Fill a Valid IRS 1095-A Template Open Editor Here

Fill a Valid IRS 1095-A Template

The IRS 1095-A form is a document that provides information about health coverage obtained through the Health Insurance Marketplace. This form is essential for individuals who need to report their health insurance status when filing their taxes. Completing the 1095-A accurately ensures compliance with tax regulations and can affect eligibility for premium tax credits.

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Form Overview

Fact Name Details
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 health plan through the Marketplace receive this form.
Tax Reporting The information on the 1095-A is necessary for individuals to complete their federal tax returns and claim premium tax credits.
State-Specific Forms Some states have their own versions of the 1095-A, such as California (Form 1095-C) and Massachusetts (Form MA 1099-HC), governed by state health care laws.
Deadline Health insurers must send the 1095-A form to recipients by January 31 of the year following the coverage year.
Correction Process If there are errors on the 1095-A, individuals should contact the Marketplace to request a corrected form.

Common Questions

  1. What is the IRS 1095-A form?

    The IRS 1095-A form is a document that provides information about your health insurance coverage obtained through the Health Insurance Marketplace. It details the months you were covered, the premium amounts, and any premium tax credits you may have received.

  2. Who receives the 1095-A form?

    Individuals who purchased health insurance through the Health Insurance Marketplace will receive the 1095-A form. This includes people who enrolled in a plan for themselves or their family members during the open enrollment period.

  3. When will I receive my 1095-A form?

    The Health Insurance Marketplace is required to send out the 1095-A form by January 31 of the year following the coverage year. For example, if you had coverage in 2022, you should receive your form by January 31, 2023.

  4. How do I use the 1095-A form when filing my taxes?

    You will use the information on your 1095-A form to complete IRS Form 8962, which calculates your premium tax credit. This credit helps lower your tax bill if you qualify. Ensure that the information on your 1095-A matches what you report on your tax return.

  5. What should I do if I don’t receive my 1095-A form?

    If you do not receive your 1095-A form by the end of January, you should contact the Health Insurance Marketplace where you purchased your coverage. They can provide you with a copy of the form or help you resolve any issues.

  6. What if the information on my 1095-A form is incorrect?

    If you notice any errors on your 1095-A form, such as incorrect coverage dates or premium amounts, you should reach out to the Health Insurance Marketplace to request a correction. It’s important to have accurate information for your tax filing.

  7. Do I need to file my taxes if I receive a 1095-A form?

    Yes, if you receive a 1095-A form, you are generally required to file a tax return. Even if you are not otherwise required to file, you may want to file to claim any premium tax credits you are entitled to.

  8. What happens if I don’t file my taxes after receiving a 1095-A?

    Failing to file your taxes after receiving a 1095-A can lead to penalties. Additionally, you may miss out on claiming any premium tax credits that could reduce your tax liability. The IRS may also flag your account for not reporting required information.

  9. Can I access my 1095-A form online?

    Yes, you can access your 1095-A form online through your Health Insurance Marketplace account. Log in to your account to download or print your form. If you cannot access it, you may need to contact customer service for assistance.

  10. What if I had coverage for only part of the year?

    If you had coverage for only part of the year, your 1095-A form will reflect the specific months you were enrolled. You will still need to file your taxes, and the premium tax credit will be calculated based on the months you had coverage.

Documents used along the form

The IRS 1095-A form is a crucial document for individuals who enrolled in a health insurance plan through the Health Insurance Marketplace. It provides information about the coverage, including the months of coverage and the premiums paid. Along with the 1095-A, several other forms and documents may be necessary for tax purposes. Below is a list of commonly used forms that complement the 1095-A.

  • 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.
  • IRS Form 8962: This form is used to calculate the Premium Tax Credit. Taxpayers use it to reconcile the amount of credit they received with the amount they are eligible for based on their income.
  • IRS Form 1095-B: This form provides information about health coverage provided by insurance companies or employers. It shows whether individuals had minimum essential coverage for each month of the year.
  • IRS Form 1095-C: Employers with 50 or more full-time employees use this form to report health coverage offered to employees. It details the type of coverage and the months it was available.
  • IRS Form 8889: This form is for individuals who have a Health Savings Account (HSA). It is used to report contributions and distributions from the HSA.
  • Wisconsin Motor Vehicle Bill of Sale: This form is essential for recording the transfer of ownership for a vehicle between a seller and a buyer. You can find the necessary template at PDF Templates.
  • IRS Form 8862: This form is used to claim the Earned Income Tax Credit (EITC) after it has been disallowed in a prior year. It must be filed with the tax return.
  • IRS Form 4506-T: This form allows taxpayers to request a transcript of their tax return, which can be helpful in verifying income for tax credits and other financial assistance programs.
  • State Tax Forms: Depending on the state, additional forms may be required for state income tax returns, which can vary widely in requirements and formats.

Having these documents ready can simplify the tax filing process and ensure that all necessary information is accurately reported. It is essential to review each form carefully to understand its purpose and how it relates to your overall tax situation.

Preview - 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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16

 

 

 

 

 

 

 

 

 

 

 

 

17

 

 

 

 

 

 

 

 

 

 

 

 

18

 

 

 

 

 

 

 

 

 

 

 

 

19

 

 

 

 

 

 

 

 

 

 

 

 

20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21

January

 

 

 

 

 

 

 

 

 

22

February

 

 

 

 

 

 

 

 

 

23

March

 

 

 

 

 

 

 

 

 

 

24

April

 

 

 

 

 

 

 

 

 

 

25

May

 

 

 

 

 

 

 

 

 

 

26

June

 

 

 

 

 

 

 

 

 

 

27

July

 

 

 

 

 

 

 

 

 

 

28

August

 

 

 

 

 

 

 

 

 

 

29

September

 

 

 

 

 

 

 

 

 

30

October

 

 

 

 

 

 

 

 

 

31

November

 

 

 

 

 

 

 

 

 

32

December

 

 

 

 

 

 

 

 

 

33

Annual Totals

 

 

 

 

 

 

 

 

 

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

Cat. No. 60703Q

 

Form 1095-A (2021)

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.

Common mistakes

Filling out the IRS 1095-A form can be a daunting task, and many individuals make common mistakes that can lead to complications. One frequent error is providing incorrect personal information. This includes misspelling names, entering the wrong Social Security numbers, or providing incorrect addresses. Such inaccuracies can delay processing and may even lead to penalties.

Another common mistake is failing to include all household members. The 1095-A form requires information for everyone in the household who was covered by a health plan. Omitting anyone can result in discrepancies when reconciling premium tax credits.

Many people also overlook the importance of accurately reporting coverage dates. The form specifies the start and end dates of health coverage, and any errors here can affect eligibility for tax credits. It is crucial to double-check these dates to ensure they align with the coverage period.

In addition, some individuals misinterpret the premium amounts listed on the form. The 1095-A details the monthly premium amounts for each covered individual. Misreporting these figures can lead to incorrect calculations of premium tax credits, which can ultimately affect tax liability.

Another mistake involves misunderstanding the purpose of the 1095-A form itself. Some individuals may confuse it with other tax forms related to health coverage, such as the 1095-B or 1095-C. Understanding that the 1095-A is specifically for those who purchased health insurance through the Marketplace is essential.

People also sometimes fail to keep copies of their 1095-A forms. It is important to retain this document for your records, as it may be needed for future tax filings or in case of an audit. Keeping a digital or physical copy can save time and hassle later.

Additionally, individuals may not take the time to review the form thoroughly before submission. Errors can be easily overlooked, so a careful review is critical. Taking a moment to check for mistakes can prevent future complications.

Some taxpayers also neglect to seek assistance when needed. If there are uncertainties about how to fill out the form correctly, reaching out to a tax professional or utilizing IRS resources can provide clarity. Avoiding this step can lead to mistakes that might have been easily corrected.

Finally, individuals often miss the deadline for submitting the 1095-A form. Awareness of tax deadlines is crucial to avoid penalties. Being proactive and submitting forms on time can help ensure compliance with IRS regulations.

Similar forms

The IRS Form 1095-A is an important document for taxpayers who have obtained health insurance through the Health Insurance Marketplace. It provides essential information about the coverage, including the months covered and the premium amounts. There are several other tax documents that share similarities with the 1095-A form. Below is a list of ten such documents, along with explanations of how they relate to the 1095-A.

  • Form 1095-B: Like the 1095-A, this form provides information about health coverage. However, it is typically issued by health insurance providers to report minimum essential coverage, rather than Marketplace coverage specifically.
  • Form 1095-C: This form is similar in that it reports health insurance coverage offered by large employers. It details the coverage available to employees, akin to how the 1095-A outlines Marketplace coverage.
  • Form W-2: While primarily a wage and tax statement, the W-2 may include information about health insurance premiums deducted from an employee's paycheck. This can complement the information provided on the 1095-A.
  • Form 1040: This is the standard individual income tax return form. Taxpayers use it to report their income and claim tax credits, including those related to health insurance, which are also reflected in the 1095-A.
  • Form 8962: This form is used to calculate the Premium Tax Credit. Taxpayers will reference the information from the 1095-A when filling out the 8962 to determine their eligibility for the credit.
  • Form 8889: This form is for Health Savings Accounts (HSAs). While it focuses on HSA contributions and distributions, it relates to health coverage and can be important for taxpayers who have both an HSA and Marketplace coverage.
  • Form 1099-SA: This document reports distributions from HSAs or other tax-advantaged health accounts. It connects to health coverage, similar to how the 1095-A outlines insurance details.
  • Form 1040-SR: This is a simplified version of the 1040 designed for seniors. It also includes sections where health insurance information from the 1095-A may be relevant for tax calculations.
  • Form 4506-T: This form allows taxpayers to request a transcript of their tax return. It can be used to verify income and health insurance coverage information, including details that may be found in the 1095-A.
  • Texas Bill of Sale: This legal document is essential for transferring ownership of personal property and can be obtained from texasdocuments.net.
  • Form 8862: This form is used to claim the Earned Income Tax Credit after disallowance. While not directly related to health insurance, the overall tax situation, including health coverage, can influence eligibility for this credit.

Each of these documents serves a unique purpose but shares a common thread with the 1095-A in terms of reporting health coverage and its implications for tax obligations. Understanding these similarities can help taxpayers navigate their financial responsibilities more effectively.

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