Form 1095-A: Purpose, Filing Requirements, and How to Complete It

Overview of What is Form 1095-A and its Purpose

Form 1095-A: Purpose and Function

• Form 1095-A is issued by Health Insurance Marketplaces to individuals who enroll in a qualified health plan through the Marketplace.
• Its primary purpose is to report enrollment information to the IRS and to provide individuals with necessary details to claim the premium tax credit.
• It enables taxpayers to reconcile advance payments of the premium tax credit (advance credit payments) with the actual credit amount they are eligible for on their tax return.
• Marketplaces must file Form 1095-A annually by January 31 for coverage in the prior calendar year, and furnish a copy to each enrollee.
• It is required for qualified health plans in the individual market, excluding catastrophic health plans and stand-alone dental policies.
  

Who Needs to File Form 1095-A?

Who Must File

• Health Insurance Marketplaces are required to file Form 1095-A for all enrollments in qualified health plans through the Marketplace.
• Do not file Form 1095-A for catastrophic health plans or stand-alone dental policies.

Purpose of Form

• Form 1095-A reports information to the IRS about individuals enrolled in qualified health plans through the Health Insurance Marketplace.
• It enables individuals to claim the premium tax credit and reconcile advance payments of the credit on their tax returns.
• It supports accurate tax return filing by providing necessary coverage and credit information.

Filing Requirements

• File with the IRS and furnish statements to individuals on or before January 31, 2026, for coverage in calendar year 2025.
• Electronic filing is required through the Department of Health and Human Services Data Services Hub.
• Statements must be furnished to individuals by mail or electronically if consent is provided.
• Each policy requires a separate Form 1095-A, and information must relate only to that policy.
• If an error is found, correct the information promptly and check the CORRECTED box.
• If a statement was sent in error (e.g., for a non-qualifying plan), send a duplicate with the VOID box checked.

General Instructions

• Marketplaces must provide Form 1095-A to each tax filer, reporting only coverage for their tax family (including spouse and dependents if applicable).
• SSNs on forms furnished to individuals may be truncated (showing only last four digits), but full SSNs must be reported to the IRS.
• Consent must be obtained for electronic delivery, either on paper or electronically, with confirmation required if provided on paper.
• For multiple covered individuals, complete additional Forms 1095-A if more than five individuals are covered under one policy.

Key Sections Form 1095-A: Important parts of the form and what they cover

Part I—Recipient Information

• Line 1: Marketplace identifier – Enter the Marketplace state name or abbreviation.
• Line 2: Marketplace-assigned policy number – Enter the policy number assigned by the Marketplace; if over 15 characters, use only the last 15.
• Line 3: Policy issuer's name – Enter the name of the insurance company that issued the policy.
• Line 4: Recipient's name – Enter the name of the tax filer (the person expected to file the return and claim premium tax credit) or the primary applicant if the tax filer is not identified.
• Line 5: Recipient's SSN – Enter the Social Security Number of the recipient shown on line 4.
• Line 6: Recipient's date of birth – Enter only if line 5 is blank.
• Lines 7–9: Recipient's spouse's information – Include spouse’s name, SSN, and date of birth if advance credit payments were made for coverage; enter date of birth only if SSN is blank.
• Line 10: Policy start date – Enter the start date of coverage; if coverage began at the start of the year, enter 1/1/2025.
• Line 11: Policy termination date – Enter termination date if policy ended during the year; if coverage continued to year-end, enter 12/31/2025.
• Lines 12–15: Recipient's address – Enter full street address, including apartment number, city, state, ZIP code, and country if applicable.

Part II—Covered Individuals

• Lines 16 through 20 and columns A through E: Enter information for each individual covered under the policy, including the recipient and their spouse if covered.
• Column A: Identify the covered individual (name, relationship, etc.).
• Column B: Enter the individual’s Social Security Number (SSN) or Taxpayer Identification Number (TIN).
• Column C: Enter date of birth only if column B is blank.
• Column D: Enter the date coverage started for the individual.
• Column E: Enter the date coverage was terminated, or 12/31/2025 if coverage was in effect at year-end.
• Multiple individuals: If more than five covered individuals, complete additional Forms 1095-A, Part II.
• Reporting rules: If advance credit payments were made or a tax family can be identified, report only those individuals certified as part of the tax filer’s tax family. Others, including children not in the tax family, must be reported on a separate Form 1095-A.
  

Part III—Coverage Information

• Columns A–C, Lines 21–32: Enter monthly coverage information for each month of the year.
  • Column A: Monthly Premium Amount – Enter the total monthly premium for the coverage.
  • Column B: Monthly Second Lowest Cost Silver Plan (SLCSP) Premium – Enter the SLCSP premium amount for that month.
  • Column C: Monthly Advance Credit Payments – Enter the portion of advance credit payments allocated to the policy for that month.
• Line 33: Total the amounts from lines 21–32 for columns A, B, and C, and enter the sums here.

Related Schedules, Forms for Form 1095-A

• Form 1040 or 1040-SR: Taxpayers use Form 1095-A to reconcile the Premium Tax Credit (PTC) on their annual tax return filed using Form 1040 or 1040-SR. The information from Form 1095-A is used to complete Form 8962, and the resulting credit amount is reported on the tax return.
• Form 8962 – Premium Tax Credit: This form is specifically used to calculate and reconcile the advance premium tax credit. Taxpayers must complete Form 8962 using the data from Form 1095-A to determine if they received too much or too little in advance credit payments.
• Form 1095-B or 1095-C: While not directly required for Form 1095-A, these forms may be relevant if a taxpayer has coverage from multiple sources (e.g., employer-sponsored insurance or other non-Marketplace plans). However, Form 1095-A is specifically for Marketplace coverage and does not replace these forms.
• IRS.gov/Form1095A: Taxpayers should consult this official IRS resource for updates, guidance, and clarifications related to Form 1095-A, especially if there are legislative changes after the form’s publication.

Common Mistakes to Avoid on Form 1095-A

• Missing or incorrect recipient information: Ensure the Marketplace state name, policy number, and issuer name are accurately entered in Part I. Incomplete or inaccurate details can delay processing.
• Incorrectly reporting covered individuals: Only include individuals who are part of the tax filer’s tax family as certified at enrollment. Do not report non-family members enrolled in the same policy unless required.
• Incorrect premium amounts in Column A: Report the total monthly enrollment premiums allocable to essential health benefits. Adjust for premium credits and exclude refunded premiums if coverage ended mid-month.
• Failure to report coverage start and end dates: Enter accurate start and termination dates for each covered individual. If coverage was active at year-end, use 12/31/2025 as the end date.
• Not furnishing Form 1095-A by January 31: The form must be provided to individuals and filed with the IRS by January 31, 2026, for 2025 coverage. Late filing may result in penalties or processing delays.
• Electronic filing without proper consent: If providing the form electronically, ensure the recipient has given affirmative consent. Without consent, paper mailing is required.
• Truncating SSNs improperly: While truncated SSNs (last four digits only) are allowed on forms sent to individuals, full SSNs must be reported when filing with the IRS.
• Overlooking multiple policies or family members: If more than five individuals are covered, use additional Forms 1095-A. Also, ensure separate forms are filed for different tax families under the same policy.
  

Helpful Tips for Completing Form 1095-A

Best Practices for Completing Form 1095-A

• Form 1095-A, Health Insurance Marketplace Statement, is provided by the Marketplace and contains essential information about your health insurance coverage and any advance premium tax credit (PTC) payments you received.
• Use the information from Form 1095-A to complete Form 8962, Premium Tax Credit, which must be attached to your federal tax return (Form 1040, 1040-SR, or 1040-NR) to claim the PTC and reconcile advance payments.
• Report any changes in household income, family size, address, or eligibility for employer-sponsored or government health coverage (such as Medicare) to the Marketplace promptly to avoid repayment of excess advance credit payments.
• File a federal income tax return for any year you received advance credit payments to reconcile the amount of advance payments with the actual premium tax credit you are allowed.
• Do not rely on automatic re-enrollment if you do not wish to continue coverage; notify the Marketplace if you want to opt out.

Source

• For more up-to-date information visit https://www.irs.gov Government website.
• Refer to the Instructions for Form 1095-A for detailed information.