

Part II. Covered Individuals, lines 16–20. Part II reports information about each individual who is covered under your policy. This information includes the name, SSN, date of birth, and the starting and ending dates of coverage for each covered individual. For each line, a date of birth is reported in column C only if an SSN isn’t entered in column B.

If advance credit payments are made, the only individuals listed on Form 1095-A will be those whom you certified to the Marketplace would be in your tax family for the year of coverage (yourself, spouse, and dependents). If you certified to the Marketplace at enrollment that one or more of the individuals who enrolled in the plan aren’t individuals who would be in your tax family for the year of coverage, those individuals won’t be listed on your Form 1095-A. For example, if you indicated to the Marketplace at enrollment that an individual enrolling in the policy is your adult child who will not be your dependent for the year of coverage, that child will receive a separate Form 1095-A and won’t be listed in Part II on your Form 1095-A.

If advance credit payments are made and you certify that one or more enrolled individuals aren’t individuals who would be in your tax family for the year of coverage, your Form 1095-A will include coverage information in Part III that is applicable solely to the individuals listed on your Form 1095-A, and separately issued Forms 1095-A will include coverage information, including dollar amounts, applicable to those individuals not in your tax family.

If advance credit payments weren’t made and you didn’t identify at enrollment the individuals who would be in your tax family for the year of coverage, Form 1095-A will list all enrolled individuals in Part II on your Form 1095-A.

If there are more than 5 individuals covered by a policy, you will receive one or more additional Forms 1095-A that continue Part II.

Part III. Coverage Information, lines 21–33. Part III reports information about your insurance coverage that you will need to complete Form 8962 to reconcile advance credit payments or to take the premium tax credit when you file your return.

Column A. This column is the monthly premiums for the plan in which you or family members were enrolled, including premiums that you paid and premiums that were paid through advance payments of the premium tax credit. If you or a family member enrolled in a separate dental plan with pediatric benefits, this column includes the portion of the dental plan premiums for the pediatric benefits. If your plan covered benefits that aren’t essential health benefits, such as adult dental or vision benefits, the amount in this column will be reduced by the premiums for the nonessential benefits. If the policy was terminated by your insurance company due to nonpayment of premiums for 1 or more months, then a -0- will appear in this column for these months regardless of whether advance credit payments were made for these months.

Column B. This column is the monthly premium for the second lowest cost silver plan (SLCSP) that the Marketplace has determined applies to members of your family enrolled in the coverage. The applicable SLCSP premium is used to compute your monthly advance credit payments and the premium tax credit you take on your return. See the instructions for Form 8962, Part II, on how to use the information in this column or how to complete Form 8962 if there is no information entered. If the policy was terminated by your insurance company due to nonpayment of premiums for 1 or more months, then a -0- will appear in this column for the months, regardless of whether advance credit payments were made for these months.

Column C. This column is the monthly amount of advance credit payments that were made to your insurance company on your behalf to pay for all or part of the premiums for your coverage. If this is the only column in Part III that is filled in with an amount other than zero for a month, it means your policy was terminated by your insurance company due to nonpayment of premiums, and you aren’t entitled to take the premium tax credit for that month when you file your tax return. You must still reconcile the entire advance payment that was paid on your behalf for that month using Form 8962. No information will be entered in this column if no advance credit payments were made.

Lines 21–33. The Marketplace will report the amounts in columns A, B, and C on lines 21–32 for each month and enter the totals on line 33. Use this information to complete Form 8962, line 11 or lines 12–23.

Detailed Instructions for Writing IRS 1095-A

After you receive your IRS 1095-A form, it’s important to ensure all the information is accurate before you use it for your tax return. This form provides details about your health coverage and is essential for calculating your premium tax credit. Follow these steps to fill it out correctly.

Begin by locating your personal information at the top of the form. Fill in your name, address, and Social Security number if it’s not already provided.
Identify the coverage details listed in Part II of the form. This section shows the names of individuals covered under the plan. Ensure all names are correct.
Review the coverage start and end dates for each individual. Confirm that these dates match your health insurance records.
Look at the monthly premium amounts listed in Part III. This section should reflect what you paid for your coverage. Double-check these figures against your payment records.
Check the second column for the premium tax credit amounts, if applicable. This will help you understand any credits you may be eligible for when filing your taxes.
After verifying all the information, sign and date the form if required. Some versions may not need a signature, so check your specific form’s instructions.
Keep a copy of the completed form for your records. You may need it when preparing your tax return.

Documents used along the form

The IRS 1095-A form is a crucial document for individuals who have purchased health insurance through the Health Insurance Marketplace. It provides essential information about the coverage, including details about premiums and any premium tax credits received. Alongside the 1095-A, several other forms and documents are commonly used to ensure accurate reporting of health coverage and tax obligations. Below is a list of these documents, each serving a specific purpose in the tax filing process.

IRS Form 1040: This is the standard individual income tax return form used by taxpayers to report their annual income and calculate their tax liability. It is essential for filing taxes and includes sections where taxpayers report health coverage information.
Power of Attorney: A NY Templates template can assist individuals in legally designating someone to manage their financial or legal matters when needed.
IRS Form 8962: This form is used to calculate the Premium Tax Credit, which helps eligible individuals and families pay for health insurance coverage. Taxpayers must complete this form if they received a premium tax credit and need to reconcile it with their actual income.
IRS Form 1095-B: This form provides information about minimum essential coverage. Insurance providers issue it to individuals who have qualifying health coverage outside the Marketplace. It is used to confirm compliance with the Affordable Care Act's individual mandate.
IRS Form 1095-C: Employers with 50 or more full-time employees must provide this form to report the health coverage offered to their employees. It helps employees understand their health insurance options and obligations, especially in relation to the Affordable Care Act.
IRS Form 8889: This form is for individuals who have Health Savings Accounts (HSAs). It is used to report contributions to and distributions from an HSA, which can affect tax calculations related to health coverage.
IRS Form 8941: This form is used to calculate the credit for small employer health insurance premiums. Small businesses can claim this credit if they provide health insurance to their employees, which can influence their tax responsibilities.
Form W-2: Employers provide this form to employees to report wages and taxes withheld. It may also indicate whether the employee had health coverage during the tax year, which is relevant for tax filings.
Form 1099: This form reports various types of income other than wages, salaries, and tips. It may include payments made for health insurance premiums, which can impact tax calculations.

Understanding these documents can greatly aid individuals and families in navigating their tax responsibilities, especially concerning health insurance coverage. Each form plays a unique role in ensuring compliance with federal regulations and maximizing potential tax benefits. Properly completing and submitting these forms can help avoid issues with the IRS and ensure that taxpayers receive any credits or deductions for which they may be eligible.