➾

Download IRS 1095-A Template

The IRS 1095-A form is a document that provides information about health insurance coverage obtained through the Health Insurance Marketplace. It is essential for taxpayers to accurately report their health coverage when filing their federal tax returns. This form helps individuals determine their eligibility for premium tax credits and assess their compliance with the Affordable Care Act requirements.

Open IRS 1095-A Editor

Content Overview

The IRS 1095-A form plays a crucial role in the landscape of health insurance and tax reporting in the United States. This form is issued by the Health Insurance Marketplace and provides essential information for individuals who have enrolled in a qualified health plan through the marketplace. It outlines details such as the months of coverage, the premiums paid, and any premium tax credits received. Understanding the 1095-A is vital for taxpayers, as it helps them accurately complete their federal tax returns, particularly when claiming the Premium Tax Credit. Additionally, this form serves as a verification tool, ensuring that individuals comply with the Affordable Care Act's requirements. For many, navigating the complexities of health insurance can be daunting, but the 1095-A simplifies the process by summarizing key information that impacts both health coverage and tax obligations. By familiarizing oneself with this form, individuals can better understand their health insurance status and its implications for their finances.

Key takeaways

The IRS 1095-A form is an important document for anyone who has obtained health insurance through the Health Insurance Marketplace. Here are some key takeaways to keep in mind when filling out and using this form:

Understand its purpose: The 1095-A provides information about your health coverage, including who was covered and for what months.
Use it for tax filing: You will need the information from the 1095-A to complete your federal tax return, especially if you received premium tax credits.
Check for accuracy: Ensure that the details on the form, such as names and coverage periods, are correct. Mistakes can lead to issues with your tax return.
Keep it handy: Store the 1095-A with your tax documents. You may need to refer to it while preparing your return.
File on time: The IRS typically requires you to file your tax return by April 15. Make sure you have your 1095-A in time to meet this deadline.
Report changes: If your coverage changes during the year, you may receive multiple 1095-A forms. Be sure to include all relevant information.
Seek assistance if needed: If you have questions about the form or your coverage, consider reaching out to a tax professional or the Marketplace for help.

Guide to Writing IRS 1095-A

After receiving your IRS 1095-A form, you will need to fill it out accurately to ensure compliance with tax regulations. This form is essential for reporting health insurance coverage obtained through the Health Insurance Marketplace. Follow these steps to complete the form correctly.

Locate the form, which is typically provided by your health insurance provider or available online.
Fill in your name, address, and Social Security number in the designated fields at the top of the form.
Identify the coverage year for which you are reporting. This is usually the previous calendar year.
Review the "Monthly Premium Amount" section. Enter the premium amounts for each month you had coverage.
In the "Second Lowest Cost Silver Plan (SLCSP) Premium Amount" section, provide the premium amount for the second lowest cost silver plan available in your area for each month.
Check the "Coverage" section to ensure it accurately reflects the months you had coverage. Mark the appropriate boxes for each month.
Verify all information for accuracy. Double-check names, numbers, and amounts.
Sign and date the form at the bottom to certify that the information provided is correct.
Make a copy of the completed form for your records before submitting it with your tax return.

Free PDF File

Browse Other PDFs

Cash Drawer Count Sheet - Streamlines cash management for businesses.

Understanding the importance of the FedEx Release Authorization form is essential for anyone who may not be available to receive their packages. This document not only allows recipients to specify a preferred delivery location but also ensures that packages are securely left in designated areas. For more comprehensive guidance on this topic, you can refer to TopTemplates.info, which offers valuable insights on managing your deliveries effectively while maintaining accountability.

Printable Sports Physical Form - Prepares athletes for discussions about their personal health.

Form Preview Example

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.

Documents used along the form

The IRS 1095-A form is a crucial document for individuals who have obtained health coverage through the Health Insurance Marketplace. It provides essential information about the insurance plan, including details about premiums and coverage periods. Along with the 1095-A, several other forms and documents may be necessary for accurately reporting health coverage and tax obligations. Below is a list of these important documents.

IRS Form 1040: This is the standard individual income tax return form used to report income, claim deductions, and calculate tax liability. It is essential for filing taxes.
IRS Form 8962: This form is used to calculate the Premium Tax Credit, which helps eligible individuals lower their health insurance premiums. It requires information from the 1095-A.
IRS Form 1095-B: This form provides information about health coverage provided by insurers or employers. It confirms whether an individual had minimum essential coverage.
New York Motorcycle Bill of Sale: A legal document essential for recording the sale of a motorcycle within New York, it ensures the transfer of ownership is clear and can be found at smarttemplates.net.
IRS Form 1095-C: Employers with 50 or more full-time employees use this form to report health coverage offered to employees. It includes details about the coverage and its affordability.
Health Insurance Marketplace Statement: This document summarizes the health coverage obtained through the Marketplace, including any changes in coverage throughout the year.
Proof of Income Documentation: This may include pay stubs, W-2 forms, or other records that verify income levels. It is necessary for determining eligibility for tax credits.
State Health Insurance Forms: Some states require additional forms for health coverage verification or tax credits. These can vary by state and may include specific reporting requirements.

Understanding these forms and documents is vital for ensuring compliance with tax obligations and maximizing available benefits. Collecting and organizing these documents can simplify the tax filing process and help individuals make informed decisions about their health coverage.