Free IRS 1095-A Template in PDF

Free IRS 1095-A Template in PDF

The IRS 1095-A form is a crucial document that provides information about health coverage obtained through the Health Insurance Marketplace. It details the months you and your dependents were enrolled in a qualified health plan and any premium tax credits you received. Understanding this form is essential for accurately filing your taxes and ensuring compliance with health coverage requirements.

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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 provides essential information about the health plans you or your family members enrolled in, including details on the coverage period, monthly premiums, and any premium tax credits received. Understanding the 1095-A is vital, as it not only helps you report your health coverage on your tax return but also ensures that you accurately reconcile any advance premium tax credits. If you received financial assistance to help pay for your health insurance, the 1095-A will detail how much assistance you received and what you need to report. Missing or incorrect information on this form can lead to complications with your tax filing, so it’s important to review it carefully. Whether you’re filing your taxes yourself or working with a tax professional, familiarity with the 1095-A can simplify the process and help you avoid potential pitfalls.

IRS 1095-A Preview

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

2025

 

Recipient Information

 

 

 

 

 

 

Part I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16

 

 

 

 

 

 

 

 

 

 

 

17

 

 

 

 

 

 

 

 

 

 

 

18

 

 

 

 

 

 

 

 

 

 

 

19

 

 

 

 

 

 

 

 

 

 

 

20

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21

January

 

 

 

 

 

 

 

 

22

February

 

 

 

 

 

 

 

 

23

March

 

 

 

 

 

 

 

 

 

24

April

 

 

 

 

 

 

 

 

 

25

May

 

 

 

 

 

 

 

 

 

26

June

 

 

 

 

 

 

 

 

 

27

July

 

 

 

 

 

 

 

 

 

28

August

 

 

 

 

 

 

 

 

 

29

September

 

 

 

 

 

 

 

 

30

October

 

 

 

 

 

 

 

 

31

November

 

 

 

 

 

 

 

 

32

December

 

 

 

 

 

 

 

 

33

Annual Totals

 

 

 

 

 

 

 

 

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 60703Q

Form 1095-A (2025) Created 6/5/25

Form 1095-A (2025)

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. If you think the information is incorrect, or if you think you should not have received a Form 1095-A because neither you nor anyone else in your family was enrolled in Marketplace health insurance, please contact your Marketplace Call Center. If you purchased insurance through the federally facilitated Marketplace, you can find your Call Center information at www.healthcare.gov/contact-us/. If you purchased insurance through a State-based Marketplace, you can find your Call Center information on your State-based Marketplace website. You can find a list of State- based Marketplace websites at www.healthcare.gov/marketplace-in- your-state/. 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 five 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. See the instructions for Form 8962, Part II, on how to complete Form 8962 if -0- is reported for 1 or more 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, the information is incorrect, or the information is reported as -0-.

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.

Document Specs

Fact Name Description
Purpose of Form The IRS 1095-A form is used to report information about health insurance coverage obtained through the Health Insurance Marketplace.
Who Receives It Individuals who enroll in a health plan through the Marketplace receive Form 1095-A from the Marketplace.
Tax Filing Requirement Taxpayers must include the information from Form 1095-A when filing their federal tax returns, especially if they are claiming premium tax credits.
State-Specific Forms Some states may have their own versions of the 1095-A, governed by state laws related to health insurance coverage, such as California's Health and Safety Code.
Deadline for Issuance The Marketplace must send out Form 1095-A by January 31st of the year following the coverage year.

Detailed Instructions for Using IRS 1095-A

The IRS 1095-A form is an important document for those who enrolled in a health insurance plan through the Health Insurance Marketplace. After filling out this form, you will use the information to complete your tax return. Follow these steps to ensure accurate completion of the form.

  1. Start with your personal information. Fill in your name, address, and Social Security number at the top of the form.
  2. Locate the section for "Coverage Information." Here, you will need to enter the details of your health insurance coverage.
  3. Identify the months you had coverage. Mark each month you were enrolled in the plan with an "X."
  4. Fill in the premium amounts for each month. This information can usually be found on your insurance documents.
  5. Provide the second lowest cost silver plan (SLCSP) premium for your area. This is necessary for determining any premium tax credits.
  6. Double-check all the information you entered for accuracy. Ensure that names, numbers, and amounts are correct.
  7. Sign and date the form if required. Some versions may not need a signature, but it’s good to confirm.

After completing the form, keep a copy for your records. You will need it when filing your taxes.

FAQ

  1. What is the IRS 1095-A form?

    The IRS 1095-A form is a document that provides information about health coverage obtained through the Health Insurance Marketplace. It includes details about the insurance plan, the months you were covered, and any premium tax credits you may qualify for. This form is essential for filing your federal tax return, as it helps determine your eligibility for premium assistance.

  2. Who receives the 1095-A form?

    Individuals and families who enrolled in a health plan through the Health Insurance Marketplace will receive the 1095-A form. The Marketplace sends this form to you and also to the IRS. If you had coverage for part of the year, you would still receive a form for the months you were covered.

  3. How do I use the 1095-A form when filing my taxes?

    When filing your federal tax return, you will need to use the information from your 1095-A form to complete IRS Form 8962, which calculates your premium tax credit. Ensure that the information on the 1095-A matches what you report on your tax return. If there are discrepancies, it may delay your tax refund.

  4. What should I do if I don’t receive my 1095-A form?

    If you do not receive your 1095-A form by mid-February, you should contact the Health Insurance Marketplace where you enrolled in your plan. They can provide a copy of your form or help resolve any issues. It is important to obtain this form, as you will need it to file your taxes accurately.

  5. Can I correct errors on my 1095-A form?

    Yes, if you find errors on your 1095-A form, you should contact the Health Insurance Marketplace to request a corrected form. Common errors might include incorrect coverage dates or premium amounts. Once you receive the corrected form, use it to file your tax return, ensuring that all information is accurate.

Common mistakes

Filling out the IRS 1095-A form can be a daunting task for many individuals. It serves as a crucial document for those who have obtained health insurance through the Health Insurance Marketplace. However, mistakes can easily occur. Here are ten common errors people make when completing this form.

One frequent mistake is failing to include all household members. When filling out the 1095-A, it’s essential to report everyone in your household who was covered under the plan. Omitting a family member can lead to incorrect tax calculations.

Another common error involves incorrect information regarding the monthly premium amounts. Each month’s premium should be accurately reported. If you miscalculate or enter the wrong figure, it can affect your eligibility for premium tax credits.

People often confuse the start and end dates of their coverage. The 1095-A requires specific dates for when coverage began and ended. Providing inaccurate dates can lead to issues with your tax return.

Many individuals neglect to check their Form 1095-A for accuracy before submission. It’s crucial to review the form thoroughly for any errors or discrepancies. A simple oversight can lead to complications during the tax filing process.

Some taxpayers forget to report changes in their coverage during the year. If you switched plans or made any adjustments, these changes need to be reflected on the 1095-A. Not doing so can result in receiving incorrect tax credits.

Another mistake is failing to keep a copy of the 1095-A for personal records. This form is essential for tax filing and future reference. Keeping a copy ensures you have the necessary documentation if questions arise later.

Many people struggle with understanding the different columns on the form. Each column has specific meanings, and misinterpreting them can lead to incorrect entries. Familiarizing yourself with what each section represents is vital.

Some individuals mistakenly think they don’t need to file the 1095-A if they didn’t receive a premium tax credit. In reality, everyone who received health coverage through the Marketplace must file this form, regardless of tax credits.

Another common oversight is not using the correct tax year’s form. The IRS updates forms annually, and using an outdated version can lead to complications. Always ensure you have the current year’s form before filling it out.

Lastly, some taxpayers fail to seek help when needed. If you’re uncertain about any part of the form, reaching out for assistance can save you from making costly mistakes. Whether it’s consulting a tax professional or using IRS resources, don’t hesitate to ask for help.

Documents used along the form

The IRS 1095-A form is essential for individuals who have health insurance through the Health Insurance Marketplace. However, it is often accompanied by other important documents that help clarify coverage and tax implications. Below is a list of forms and documents that are commonly used alongside the 1095-A.

  • IRS Form 1040: This is the standard individual income tax return form used to report your income, claim deductions, and calculate your tax liability.
  • IRS Form 8962: This form is used to calculate the Premium Tax Credit. It helps determine how much of the credit you can claim based on your income and the coverage you had.
  • IRS Form 1095-B: This form provides information about health coverage offered to you and your family. It is typically issued by insurance providers.
  • IRS Form 1095-C: Employers with 50 or more full-time employees provide this form. It details the health insurance coverage offered to employees and their dependents.
  • Health Insurance Marketplace Statement: This document provides details about the health plan you enrolled in, including coverage dates and premiums paid.
  • Proof of Income Documentation: This may include W-2 forms, pay stubs, or other income statements needed to verify your income when applying for tax credits.
  • Tax Return Documentation: Prior year tax returns may be needed to establish your income history and eligibility for credits or deductions.

Gathering these documents will ensure a smoother tax filing process and help you accurately report your health coverage. Always keep them organized and accessible for reference when preparing your tax return.

Similar forms

The IRS 1095-B form serves a similar purpose as the 1095-A, providing information about health coverage. This form is issued by health insurance providers to individuals who had minimum essential coverage during the tax year. It confirms that the individual met the Affordable Care Act's requirement for health insurance. Unlike the 1095-A, which is specifically for those enrolled in Marketplace plans, the 1095-B applies to various types of coverage, including employer-sponsored plans and government programs like Medicaid. Both forms help taxpayers report their health insurance status when filing taxes.

The IRS 1095-C form is another document that aligns closely with the 1095-A. Employers with 50 or more full-time employees must provide this form to their workers. It details the health coverage offered to employees and whether it meets the Affordable Care Act's standards. While the 1095-A focuses on Marketplace coverage, the 1095-C provides information about employer-sponsored plans. Taxpayers may need both forms to fully understand their health coverage options and obligations when filing their taxes.

The W-2 form, commonly known as the Wage and Tax Statement, also shares similarities with the 1095-A. While the W-2 primarily reports an employee's annual wages and the taxes withheld from their paycheck, it can also indicate whether health insurance was offered by the employer. For individuals receiving employer-sponsored health coverage, the W-2 can provide context for the health insurance information reported on the 1095-A. Both documents are essential for accurately reporting income and health coverage on tax returns.

The 1099 form, particularly the 1099-MISC or 1099-NEC, can be likened to the 1095-A in that it serves as a reporting tool for income received outside of traditional employment. While the 1095-A focuses on health insurance coverage, the 1099 forms report various types of income, including freelance or contract work. Taxpayers may need to use information from both the 1095-A and 1099 forms to ensure compliance with tax regulations, particularly if they are self-employed or have multiple sources of income.

Dos and Don'ts

When filling out the IRS 1095-A form, it’s important to be thorough and accurate. This form is essential for reporting health coverage through the Health Insurance Marketplace. Here’s a helpful list of things you should and shouldn’t do.

  • Do ensure that all personal information is correct, including names and Social Security numbers.
  • Do review the coverage months carefully to confirm that they match your enrollment dates.
  • Do check the premium amounts listed to ensure they reflect what you actually paid.
  • Do keep a copy of the form for your records once it’s completed.
  • Do file the form with your tax return, as it’s needed to claim premium tax credits.
  • Don’t ignore any discrepancies. If something doesn’t look right, contact the Marketplace for clarification.
  • Don’t forget to report any changes in your household that might affect your coverage.
  • Don’t leave any sections blank. Each part of the form needs to be filled out completely.
  • Don’t rush through the process. Take your time to ensure accuracy and completeness.
  • Don’t overlook the deadline for submitting your tax return, which includes this form.

By following these guidelines, you can help ensure that your form is filled out correctly, minimizing any potential issues with your tax return.

Misconceptions

The IRS 1095-A form can be confusing for many people. Here are some common misconceptions about this important document:

  • It’s only for people who received premium tax credits. Many believe the 1095-A is only relevant for those who received premium tax credits. In reality, anyone who enrolled in a health plan through the Health Insurance Marketplace receives this form, regardless of whether they received financial assistance.
  • It’s optional to file with your tax return. Some individuals think that submitting the 1095-A form with their tax return is optional. However, this form is necessary for accurately reporting health coverage and calculating any premium tax credits.
  • It only reports health coverage for one person. Many people assume the 1095-A only covers one individual. In fact, the form can include information for multiple members of a household, providing a comprehensive overview of coverage for the entire family.
  • The information on the form is always accurate. Some individuals trust that the details on the 1095-A are always correct. Mistakes can occur, so it’s essential to review the information carefully and report any discrepancies to the Health Insurance Marketplace.
  • Receiving a 1095-A means you owe taxes. There’s a misconception that receiving this form automatically means you will owe taxes. While it’s true that the form is used to reconcile any premium tax credits, it does not inherently indicate a tax liability.
  • You can’t get a 1095-A if you didn’t enroll during open enrollment. Some people believe that if they missed the open enrollment period, they won’t receive a 1095-A. However, individuals who qualify for special enrollment periods may still receive this form.
  • It is the same as the 1095-B form. There’s confusion between the 1095-A and 1095-B forms. The 1095-A is specifically for those who used the Health Insurance Marketplace, while the 1095-B is for those who had coverage through other means.
  • It can be ignored if you have employer-sponsored insurance. Some believe that if they have employer-sponsored insurance, they don’t need to worry about the 1095-A. However, if they also had Marketplace coverage at any point during the year, they must still file this form.

Understanding these misconceptions can help ensure that you handle your taxes correctly and avoid potential issues with the IRS.

Key takeaways

The IRS 1095-A form is an important document for those who have health insurance through the Health Insurance Marketplace. Here are key takeaways to keep in mind when filling it out and using it:

  • The 1095-A form provides information about your health coverage, including who was covered and for what months.
  • You will receive the form from the Marketplace, typically by early February each year.
  • Ensure that all personal details on the form, such as names and Social Security numbers, are accurate.
  • Use the information on the 1095-A to complete your federal tax return, particularly Form 8962.
  • If you received premium tax credits, you must reconcile them using the 1095-A.
  • Keep the form with your tax records for at least three years in case of an audit.
  • If you notice any errors on the 1095-A, contact the Marketplace to request corrections.
  • The form includes a “Coverage Start Date” and “Coverage End Date” for each individual, which is crucial for tax filing.
  • Filing your taxes without the 1095-A may delay your refund or result in penalties.
  • Understand that the 1095-A is not a tax return itself; it is a statement of your insurance coverage.

Free IRS 1095-A Template in PDF

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