Haris Ashley
If you had health insurance during the tax year, you may need to file a tax form to reconcile your premium tax credit. This is done using Form 8962, which requires information from Form 1095-A, the Health Insurance Marketplace Statement. This form will be sent to you by mail or may be available in your Marketplace account. It is important to note that you do not need to send Form 1095-A to the IRS, but you should wait to file your taxes until you have received it.
| Characteristics | Values |
|---|---|
| What is Form 1095-A? | Health Insurance Marketplace Statement |
| Who will receive Form 1095-A? | Anyone in a household with a Marketplace plan |
| When will they receive it? | By mail no later than mid-February |
| What to do with Form 1095-A? | Use it to complete Form 8962 to reconcile your APTC with the premium tax credit |
| Who needs to file Form 8962? | Anyone who had Marketplace coverage and used the premium tax credit to lower their monthly plan premiums |
| Who is exempt from filing Form 8962? | Those who don't qualify for a premium tax credit |
| What if you don't receive Form 1095-A? | You can file your taxes without it, but it may delay your refund and affect future advance credit payments |
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What You'll Learn
When to file
If you had Marketplace coverage and used the premium tax credit to lower your monthly plan premiums, you must file this tax form with your federal income tax return. You should receive Form 1095-A by mail no later than mid-February, and it may be available in your Marketplace account from mid-January to February 1. It is recommended that you wait to file your income tax return until you receive Form 1095-A.
If you are claiming a net premium tax credit for 2020, you must file Form 8962, Premium Tax Credit (PTC). For tax years other than 2020, if advance payments of the premium tax credit were made for your health insurance coverage, you must complete Form 8962 and attach it to your return.
If you had Marketplace coverage at any point during the year, you must file your taxes and reconcile using Form 8962 to determine if you used the correct amount of premium tax credit.
It is important to note that while health care forms can assist in preparing a return, they are not required. Individual taxpayers can file their returns using other information about their health insurance.
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What form to use
If you had health insurance through the Marketplace or a state exchange, you may need Form 1095-A, the Health Insurance Marketplace Statement, to help you fill out your taxes. This form will be sent to you by mail no later than mid-February. It may also be available in your Marketplace account from mid-January to February 1. You should wait to file your income tax return until you receive this form.
Form 1095-A provides information about your health care coverage and that of your household members. You can use the information on this form to complete Form 8962, which you must include with your tax return. Form 8962 is used to reconcile your Advance Premium Tax Credit (APTC) with the premium tax credit you are allowed or to claim the premium tax credit on your tax return. You can also use Form 8962 to check if you qualify for a premium tax credit based on your final income.
If you had Marketplace coverage but did not use the premium tax credit, you enrolled in a Marketplace plan but paid the full price. This could be because you did not qualify for a premium tax credit or did not apply for one. In this case, you do not need to include Form 8962 when you file your taxes.
If you had health coverage through your job, a retiree health plan, COBRA, or the Small Business Health Options Program (SHOP), you bought a plan outside the Marketplace, or were covered by Medicare, Medicaid, or the Children's Health Insurance Program (CHIP), you do not need Form 1095-A to file your taxes.
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Tax credits
If you had Marketplace coverage and used the premium tax credit to lower your monthly insurance premiums, you must file this tax form with your federal income tax return. The premium tax credit is a tax credit you can use to lower your monthly insurance payment (your "premium").
If you had Marketplace coverage at any point during 2024, you must file your taxes and reconcile using IRS Form 8962. This will allow you to find out if you used the right amount of premium tax credit during the year. Use Form 8962 to compare the advance amount you used to the amount you qualify for based on your final income. If you used too much, you will need to repay it via taxes. If you used too little, you can claim the difference as a credit.
If you receive Form 1095-A, Health Insurance Marketplace Statement, showing that advance payments of the premium tax credit were made for you or your family member, you must file an individual income tax return and submit Form 8962 to reconcile those advance payments. Form 1095-A should be mailed to you, but you can also usually find it in your online marketplace account. If you were due a 1095-A and didn't get it, contact the state or federal marketplace in charge of your coverage. You must have your Form 1095-A before you file your taxes.
For tax years other than 2020, if advance payments of the premium tax credit were made for your or a member of your tax family's health insurance coverage through the Health Insurance Marketplace, you must complete Form 8962, Premium Tax Credit, and attach it to your return.
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Health coverage types
Marketplace or Exchange Plans
These are individual or family plans purchased through a government-run marketplace, such as the Affordable Care Act (ACA) Marketplace. They offer a range of coverage levels, from bronze to platinum, with platinum plans having the highest premiums but also the most comprehensive coverage.
Job-Based or Employer-Sponsored Health Coverage
Around 49% of Americans get health insurance through their jobs. Employer-sponsored plans can vary, but they often provide a range of options and may include additional benefits such as dental and vision coverage.
Government Programs
Medicare and Medicaid are government-funded health insurance programs. Medicare was originally designed for people aged 65 or older but has since expanded to include disabled individuals under 65 and those with special circumstances. Medicaid, on the other hand, is based on income and other factors, and each state has its own rules for eligibility.
Short-Term Health Insurance
Short-term health insurance, also known as temporary health insurance, is ideal for filling gaps in coverage. For instance, if you're in between jobs, waiting for coverage to start, or transitioning off your parents' insurance.
Types of Health Insurance Plans
Within these broader categories, there are different types of health insurance plans, such as HMO, PPO, EPO, and POS plans. These plans differ in terms of provider networks, freedom to choose healthcare providers, paperwork requirements, and cost-sharing structures.
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What to do if you don't receive the form
If you are expecting to receive a Form 1095-A, Health Insurance Marketplace Statement, you should wait to file your income tax return until you receive that form. This form provides you with information about your health care coverage. You can expect to receive this form by mail no later than mid-February, and it may be available in your Marketplace account from mid-January to February 1.
If you had Marketplace coverage at any point during the year, you must file your taxes and reconcile using IRS Form 8962. This form allows you to find out if you used the right amount of premium tax credit during the year by comparing the advance amount used with the amount you qualify for based on your final income. You must include Form 8962 with your tax return, and you will need to resubmit your tax return if it is rejected for a missing Form 8962.
If you are still awaiting an IRS Form W-2 from your employer, you can log into your employee portal to check if your W-2 has been uploaded. Some companies may provide former employees with access to this portal as well. As a last resort, some tax software may be able to import your W-2 electronically, but you will need information such as your company's employer identification number (EIN). Filing taxes without a W-2 is possible and may be preferable to waiting for another copy, but it will slow down the processing of your return.
If you are missing other tax documents, you can learn how to order tax forms by mail or get them online.
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Frequently asked questions
Form 1095-A is a Health Insurance Marketplace Statement that provides information about your health care coverage.
You need to use Form 1095-A if you had Marketplace coverage at any point during the year and used the premium tax credit to lower your monthly plan premiums. You must also have Form 1095-A before you file your taxes.
Use the information from Form 1095-A to complete Form 8962 to reconcile your APTC with the premium tax credit you are allowed or – if you are eligible – to claim the premium tax credit on your tax return.
