q. what are the tax forms associated with health insurance and where do I get them?
a. There are three different forms used by exchanges, employers, and health insurance companies to report health insurance coverage to the IRS. and there are two forms related to health insurance that some taxpayers must complete when they file their return.
If you have specific questions about your situation, consult a tax advisor or the Voluntary Income Tax Assistance Program. Here’s an overview of the new forms Americans have been receiving since early 2015:
Form 1095-a is sent by health insurance exchanges (healthcare.gov or a state exchange, depending on the state). This form is mailed to the IRS and the policyholder.
includes information about the cost of your plan, the cost of the second lowest cost silver plan (benchmark plan) in your area, any premium subsidies paid on your behalf during the year, the months you had coverage, and which household members were covered under the plan. Form 1095-A is your proof that you had health insurance coverage for the year, and is also used to reconcile your premium subsidy on your tax return using Form 8962 (details below).
Form 1095-a is essential for preparing your tax return if you received a premium subsidy or 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 should not file your taxes until you receive your Form 1095-A. Your 1095-A should be available online in January, and the exchange should also send it to you in early or mid-February (via email, mail, or both, depending on the preference you indicated when you signed up). If the delivery of your 1095-a is delayed or the information on it is incorrect, you can contact your exchange.
(for tax year 2020, due to covid-19, the rules were different. people who received excess premium tax credits in 2020 didn’t have to pay them back to the irs, and they didn’t even have to file form 8962 at everything, unless they needed to claim additional premium tax credits, but that was only for 2020, and normal rules are back in place for 2021 and future years).
form 1095-b is submitted by health insurance companies, government-sponsored plans such as medicare, medicaid, and chip, and small self-insured employers (large employers, including self-insured, submit form 1095 – c instead). This form is mailed to the IRS and the insured member. if you purchase your own coverage outside of the exchange, you will receive form 1095-b instead of form 1095-a (you may need to request form 1095-b if you wish, as it may not be automatically sent to you the way was in the past).
Form 1095-b essentially just shows who was covered and what months of the year they were covered. premium subsidies are not available for plans that submit a 1095-b. And there’s no longer a penalty for not having health insurance (unless you’re in a state that has its own individual mandated penalty), so having proof of coverage isn’t as important as it was before 2019. States still impose a penalty for not having insurance, but unless you’re in one of those states, Form 1095-b is no longer necessary.
Some entities that used to submit Form 1095-B, such as Medicaid agencies in some states, no longer submit this form (see IRS regulations). This is because, in most states, people no longer need to show they had coverage for the year, and there is no longer a box on the federal tax return that asks if the taxpayer had health insurance.
form 1095-c is sent by large employers that 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 submitted to the IRS and to full-time employees (more than 30 hours per week). it is 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 chose not to have insurance, Form 1095-c is generally not required when you file your taxes. (Like Form 1095-b, you may need proof of health insurance coverage if you’re in a state that imposes a penalty for not having insurance; Form 1095-c will serve as proof.)
what form will you receive?
Most people will only receive one of those three forms. but there are some circumstances where you may receive more than one.
For example, if you work for a large company and have access to coverage from your employer, but chose to purchase coverage on the exchange, you will receive Forms 1095-a and 1095-c. the 1095-c would indicate that you were offered employer-sponsored coverage, even though you turned it down.
(Note that if you declined an employer’s offer of coverage and enrolled in a Marketplace plan, Marketplace subsidies will not be available if the employer’s plan was deemed affordable and would have provided minimal value. If you receive both a 1095-a and a 1095-c for the same months of the year, you’ll want to check with a CPA to make sure your premium tax credit is properly reconciled).
And if you switched from an individual plan to a plan offered by a large employer in the middle of the year, you’ll end up with a form for each. Any form you receive is also received by the IRS, so everyone is on the same page.
Forms 1095-a, b, and c can be filed electronically or on paper, depending on whether you opted for electronic filing. You will use the information from the form to complete your tax return, but you will keep it with your records (do not attach it to your tax return).
when will my 1095 form arrive?
For 2016 and later coverage, the deadline for exchanges, health insurers, and employers to submit forms is January 31 of the following year. But every year so far, the IRS has granted a deadline extension for the distribution of Forms 1095-B and 1095-C. The deadline to distribute 2021 forms has been pushed back to March 2, 2022, and the IRS has proposed making this extension permanent.
Forms 1095-a (from the exchanges) for 2021 coverage still had to be sent to enrollees by January 31, 2022. Sometimes they take a while to arrive, so you may have received the yours in February; As noted above, you can log in to your online exchange account and view your 1095-a if you didn’t receive it in the mail or misplaced it.
So, depending on where you got your health insurance in 2021, your form may have arrived in January, February, or March. If you don’t receive your form in a timely manner, you can contact the exchange, your health insurance company, or your employer, depending on who should send you a form.
Most Americans don’t have to do anything on their tax returns related to health insurance (for tax years 2014 through 2018, most people could simply check the “health care coverage from full year” on your tax return and continue; that box is no longer part of the federal tax return since there is no longer a federal penalty for not having insurance, although it is part of the state tax return in california, new jersey, rhode island, massachusetts and dc).
but 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 must complete Form 8962 with your tax return.
If you received a subsidy and do not complete the 8962 form, you will not be able to continue to receive a subsidy in the future, so this form is essential for the millions of people who receive premium subsidies on the exchange. and if you paid full price for a Marketplace plan during the year and are eligible for the premium tax credit (or received any premium tax credit but are eligible for more), you’ll use Form 8962 to claim your tax credit for the cousin. Information from form 1095-a is used to complete form 8962.
For individuals who did not have minimum essential coverage at any time between 2014 and 2018, Form 8965 was used to claim individual mandated penalty exemptions, if applicable. IRS-granted exemptions are no longer required (since there is no longer a federal penalty for not having insurance), so this form is no longer required for current tax returns. but some states have their own individual mandates now, and residents can access state tax forms to claim exemptions. health insurance exchanges may also provide exemptions from the individual mandate, which are required to enroll in a catastrophic health plan if you are age 30 or older (note that exchanges use their own form for this; it is not an insurance form). tax).
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 opinion pieces and educational articles on the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by the media covering health reform and by other health insurance experts.