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Fill Out a Valid 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. It is essential for individuals who want to report their health coverage on their tax returns. Understanding how to fill out this form correctly can help ensure you receive any applicable tax credits, so be sure to complete it accurately by clicking the button below.

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Structure

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 serves as a vital record that provides information about the insurance plan, including details on the coverage period, the premiums paid, and the amount of any premium tax credits received. For individuals and families who enrolled in a Marketplace plan, the 1095-A is essential for accurately completing their federal tax returns. It helps taxpayers report their health coverage and determine if they qualify for certain tax benefits. Additionally, the information contained in the form can assist in reconciling any advance payments of the premium tax credit, ensuring that taxpayers receive the appropriate financial support. Understanding the significance of the 1095-A form is important for anyone navigating the complexities of health insurance and tax obligations, making it a key document in the intersection of healthcare and taxation.

Common mistakes

Incorrect Personal Information: Many people mistakenly enter the wrong names, Social Security numbers, or addresses. Double-checking this information is crucial. Even a small typo can lead to delays or issues with your tax return.
Missing Coverage Dates: Some individuals forget to include the start and end dates of their health coverage. This information is vital for determining eligibility and calculating any potential tax credits.
Not Reporting All Covered Individuals: When filling out the form, it's easy to overlook family members who were covered under the same plan. Ensure that all individuals who were on the policy are listed accurately.
Ignoring the Premium Tax Credit: People often fail to report the premium tax credit correctly. This can happen if they don't understand how to calculate it based on their income and family size. Be sure to review the guidelines to avoid missing out on potential savings.

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		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.

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Documents used along the form

The IRS 1095-A form is essential for individuals who have health insurance coverage through the Health Insurance Marketplace. However, several other forms and documents are often used in conjunction with the 1095-A to ensure accurate reporting and compliance with tax regulations. 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 U.S. taxpayers to report their annual income and calculate their tax liability.
IRS Form 8962: This form is used to calculate the Premium Tax Credit, which helps individuals afford health insurance purchased through the Marketplace. It requires information from the 1095-A.
IRS Form 1095-B: This form provides information about health coverage provided by insurance companies or employers. It is used to verify compliance with the Affordable Care Act's individual mandate.
IRS Form 1095-C: Employers use this form to report health insurance coverage offered to employees. It is relevant for those who work for large employers and need to understand their coverage options.
IRS Form 8889: This form is for taxpayers who have Health Savings Accounts (HSAs). It reports contributions and distributions related to HSAs and may affect tax calculations.
IRS Form 8965: This form is used to claim a health coverage exemption from the Affordable Care Act's individual mandate. It is important for those who did not have coverage for part of the year.
W-2 Form: Employers provide this form to report wages and taxes withheld. It is crucial for completing the 1040 form and determining overall income.
Schedule A: This form is used for itemizing deductions on the 1040. Taxpayers may include medical expenses that exceed a certain threshold, impacting their overall tax liability.
Motorcycle Bill of Sale Form: When buying or selling a motorcycle in Minnesota, it is important to include the Motorcycle Bill of Sale form, which serves as proof of ownership transfer. More details can be found at https://autobillofsaleform.com/motorcycle-bill-of-sale-form/minnesota-motorcycle-bill-of-sale-form/.
Schedule C: Self-employed individuals use this form to report income and expenses related to their business. It can influence overall taxable income and health insurance deductions.
Form 1099: Various types of 1099 forms report different types of income received by taxpayers, such as freelance income or interest. They are essential for accurately reporting total income on the 1040.

Understanding these forms and documents is crucial for anyone navigating the tax implications of health insurance coverage. Properly completing and submitting these forms can help ensure compliance with tax laws while maximizing potential credits and deductions.

Similar forms

The IRS 1095-B form serves a similar purpose to the 1095-A, as both documents provide information about health coverage. The 1095-B is issued by health insurance providers and indicates whether an individual had minimum essential coverage throughout the year. While the 1095-A focuses on coverage obtained through the Health Insurance Marketplace, the 1095-B covers other types of health insurance, such as employer-sponsored plans or government programs like Medicaid. Both forms help individuals confirm their health coverage status when filing their taxes.

The IRS 1095-C form is another document that resembles the 1095-A. This form is specifically for employees of large employers who are required to offer health insurance under the Affordable Care Act. The 1095-C provides details about the coverage offered to the employee, including the months of coverage and whether the coverage met minimum standards. Like the 1095-A, it plays a crucial role in determining whether an individual qualifies for premium tax credits or needs to pay a penalty for not having health insurance.

When considering the transfer of vehicle ownership, it's essential to document the sale accurately, and utilizing a Motor Vehicle Bill of Sale form can streamline this process. This form not only protects both buyer and seller but also lays out the necessary details about the vehicle and transaction. For those seeking further information or needing to create such a document, you can find helpful resources at https://billofsaleforvehicles.com/.

The W-2 form is also similar in that it is a tax-related document that provides essential information for filing income taxes. While the W-2 reports an employee's annual wages and the taxes withheld, it does not address health coverage directly. However, both forms are important for tax preparation and can impact an individual’s tax liability. The W-2 may also provide information about employer-sponsored health insurance, which can be relevant when considering health coverage options.

The 1099 form, particularly the 1099-MISC or 1099-NEC, shares similarities with the 1095-A in that it reports income received by independent contractors or freelancers. While the 1095-A focuses on health coverage, both forms are used for tax reporting purposes and help individuals understand their financial obligations when filing taxes. The 1099 forms can also indicate whether an individual had health insurance through a different avenue, which may affect their overall tax situation.

Lastly, the Form 8962, Premium Tax Credit, is closely related to the 1095-A. This form is used to calculate the premium tax credit for individuals who purchased health insurance through the Marketplace. The 8962 requires information from the 1095-A to determine the amount of credit a taxpayer can claim. Both forms are essential for ensuring compliance with tax laws and for accurately reporting health coverage and tax credits related to that coverage.

Dos and Don'ts

When filling out the IRS 1095-A form, it's important to ensure accuracy and completeness. Here are some guidelines to help you through the process:

Do verify that all personal information is correct, including names and Social Security numbers.
Do use the information provided in your Health Insurance Marketplace statement.
Do check the coverage months to ensure they align with your insurance period.
Do keep a copy of the completed form for your records.
Don't leave any fields blank unless instructed to do so.
Don't forget to report any changes in your coverage status during the year.
Don't submit the form without reviewing it for errors.

Following these tips can help make the process smoother and ensure you meet your tax obligations accurately.

Key takeaways

The IRS 1095-A form is an important document for individuals who have health insurance coverage through the Health Insurance Marketplace. Here are some key takeaways to consider when filling out and using this form:

The 1095-A provides information about your health coverage, including the months you were covered and the premiums paid.
It is essential to receive your 1095-A form before filing your federal tax return, as it is needed to complete Form 8962 for premium tax credits.
Ensure that all information on the form is accurate, including names, Social Security numbers, and coverage details, to avoid delays in processing your tax return.
If you find any errors on the 1095-A, contact the Health Insurance Marketplace to request a corrected form.
Keep a copy of the 1095-A for your records, as it may be needed for future reference or audits.
Understanding how to use the 1095-A can help you accurately report your health coverage and potentially qualify for tax credits, which can lower your tax liability.

How to Use 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 provides important information regarding your health insurance coverage, which will be necessary for completing your tax return. Follow these steps to fill out the form correctly.

Begin with your personal information. Enter your name, Social Security number, and address in the designated sections.
Locate the section that details the coverage. This part usually includes information about the insurance provider and the policy number.
Fill in the coverage start and end dates. Make sure to check your records for the exact dates.
Review the premium amounts. You should find this information on your insurance statements or online account.
Check the box for any special circumstances that apply to your coverage, such as if you were enrolled in a qualified health plan.
Double-check all entries for accuracy. Any errors could delay your tax return processing.
Sign and date the form as required. Ensure that you have filled out all necessary sections before submitting.

Once you have completed the form, keep a copy for your records. You will need this information when filing your taxes. Make sure to submit the form along with your tax return to the IRS by the deadline.