IRS Form 1095 A – Health Insurance Marketplace Statement
What is the purpose of the Form 1095-A?
For health insurance providers, the purpose of Form 1095-A is to report certain information to the IRS about individuals who enrolled in a qualified health plan through the Health Insurance Marketplace.
For the taxpayer, the purpose of the Form 1095-A is to serve as proof of qualified health insurance coverage during the tax year through one of the Health Insurance Marketplace providers. For the taxpayer, the Form 1095-A is for informational purposes only. It does not have to be filed with your tax return. However, information from the Form 1095-A is needed to complete the Form 8962 (Premium tax Credit) if applicable.
Who needs the Form 1095-A?
Health insurance providers who provide health insurance through the Health Insurance Marketplace need Form 1095-A.
Taxpayers also need this form to serve as proof that they had healthcare coverage during the tax year. Information from the Form 1095-A is also needed to complete the Form 8962 (Premium Tax Credit), when applicable.
Is the Form 1095 A accompanied by any other forms?
For the health insurance provider, the answer is no.
For the taxpayer, if applicable, the Form 8962 (Premium Tax Credit) must also be completed. If any amount other than zero is shown in Part III of the Form 1095-A, Form 8962 must be filed.
When is the Form 1095-A due?
For the health insurance provider, the 1095 A Form is due to the IRS on or before January 31st. The health insurance provider must also furnish the statements to individuals on or before January 31st.
How is the Form 1095 A completed?
The Form 1095-A is completed by health insurance providers who offer coverage through the Health Insurance Marketplace. There are three sections to the form; Part I, Part II, and Part III.
Part I: Fill out Recipient Information including:
Box 1: Marketplace Identified Number
Box 2: Marketplace – Assigned Policy Number
Box 3: Policy Issuer’s Name
Box 4: Recipient’s Name
Box 5: Recipient’s Social Security Number
Box 6: Recipient’s Date of Birth
Box 7: Recipient’s Spouse Name
Box 8: Recipient’s Spouse Social Security Number
Box 9: Recipient’s Spouse Date of Birth
Box 10: Policy Start Date
Box 11: Policy Termination Date
Box 12: Street Address
Box 13: City or town
Box 14: State or province
Box 15: Country and zip or foreign postal code.
Part II: Provide information on the Covered Individuals
This section consists of 5 columns, columns A-E.
Column A: Name of covered individual
Column B: Social Security number of covered individual
Column C: Date of birth of covered individual
Column D: Coverage start date
Column E: Coverage termination date
Part III: This section deals with Coverage Information
In addition to the Month column, this section consists of 3 columns, columns A-C.
Column A: Monthly enrollment premiums.
Enter the total monthly enrollment premiums for the policy in which the covered individuals enrolled.
Column B: Monthly second lowest cost silver plan (SLCSP) premium.
Enter the premiums for the applicable second lowest cost silver plan (SLCSP) used as a benchmark to compute monthly advance credit payment.
Column C: Monthly advance payment of premium tax credit.
Enter the amount of advance credit payments for the month.
What is the mailing address for the Form 1095-A?
Health insurance providers must submit Form 1095 A to the IRS electronically through the Department of Health and Human Services Data Services Hub. For taxpayers, the form should be kept for your own records.
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