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What are the tax forms used to report health insurance coverage?
There are three different forms that are used by exchanges, employers, and health insurance companies, to report health insurance coverage to the IRS. And there are two health insurance-related forms that some tax filers need to complete when they file their return.
Does everyone have to file a tax form to show whether they had health insurance?
Most Americans don’t have to do anything on their tax returns pertaining to health insurance. (For 2014 through 2018 tax years, most people were able to simply check the box for “full-year health care coverage” on their tax return and carry on. That box is no longer part of the federal tax return, as there’s no longer a federal penalty for being uninsured, although it is part of the state tax return in California, New Jersey, Rhode Island, Massachusetts, and DC.)
Here’s an overview of the new forms that Americans have been receiving since early 2015:
Health Insurance Tax Forms |
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|---|---|---|---|
| Tax form | What is it? | Who needs it / uses it? | How to get the form |
| 1095-A | For each month of the year, Form 1095-A shows how much your Marketplace health plan cost and how much the benchmark plan cost. If a subsidy was paid on your behalf, the form will show the subsidy amount that was paid for each month, along with the after-subsidy premium that the enrollee paid. | You and the IRS will receive Form 1095-A if you had health coverage through the Marketplace. This form is essential for preparing your tax return if you received a premium subsidy or if you paid full price for coverage through the exchange and want to claim the premium subsidy on your tax return. | Your 1095-A should be available online through your Marketplace account in January, and the exchange should also send it to you by early-mid February (by email, regular mail, or both, depending on the preference you indicated when you enrolled). |
| 1095-B | Form 1095-B shows the entity that offered the coverage, who was covered, and which months of the year they had coverage. | You and the IRS may receive Form 1095-B if you purchased coverage outside the exchange, were covered by a small employer, or had Medicaid coverage. But not all entities send this form anymore, as there’s no longer a federal penalty for not having health coverage. | This form can be mailed to the IRS and to the insured member by health insurance carriers, government-sponsored plans such as Medicaid, CHIP, and Medicare, and self-insured small employers. But you may have to request Form 1095-B, as it may not be sent to you automatically the way it was in the past. |
| 1095-C | Form 1095-C shows whether the employer offered affordable, comprehensive coverage, and whether the employee accepted or declined that coverage. (Subsidies for Marketplace coverage generally cannot be claimed by someone who was offered affordable, comprehensive coverage from an employer.) | You and the IRS will receive Form 1095-C if you work for a large employer (50+ employees). This form indicates whether the employee was offered affordable, comprehensive employer-sponsored health coverage, and whether they enrolled in it or declined it. | If you work full time and your employer has 50 or more employees, you will receive a Form 1095-C from the employer. If you were enrolled in your employer’s plan or opted to be uninsured, Form 1095-C is generally not necessary when you’re filing your taxes. |
| 8962 | Form 8962 must be attached to your federal tax return in order to reconcile your premium subsidy if one was paid on your behalf during the year for marketplace coverage. It’s also used if you paid full price for marketplace coverage and want to claim the subsidy on your tax return. | People who had subsidized coverage through the Marketplace, as well as people who paid full price for a Marketplace plan and want to claim the subsidy on their tax return. | The IRS website. (Tax preparation software will automatically generate this form if you indicate that you had Marketplace coverage and a subsidy was paid on your behalf, or you or want to claim a subsidy.) |
| 8965 | Form 8965 was used to claim exemptions from the individual mandate penalty from 2014 through 2018. It’s no longer used for current tax years. | For people who didn’t have minimum essential coverage at some point between 2014 and 2018, Form 8965 was used to claim exemptions from the individual mandate penalty, if applicable. | The IRS website |
What is Form 1095-A?
Form 1095-A is your proof that you had health insurance coverage during the year, and it’s also used to reconcile your premium subsidy on your tax return, using Form 8962 (details below).
This form includes information about:
- the cost of your plan,
- the cost of the second-lowest-cost Silver plan (benchmark plan) in your area,
- any premium subsidy (premium tax credit) that was paid on your behalf during the year,
- the months you had coverage, and
- which household members had coverage under the plan.
Form 1095-A is essential for preparing your tax return if you received a premium subsidy or if you paid full price for coverage through the exchange and want to claim the premium subsidy on your tax return. If you got your coverage through the exchange, you shouldn’t file your federal tax return until you receive your Form 1095-A.
How do I get my Form 1095-A?
Form 1095-A is sent to the IRS and to the policyholder by the health insurance exchanges (HealthCare.gov or a state-based exchange, depending on the state).
Your 1095-A should be available online through your exchange/marketplace account in January, and the exchange should also send it to you by early-mid February (by email, regular mail, or both, depending on the preference you indicated when you enrolled). If delivery of your 1095-A is delayed or the information on it is incorrect, you can contact your exchange.
What can I do if my Form 1095-A has an error?
If you receive Form 1095-A and it has an error, you can contact the marketplace to ask it to issue a corrected form. You might see an error if, for example, you switched plans mid-year, only had marketplace coverage for part of the year, or adjusted your subsidy amount mid-year.
If you’re in a state that uses HealthCare.gov and you paid full-price for your marketplace plan during the year (ie, no subsidy was paid on your behalf during the year), you might find that all of the entries for the cost of the second-lowest-cost Silver plan are listed as $0, even though that’s obviously not correct.
If your 1095-A shows all zeros in that column, you can use this tool to find out what the second-lowest-cost Silver plan actually cost. (It’s recommended that you print it out and keep it with your 1095-A, in case you need it again in the future). Then you can use that information to fill out Form 8962 and claim any premium tax credit that you’re owed, if applicable.
What is Form 1095-B?
Form 1095-B essentially just shows who was covered, and which months of the year they had coverage. Form 1095-B is issued by health insurance companies (for plans that aren’t on-exchange individual/family coverage) and other entities such as state Medicaid agencies. If you buy your own coverage outside the exchange, you’ll receive Form 1095-B instead of Form 1095-A.
Premium subsidies aren’t available for plans that send a 1095-B. And there’s no longer a penalty for being without health insurance (unless you’re in a state that has its own individual mandate penalty) so having proof of coverage isn’t as important as it was prior to 2019. Some states still impose a penalty for being uninsured, but unless you’re in one of those states, Form 1095-B is no longer necessary.
Some entities that used to send Form 1095-B — such as some states’ Medicaid agencies — are no longer sending this form (see IRS regulations about this). This is because people in most states no longer need to prove that they had coverage during the year, and there is no longer a box on the federal tax return asking whether the tax filer had health insurance.
How do I get Form 1095-B?
This form is mailed to the IRS and to the insured member by health insurance carriers, government-sponsored plans such as Medicare, Medicaid, and CHIP, and self-insured small employers. But you may have to request Form 1095-B if you want it, as it may not be sent to you automatically the way it was in the past.
What is Form 1095-C?
Form 1095-C is sent out by large employers who are required to offer health insurance coverage as a provision of the ACA. This applies to employers with 50 or more full-time equivalent employees (ie, Applicable Large Employers). Form 1095-C is sent to the IRS and to full-time employees (30+ hours per week). It’s provided to all employees who were eligible to enroll in the employer’s plan, regardless of whether the employee actually enrolled in the plan or not.
If you were enrolled in your employer’s plan or opted to be uninsured, Form 1095-C is generally not necessary when you’re filing your taxes. (As is the case for Form 1095-B, you may need proof of health insurance coverage if you’re in a state that imposes a penalty for being uninsured; Form 1095-C will serve as that proof.)
Which Form 1095 will you receive?
Most people will only receive one of those three forms. But there are some circumstances where you might receive more than one.
For example, if you work for a large company and have access to coverage from your employer, but you opted to buy coverage in the exchange instead, you’d receive Forms 1095-A and 1095-C. The 1095-C would indicate that you were offered employer-sponsored coverage, even though you declined it.
(Note that if you rejected an employer’s offer of coverage and enrolled in a marketplace plan instead, marketplace subsidies are not available if the employer’s plan was considered affordable and would have provided minimum value. If you receive both a 1095-A and a 1095-C for the same months of the year, you’ll want to consult with a CPA to make sure that your premium tax credit is correctly reconciled.)
And if you switched from an individual plan to a plan offered by a large employer mid-year, you’ll end up with a form from each of them. Whatever forms you receive are also received by the IRS, so everyone is on the same page.
Forms 1095-A, B, and C may be delivered electronically or on paper, depending on whether you opted for electronic delivery. You’ll use the information on the form to complete your tax return, but you keep it with your records (don’t attach it to your tax return.)
Will I receive a Form 1095 if I had SHOP coverage?
If you had health insurance sponsored by a small business and obtained through a SHOP exchange, you will not receive any Form 1095 from the exchange (in most states, the exchange no longer facilitates small group enrollment, but there are some states that do; even in those states, the exchange does not send any Form 1095 for small group enrollees).
But you may receive a Form 1095-B from the insurance company that provided your employer’s plan. And if your employer has 50 or more employees, you will receive a Form 1095-C from the employer. As described above, neither of these forms is necessary when you’re filing your federal tax return. And unless you’re in a state that imposes an individual mandate penalty, you don’t need to address health insurance on your state tax return either.
When will my Form 1095 arrive?
For 2016 coverage and beyond, the deadline for exchanges, health insurers, and employers to send out the forms is January 31 of the following year. But the IRS consistently granted a deadline extension for the distribution of Form 1095-B and 1095-C and finalized a permanent 30-day extension in late 2022. So Forms 1095-B and 1095-C have to be distributed to enrollees by March 2, or by March 1 in a leap year (they must be filed with the IRS by February 28, or by March 31 if filing electronically).
Forms 1095-A (from the exchanges) for 2022 coverage still had to be sent to enrollees by January 31, 2023. They sometimes take a while to arrive, so it may have been February before you received yours; as noted above, you can log into your exchange account online and see your 1095-A if you didn’t receive it in the mail or have misplaced it.
So depending on where you got your health insurance in 2022, your form may arrive in January, February, or March. If you don’t get your form in a timely manner, you can contact the exchange, your health insurance carrier, or your employer, depending on who should be sending you a form.
What is Form 8962?
If you received a premium subsidy from the exchange – or if you paid full price through the exchange but are eligible to claim the subsidy on your tax return – you have to complete Form 8962 with your tax return.
If you received a subsidy and fail to complete Form 8962, you won’t be able to continue receiving a subsidy going forward, so this form is essential for the millions of people who are receiving premium subsidies in the exchange. (Note that this rule was suspended during the COVID pandemic, and HHS has proposed a rule change for 2024 and future years that would result in loss of the subsidy only if the person fails to reconcile prior subsidies for two consecutive years).
And if you paid full price for a marketplace plan during the year and are eligible for the premium tax credit (or if you received some premium tax credit but are eligible for more), you’ll use Form 8962 to claim your premium tax credit. The information on Form 1095-A is used to complete Form 8962.
What is Form 8965?
For people who didn’t have minimum essential coverage at any point between 2014 and 2018, Form 8965 was used to claim exemptions from the individual mandate penalty, if applicable. Exemptions granted by the IRS are no longer necessary (as there’s no longer a federal penalty for being uninsured), so this form is no longer needed for current tax returns.
But some states have their own individual mandates now, and residents can access state tax forms for claiming exemptions. The health insurance exchanges can also still provide exemptions from the individual mandate, which are necessary in order to enroll in a catastrophic health plan if you’re 30 or older (note that the exchanges use their own form for this; it’s not a tax form).
If you have specific questions about your situation, consult a tax advisor or the Volunteer Income Tax Assistance Program.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
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