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The Affordable Care Act resulted in the creation of some new tax forms, including Form 1095-A, Form 1095-B, and Form 1095-C. These forms are sent to individuals and the Internal Revenue Service (IRS) early each year, to report details about the coverage that the person had (or was offered) during the previous year.
Although there is no longer a federal penalty for not having health insurance, these forms are still a necessary part of the tax filing process for some Americans.
This article will explain the three versions of Form 1095, what version you can expect to receive (if any), and how these forms are used for tax filing purposes.
Everyone who has coverage through the health insurance exchange/marketplace will receive Form 1095-A. You’ll get this form even if you only had coverage through the exchange for a month or two during the year.
In 2022, more than 14.5 million Americans had marketplace coverage. This is less than 5% of the U.S. population, so most Americans will not receive Form 1095-A. But for most people who have marketplace coverage, Form 1095-A is a crucial part of the tax-filing process.
Form 1095-A is used to reconcile the premium tax credit (premium subsidy), or to claim it in full on your tax return if you paid full price for your marketplace coverage (note that you cannot claim the premium tax credit if you obtained your coverage outside the exchange).
Form 1095-A will be sent to you by the exchange, which is either HealthCare.gov or a state-run exchange, depending on where you live. It will show:
You’ll use the information on Form 1095-A to complete Form 8962. This is the form that’s used to reconcile your advance premium tax credit.
If your premium tax credit was too large, you may have to repay some or all of it to the IRS. But if it was too small, you’ll be able to claim the rest of it with your tax return. And if you paid full price for a marketplace plan but ended up being eligible for a premium tax credit, you’ll use Form 8962 to claim it.
You cannot complete Form 8962 without the information on Form 1095-A. The exchange should send you this form by the end of January, and you should also be able to log into your online exchange account and find your 1095-A there. If you’re having trouble finding it, you can reach out to the exchange or to your broker or navigator for assistance.
Form 1095-B is sent to enrollees and the IRS by various entities that provide minimum essential coverage, including:
The official deadline for entities to send Form 1095-B to their covered enrollees is January 31 (reporting coverage from the previous year), but this has historically always been extended by at least a month. The IRS has recently enacted a permanent extension to March 2 (March 1 in a leap year).
Form 1095-B generally does not need to be used during the tax filing process unless you’re in a state that has its own requirement that residents maintain health coverage. There is no longer a federal penalty for not having health coverage, and the federal Form 1040 no longer asks whether you had health coverage during the year.
The IRS allows entities to not send Form 1095-B to their enrollees, which means you might not receive a 1095-B even though you had health coverage during the year and used to receive Form 1095-B.
Entities that take this option are required to post a notice on their website, informing people how they can request and receive Form 1095-B if they would like it. Colorado’s Medicaid program (Health First Colorado) is an example of an entity that used to send Form 1095-B to members but is not currently doing so.
You do not need Form 1095-B to file your taxes in most cases. But if you’re in a state with a tax penalty for not having health coverage, you may need proof that you had coverage during the year.
Depending on where you got your coverage, Form 1095-B may be the necessary proof. You can request it from the entity that provided your coverage if you don’t receive it automatically.
Form 1095-C is used by applicable large employers (those with 50 or more full-time equivalent employees) to report coverage and coverage offers. The form is sent to full-time (30 or more hours per week) employees and the IRS. It is sent by large employers that purchase health coverage for their employees and those that self-insure.
The official deadline for employers to send Form 1095-C to full-time employees was January 31. But just like Form 1095-B, this has been extended to March 2 (March 1 in a leap year).
As is the case with Form 1095-B, most people do not need Form 1095-C in order to file their tax return. But if you’re in a state with a penalty for not having health coverage, a 1095-C will be your proof of coverage if you received your coverage from a large employer.
There is one other scenario in which Form 1095-C can be an important part of the tax filing process. If you had marketplace coverage (and thus received Form 1095-A) and also had an offer of coverage from an applicable large employer (and thus received Form 1095-C), you’ll need to pay close attention to the details of Form 8962 and the premium tax credit reconciliation process.
You may have received both forms simply due to a change in circumstances during the year. Maybe you had employer-sponsored coverage for the first few months of the year but then left your job to become self-employed and switched to marketplace coverage at that point. In that case, you may receive Form 1095-A and 1095-C, but they’ll apply to different months of the year.
However, if you had an offer of coverage from your employer and rejected it and took marketplace coverage instead, it might be more complicated. If the employer’s offer of coverage was considered affordable and provided minimum value, you would not have been eligible for premium tax credits in the marketplace.
The marketplace application asks about offers of coverage from an employer, but it’s possible to misunderstand this, especially in cases where the family glitch is involved and family members are thus ineligible for premium tax credits.
If you find yourself with a Form 1095-C and a Form 1095-A indicating that marketplace premium tax credits were paid for months when you were also eligible for employer-sponsored coverage, you’ll want to consult with an accountant before completing your tax return.
Form 1095-A, 1095-B, and 1095-C are tax forms that are used to report health insurance coverage to enrollees and to the IRS. These forms came about as a result of the Affordable Care Act.
For most people who had marketplace/exchange coverage during the year, Form 1095-A is an essential part of the tax filing process, as it’s necessary in order to claim or reconcile the marketplace premium tax credit.
But most Americans don’t get their health coverage through the exchange, and will receive Form 1095-B, 1095-C, or nothing at all. For most of them, these forms are not necessary to file taxes.
If you didn’t get your health coverage through the exchange/marketplace in your state (most people don’t), you probably don’t need to worry about any of the 1095 tax forms. You may receive one, but likely will not need it in order to file your taxes.
But if you did have marketplace coverage, you’ll want to wait until you receive Form 1095-A before filing your taxes. You’ll need this form to reconcile or claim your premium tax credit, if you were eligible for one. If you don’t receive it in the mail or by email, you can log into your exchange account and obtain a copy of it there.
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By Louise Norris
Norris is a licensed health insurance agent, book author, and freelance writer. She graduated magna cum laude from Colorado State University.
