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Outline

The IRS 1095-A form plays a crucial role in the healthcare landscape, particularly for individuals who have obtained health insurance through the Health Insurance Marketplace. This form provides essential information regarding the coverage received, including details about the months of coverage, the premium amounts, and any premium tax credits that were applied. Understanding the 1095-A is vital for accurate tax reporting, as it directly impacts the calculation of the premium tax credit and determines whether taxpayers may owe money or receive a refund. Additionally, the form is instrumental in helping individuals reconcile their advance payments of the premium tax credit with the actual credit they qualify for based on their final income for the year. As such, it serves as a critical document for both taxpayers and tax professionals alike, ensuring compliance with federal regulations while facilitating access to affordable healthcare options.

Sample - 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

2025

 

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 (2025) Created 6/5/25

Form 1095-A (2025)

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. If you think the information is incorrect, or if you think you should not have received a Form 1095-A because neither you nor anyone else in your family was enrolled in Marketplace health insurance, please contact your Marketplace Call Center. If you purchased insurance through the federally facilitated Marketplace, you can find your Call Center information at www.healthcare.gov/contact-us/. If you purchased insurance through a State-based Marketplace, you can find your Call Center information on your State-based Marketplace website. You can find a list of State- based Marketplace websites at www.healthcare.gov/marketplace-in- your-state/. 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 five 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. See the instructions for Form 8962, Part II, on how to complete Form 8962 if -0- is reported for 1 or more 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, the information is incorrect, or the information is reported as -0-.

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.

Form Information

Fact Name Description
Purpose The IRS 1095-A form is used to report information about health coverage obtained through the Health Insurance Marketplace.
Who Receives It Individuals who enrolled in a health plan through the Marketplace will receive this form from the Marketplace.
Tax Filing Requirement Taxpayers must include the information from Form 1095-A when filing their federal tax returns to reconcile premium tax credits.
State-Specific Forms Some states have their own versions of the 1095-A, governed by state laws such as the California Health and Safety Code.

Detailed Guide for Filling Out IRS 1095-A

After receiving your IRS 1095-A form, it’s important to ensure that you fill it out correctly. This form provides information about your health insurance coverage and is essential for completing your tax return. Follow these steps to fill out the form accurately.

  1. Begin by locating the “Part I” section of the form, which contains your personal information. Fill in your name, address, and Social Security number.
  2. In “Part II”, identify the coverage details for each month. Indicate whether you had coverage for each month of the year.
  3. Move to “Part III”, where you will find information about the premium amounts. Enter the monthly premium for your coverage.
  4. Next, check if you received any premium tax credits. If applicable, fill in the amount you received in the appropriate section.
  5. Review all the information you have entered to ensure accuracy. Double-check names, Social Security numbers, and premium amounts.
  6. Finally, sign and date the form at the bottom to certify that the information provided is correct.

Once you have completed the form, keep a copy for your records and submit it with your tax return as required. This will help ensure that your tax filing is accurate and compliant with IRS regulations.

Obtain Answers on IRS 1095-A

  1. What is the IRS 1095-A form?

    The IRS 1095-A form is a document that provides information about health insurance coverage obtained through the Health Insurance Marketplace. This form is crucial for individuals who have enrolled in a qualified health plan and need to report their health coverage on their tax returns. It includes details such as the months you were covered, the premiums you paid, 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 a 1095-A form. This includes those who enrolled in a plan for themselves, their spouse, or their dependents. The form is typically sent out by the Marketplace by the end of January each year, ensuring that you have it in time to file your taxes.

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

    When filing your taxes, the information on the 1095-A form is essential for completing Form 8962, which is used to calculate your premium tax credit. This credit helps lower the cost of your health insurance premiums. You will need to provide details such as the monthly premium amounts and the amount of premium tax credit you received. It is important to ensure that the information on the 1095-A matches your records to avoid any discrepancies that could delay your tax refund.

  4. What should I do if I did not receive my 1095-A form?

    If you have not received your 1095-A form by mid-February, you should first check your email and any online accounts you may have with the Health Insurance Marketplace. If you still cannot find it, you can contact the Marketplace directly for assistance. They can provide you with a copy of your 1095-A form or help resolve any issues that may have prevented its delivery.

Common mistakes

Filling out the IRS 1095-A form can be a straightforward process, but many people make common mistakes that can lead to issues later on. One significant error is not checking the information against other documents. For instance, if the names or Social Security numbers do not match those on the tax return, it can cause delays or even rejection of the tax return.

Another frequent mistake is misreporting the coverage start and end dates. Individuals often overlook the importance of these dates. If the dates are incorrect, it could affect the calculation of premium tax credits and other benefits. Always double-check these details to ensure accuracy.

Many people fail to report all members of the household. The 1095-A form requires information on all individuals covered under the health plan. Omitting someone can lead to discrepancies in tax credits and could result in an unexpected tax bill.

Some individuals also neglect to review the monthly premium amounts listed on the form. Errors in these figures can significantly impact the tax credits received. It’s essential to verify that the premiums match what was actually paid during the coverage period.

Another common mistake is misunderstanding the “Marketplace” section. This section provides critical information about the health coverage purchased. Misinterpretation can lead to incorrect reporting, which may affect eligibility for tax credits. Make sure to read this section carefully.

Finally, failing to keep a copy of the completed form is a mistake that many make. Retaining a copy is vital for future reference. It can help clarify any questions that may arise when filing taxes in subsequent years. Always keep your records organized and accessible.

Documents used along the form

The IRS 1095-A form is important for individuals who enrolled in health insurance through the Health Insurance Marketplace. It provides information about your coverage, which you will need when filing your taxes. Along with the 1095-A, several other forms and documents may be necessary to complete your tax return accurately. Here’s a brief overview of those documents.

  • IRS Form 1040: This is the standard individual income tax return form. You will use it to report your income, claim deductions, and calculate your tax liability.
  • IRS Form 8962: This form is used to calculate the Premium Tax Credit. If you received advance payments of the premium tax credit, you'll need this form to reconcile those payments with your actual premium tax credit.
  • IRS Form 1095-B: This form provides information about health coverage you had throughout the year. It helps to show whether you met the requirement for health insurance coverage under the Affordable Care Act.
  • IRS Form 1095-C: If you worked for a large employer, this form details the health insurance offered to you. It helps you understand your coverage options and whether you qualify for premium tax credits.
  • Health Insurance Marketplace Enrollment Confirmation: This document confirms your enrollment in a health plan through the Marketplace. It usually includes details about your coverage and can help verify your information.
  • Proof of Income Documents: These may include W-2 forms, 1099 forms, or other income statements. You'll need these to report your income accurately on your tax return.

Having these documents ready will help ensure a smooth tax filing process. It’s always a good idea to double-check your information to avoid any potential issues with your tax return.

Similar forms

  • IRS Form 1095-B: This form provides information about health coverage provided to individuals. It is similar to the 1095-A in that both documents report health insurance coverage, but the 1095-B is typically issued by insurance companies rather than the Health Insurance Marketplace.
  • IRS Form 1095-C: Employers use this form to report health insurance coverage offered to employees. Like the 1095-A, it details coverage but focuses on employer-sponsored plans rather than Marketplace plans.
  • IRS Form W-2: This form reports wages and tax withholdings for employees. While it does not focus on health coverage, it is similar in that both documents are used for tax reporting purposes and provide essential information for filing income tax returns.
  • IRS Form 1040: This is the standard individual income tax return form. It requires information about health coverage, making it similar to the 1095-A as both are integral to understanding an individual's tax situation regarding health insurance.
  • IRS Form 8962: This form is used to calculate the Premium Tax Credit. It relies on information from the 1095-A to determine eligibility and amount, linking the two documents closely in the context of health insurance affordability.
  • IRS Form 8889: This form is for Health Savings Accounts (HSAs). While it focuses on contributions and distributions from HSAs, it shares a common goal with the 1095-A of providing information related to health care expenses and coverage.

Dos and Don'ts

When filling out the IRS 1095-A form, it’s important to follow specific guidelines to ensure accuracy and compliance. Below are some key dos and don’ts to consider.

  • Do verify all personal information, such as your name and Social Security number, for accuracy.
  • Do check the coverage months to ensure they accurately reflect your enrollment period.
  • Do review the premium amounts listed to confirm they match your records.
  • Do keep a copy of the completed form for your records.
  • Don't leave any sections blank; all required fields must be filled out.
  • Don't ignore instructions provided by the IRS; they offer guidance specific to the form.

By following these guidelines, you can help ensure that your IRS 1095-A form is completed correctly, reducing the risk of issues with your tax filing.

Misconceptions

The IRS 1095-A form is an important document for those who have health insurance through the Health Insurance Marketplace. However, several misconceptions surround this form. Here are seven common misunderstandings:

  1. It’s only for people who received premium tax credits.

    Many believe that the 1095-A is only necessary if they received premium tax credits. In reality, anyone who enrolled in a Marketplace plan will receive this form, regardless of whether they received financial assistance.

  2. It is the same as the 1095-B or 1095-C forms.

    Some confuse the 1095-A with the 1095-B or 1095-C forms. While all three provide information about health coverage, the 1095-A specifically details coverage from the Marketplace, whereas the others pertain to employer-sponsored plans or government programs.

  3. Receiving the form means I owe taxes.

    Receiving a 1095-A does not automatically mean you owe taxes. It simply reports your health coverage status, which can affect your tax return but does not determine tax liability on its own.

  4. It’s optional to file the 1095-A with my taxes.

    Some individuals think they can ignore the 1095-A when filing taxes. However, this form is necessary for accurately completing your tax return, especially if you received premium tax credits.

  5. All information on the form is correct.

    It’s a misconception that the information on the 1095-A is always accurate. You should review the details carefully and report any discrepancies to the Marketplace.

  6. It only affects my taxes for the current year.

    Many believe that the 1095-A only impacts their taxes for the year they receive it. However, it can also affect future tax returns, especially if you reconcile premium tax credits or have changes in coverage.

  7. Once I receive it, I don’t need to keep it.

    Some people think they can discard the 1095-A after filing their taxes. It’s important to keep this form for your records, as it may be needed for future reference or in case of an audit.

Key takeaways

The IRS 1095-A form is essential for those who have health insurance through the Health Insurance Marketplace. Understanding how to fill it out and use it correctly is crucial for accurate tax reporting. Here are key takeaways to keep in mind:

  • What it is: The 1095-A form provides information about your health coverage, including who was covered and the months of coverage.
  • When to receive it: You should receive your 1095-A form by January 31 of the year following the tax year for which you are filing.
  • Who needs it: If you or anyone in your household enrolled in a health plan through the Marketplace, you will need this form to file your taxes.
  • Using it for taxes: The information on the 1095-A is necessary for completing your tax return, particularly if you received premium tax credits.
  • Correcting errors: If you find mistakes on your 1095-A, contact the Marketplace for a corrected form before filing your taxes.
  • Filing without it: You should not file your tax return until you have received your 1095-A, as it is needed to ensure accuracy.
  • Multiple forms: If you had multiple health plans during the year, you may receive more than one 1095-A. Each form must be included in your tax filing.
  • Reporting changes: Keep track of any changes in your coverage throughout the year, as these can affect the information on your 1095-A.
  • Storing it: After filing, keep your 1095-A form with your tax records for at least three years, as the IRS may request it for verification.

Be proactive in understanding and managing your 1095-A form to avoid complications during tax season. Accurate information is vital for your financial well-being.