Alyssa Lane
There are several tax forms related to medical insurance in the United States. Form 1095 is a Health Insurance Marketplace Statement that provides information about an individual's health care coverage. There are three types of Form 1095: Form 1095-A, Form 1095-B, and Form 1095-C. Form 1095-A is used to reconcile Advance Premium Tax Credits (APTC) and to claim Premium Tax Credits (PTC) on federal tax returns. Form 1095-B provides information about health coverage for those enrolled in Medicaid, Child Health Plus, or Essential Plans. Form 1095-C is sent by certain employers to provide information about the health coverage they offer. Additionally, Form 8962, Premium Tax Credit (PTC), is used to reconcile advance payments of the premium tax credit and must be attached to the tax return for tax years other than 2020.
| Characteristics | Values |
|---|---|
| Form name | 1095-A |
| Other names | Health Insurance Marketplace Statement |
| Use case | Used to reconcile Advance Premium Tax Credits (APTC) and to claim Premium Tax Credits (PTC) on federal tax returns |
| Who should file | Individuals who enroll in a qualified health plan through the Health Insurance Marketplace |
| When to file | No later than mid-February of the following year |
| Where to file | The form will be mailed to the individual and may also be available in the individual's Marketplace account |
| Notes | - Form 1095-A should be received before filing taxes. |
| - Form 1095-A must be filed along with Form 8962, Premium Tax Credit (PTC) | |
| - Form 1095-B is sent by health insurance providers to individuals they cover, with information about who was covered and when | |
| - Form 1095-C is sent by certain employers to employees, providing information about the coverage offered |
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What You'll Learn
Form 1095-A: Health Insurance Marketplace Statement
Form 1095-A, also known as the Health Insurance Marketplace Statement, is a form that taxpayers who are eligible for the premium tax credit should receive. This form is important for those who have purchased health insurance through a Health Care Exchange or Marketplace, as it provides information about their insurance policy, including the amount of coverage and the names of people covered by the policy. It also includes details about the cost of insurance, known as premiums, and any advance payment of premium tax credit received. This form is necessary for completing income tax filings, adjusting tax credit payments, and claiming or repaying any tax credit overpayment.
The Health Insurance Marketplace is responsible for sending Form 1095-A to eligible individuals who had a Marketplace plan in the previous year. It is typically mailed out by mid-February and may also be accessible through an individual's Marketplace account as early as mid-January. It is important to review and ensure the accuracy of the information on Form 1095-A, including coverage details and household information. Any discrepancies should be addressed by contacting the Marketplace Call Center.
Form 1095-A plays a crucial role in tax filings. It helps individuals reconcile their premium tax credit, which can impact their tax refund or liability. This reconciliation is done by completing IRS Form 8962, where individuals compare the advance amount they used with the amount they qualify for based on their final income. If an individual used too much credit, they will need to repay it through taxes, while any underutilized credit can be claimed as a refund.
It is important to note that individuals may receive more than one Form 1095-A if their household members were not all enrolled in the same health plan or if there were changes in family composition or residence during the year. In such cases, each form will correspond to the coverage for different months, and individuals will need to enter the information for the appropriate month on Form 8962. Additionally, Form 1095-A may be corrected or voided, requiring individuals to amend their tax returns accordingly.
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Form 1095-B: For Medicaid, Child Health Plus, or Essential Plan
Form 1095-B is a form that provides information to verify coverage provided by Medicaid, Child Health Plus, or the Essential Plan (EP). Consumers enrolled in these health plans may request a copy of Form 1095-B from the NYS Department of Health. This includes individuals whose coverage is through Local Departments of Social Services (LDSS), Human Resources Administration (HRA), or NY State of Health.
For Medicaid, a separate form will be available for each consumer, even if multiple children are on the same Child Health Plus policy. These forms are only provided upon request and are not automatically mailed out. To obtain a copy of Form 1095-B, consumers can contact the NY State of Health via phone, email, or mail. The phone number provided is 1-800-541-2831, and the mailing address is NY State of Health, P.O. Box 11774, Albany, NY 12211.
Health plans send Form 1095-B to consumers who were enrolled in Catastrophic plans, purchased their plan directly from the insurer, or had coverage through the Small Business Marketplace. It is important to note that Form 1095-B is not required to be attached to your federal income tax return. However, it is essential for verifying coverage information.
If consumers believe that the information on their Form 1095-B is incorrect, they can call NY State of Health at 1-855-766-7860 for assistance. It is important to ensure that the information on the form is accurate and up-to-date.
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Form 8962: Premium Tax Credit
The PTC provides financial assistance to pay the premiums for the qualified health plan offered through the Marketplace by reducing the amount of tax you owe, giving you a refund, or increasing your refund amount. To be eligible for the PTC, your income must fall between 100% and 400% of the federal poverty line, and you must meet certain other requirements, such as not filing a tax return using the status of "Married Filing Separately" (with some exceptions).
If you or a family member enrolled in health insurance coverage through the Marketplace for the tax year, you should have received Form 1095-A, Health Insurance Marketplace Statement. This form shows the months of coverage purchased through the Marketplace and any Advance Payments of the Premium Tax Credit (APTC) paid to your insurance company to help cover your monthly premium. If you received APTC, you must file Form 8962 to reconcile this APTC with your PTC. Even if you did not receive APTC, you must still file Form 8962 if you wish to take the PTC.
Form 8962 should be attached to your Form 1040, 1040-SR, or 1040-NR tax return and filed with your federal income tax return. You can e-file Form 8962, which offers a faster and more seamless filing experience. Most modern tax software programs are equipped to handle the complexities of Form 8962 and will guide you through the process.
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Form 1095-C: For certain employees
Form 1095-C, titled Employer-Provided Health Insurance Offer and Coverage, is a statement of health coverage offered to eligible employees. Applicable Large Employers (ALEs) are required to file Form 1095-C. According to the law, a company or organization is an ALE if it has at least 50 full-time workers or full-time equivalents. A full-time worker is defined as someone who works at least 30 hours a week. A full-time equivalent, on the other hand, is two or more part-time employees whose total working hours equal a full-time workload. For instance, two employees working 15 hours a week each would constitute one full-time equivalent (15 x 2 = 30 = 1 FTE).
Every employee of an ALE who is eligible for insurance coverage should receive a 1095-C. Eligible employees who choose not to participate in their employer's health plan will still receive a 1095-C. If an ALE does not offer insurance to its employees, the 1095-C will indicate this, and the employer may be subject to financial penalties. Form 1095-C identifies the employee and employer, the months the employee was eligible for coverage, and the cost of the cheapest monthly premium under the plan.
Form 1095-C is used by ALEs to verify employer-sponsored health coverage and to administer the shared employer responsibility provisions of section 4980H. When sending Form 1095-C to the IRS, employers should also submit Form 1094-C, titled "Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Return". Form 1094-C provides an IRS summary of the 1095-C forms, allowing the IRS to determine whether the business owes payment and if employees are eligible for the premium tax credit.
Form 1095-C has been mandatory since the 2015 tax year. Employers must send the forms to their eligible employees and the IRS. Employees should receive the forms by the end of January, and employers have until the end of February or March to send them to the IRS, depending on whether they are filing paper forms or electronically.
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$26.77
Advance Premium Tax Credits (APTC)
When filing federal taxes at the end of the year, the IRS will compare the amount of APTC received with the income reported. If an individual received too much APTC, they may have to repay a portion of it. On the other hand, if they did not receive the full amount of APTC, they will receive the remaining amount of the premium tax credits when filing federal taxes.
To reconcile Advance Premium Tax Credits, individuals use Form 1095-A, also known as the Health Insurance Marketplace Statement. This form is typically received by mail or can be accessed through one's Marketplace account. It is important to ensure that the information on Form 1095-A is accurate, especially regarding coverage and household details. Any discrepancies should be addressed with the Marketplace Call Center.
Additionally, Form 8962 is used in conjunction with Form 1095-A to determine if the correct amount of premium tax credit was used during the year. Form 8962 allows individuals to compare the advance amount they used with the amount they qualify for based on their final income. If an individual used too much credit, they will repay the excess through taxes. Conversely, if they used too little, they can claim the difference as a credit.
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Frequently asked questions
Form 1095 is the tax form for medical insurance. There are three variations: Form 1095-A, Form 1095-B, and Form 1095-C.
Form 1095-A, Health Insurance Marketplace Statement, is used to reconcile Advance Premium Tax Credits (APTC) and to claim Premium Tax Credits (PTC) on your federal tax returns.
Form 1095-B provides important tax information about your health coverage. It is available by request for consumers who were enrolled in Medicaid, Child Health Plus, or EP during the past year.
