IRS 1095-A PDF Template

The IRS 1095-A form is a document that provides information about health insurance coverage obtained through the Health Insurance Marketplace. It is essential for taxpayers who need to report their health coverage when filing their taxes. Completing this form accurately is important for ensuring compliance and receiving any potential tax credits.

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Article Guide

The IRS 1095-A form plays a crucial role in the health insurance landscape, particularly for those who have purchased coverage through the Health Insurance Marketplace. This form provides essential information about your health insurance plan, including details such as the months you were covered, the premiums you paid, and any premium tax credits you may have received. Understanding the 1095-A is vital for accurately completing your tax return, as it helps determine your eligibility for these credits and ensures compliance with the Affordable Care Act. Moreover, it serves as a record of your insurance coverage, which can be important for both tax purposes and personal documentation. Each year, individuals and families must carefully review this form to confirm that all information is correct, as discrepancies can lead to delays in processing tax returns or potential penalties. Overall, the 1095-A is an important document that supports taxpayers in navigating their health insurance responsibilities and benefits.

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		Recipient Information

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		Covered Individuals

		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		Coverage Information

		Month	A. Monthly enrollment premiums		B. Monthly second lowest cost silver				C. Monthly advance payment of
		Month			plan (SLCSP) premium				premium tax credit
					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.

↓ IRS 1095-A

File Properties

Fact Name	Description
Purpose	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 enrolled in a health plan through the Marketplace receive the 1095-A form.
Filing Requirement	Taxpayers must include information from the 1095-A when filing their federal income tax returns.
Information Included	The form includes details about the covered individuals, the months of coverage, and the premium amounts.
State-Specific Forms	Some states, like California and Massachusetts, have their own versions of the 1095 form, governed by state laws such as the California Health and Safety Code.
Premium Tax Credit	The 1095-A form is essential for determining eligibility for the Premium Tax Credit, which helps lower the cost of health insurance premiums.
Corrections	If errors are found on the 1095-A, individuals should contact the Marketplace to obtain a corrected form.
Deadline	The IRS requires that the 1095-A form be sent to recipients by January 31 of the year following the tax year.
Impact on Taxes	Failure to report information from the 1095-A may result in penalties or delays in processing tax returns.

Instructions on Utilizing IRS 1095-A

After obtaining your IRS 1095-A form, you will need to carefully fill it out to ensure accurate reporting. This form is essential for your tax return, and completing it correctly is important for your financial well-being. Follow these steps to fill out the form accurately.

Begin by locating your personal information at the top of the form. Enter your name, address, and Social Security number as prompted.
Next, find the section that identifies the coverage you had during the year. Fill in the details for each month you were covered under a health plan.
Review the column that shows the premium amounts. Make sure to enter the correct amounts for each month you were enrolled in the plan.
Look for the section that lists the number of individuals covered under your plan. Provide the names and Social Security numbers of all covered individuals.
If applicable, check for any additional information that may be required regarding your specific health coverage. Fill in any necessary details as prompted.
Double-check all the information you have entered for accuracy. Ensure that names, numbers, and amounts are correct.
Once you are confident that all information is accurate, sign and date the form as required.

After completing the form, keep a copy for your records. This will be useful when filing your taxes. You will need to submit the form along with your tax return to the IRS.

Important Facts about IRS 1095-A

What is the IRS 1095-A form?

The IRS 1095-A form, also known as the Health Insurance Marketplace Statement, is a document that provides information about health coverage obtained through the Health Insurance Marketplace. It includes details such as the coverage period, the individuals covered, and the premium amounts. This form is essential for individuals who enrolled in a health plan through the Marketplace, as it is used to complete tax returns and determine eligibility for premium tax credits.

Who receives the IRS 1095-A form?

Individuals who purchased health insurance through the Health Insurance Marketplace will receive the IRS 1095-A form. The form is sent to all policyholders, including those who may have had coverage for only part of the year. It is typically mailed out by the Marketplace by the end of January each year, allowing taxpayers to use the information when filing their taxes.

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

When filing your taxes, the information on the IRS 1095-A form is used to complete Form 8962, Premium Tax Credit. This form helps determine if you are eligible for a premium tax credit based on your income and the size of your household. It is important to ensure that the information on the 1095-A matches your records, as discrepancies can lead to delays or issues with your tax return.

What should I do if I notice an error on my IRS 1095-A form?

If you find an error on your IRS 1095-A form, such as incorrect coverage dates or premium amounts, it is crucial to contact the Health Insurance Marketplace as soon as possible. They can provide a corrected form, which you will need to use when filing your taxes. Prompt action is important to avoid complications with your tax return and potential penalties.

Common mistakes

Filling out the IRS 1095-A form can be a straightforward process, but many individuals make common mistakes that can lead to delays or complications in their tax filings. One frequent error is providing incorrect personal information. This includes misspellings of names, wrong Social Security numbers, or incorrect addresses. Such inaccuracies can cause confusion and may result in the IRS rejecting the form.

Another mistake involves the failure to accurately report the coverage details. The 1095-A form requires information about health insurance coverage, including the months of coverage and the premium amounts. Omitting any of these details or entering incorrect figures can lead to issues when reconciling premium tax credits.

Many people also overlook the importance of checking the Marketplace Identifier. This identifier is crucial as it links the form to the specific health insurance Marketplace. If the identifier is incorrect or missing, it can complicate the process of verifying coverage, leading to potential issues with tax credits.

Additionally, some individuals neglect to double-check the amounts listed in Part III of the form. This section details the monthly premium amounts and any advance premium tax credits received. Errors in these amounts can result in discrepancies when filing taxes, possibly leading to underpayment or overpayment of taxes owed.

Another common mistake is misunderstanding the reporting requirements for dependents. Individuals may fail to list all eligible dependents or mistakenly include individuals who do not qualify. This can impact the overall tax calculation and eligibility for credits.

Lastly, people often forget to keep a copy of the completed 1095-A form for their records. Retaining this document is essential, as it serves as proof of health coverage and is necessary for future reference. Without a copy, individuals may struggle to provide the necessary information if the IRS requests it later.

Documents used along the form

The IRS 1095-A form is essential for individuals who enrolled in a health insurance plan through the Health Insurance Marketplace. This form provides crucial information about your coverage, which is necessary for filing your federal tax return. However, several other documents may also be required to ensure a complete and accurate filing. Below is a list of forms and documents that are commonly used alongside the IRS 1095-A form.

IRS Form 1040: This is the standard individual income tax return form used to report your annual income and calculate your tax liability. It is the primary document needed for filing taxes.
IRS Form 8962: This form is used to calculate the Premium Tax Credit. It helps determine the amount of credit you can claim based on your income and the information provided in the 1095-A form.
IRS Form 1095-B: This form provides information about health coverage provided by insurers or employers. It is used to verify that you had health insurance coverage throughout the year.
IRS Form 1095-C: This document is issued by applicable large employers. It details the health insurance coverage offered to employees and is important for those who may have received coverage through their employer.
Health Insurance Marketplace Enrollment Confirmation: This document confirms your enrollment in a health plan through the Marketplace. It contains details about your coverage period and plan type.
Income Documentation: This includes pay stubs, W-2 forms, or 1099 forms that report your income. This information is necessary for calculating your eligibility for tax credits and subsidies.

Collecting these documents will streamline the tax filing process and ensure compliance with IRS requirements. Each form serves a unique purpose, contributing to a comprehensive understanding of your health coverage and tax obligations. Being prepared with the right paperwork can help avoid delays and complications when filing your taxes.

Similar forms

The IRS 1095-A form is an important document for those who receive health insurance through the Health Insurance Marketplace. It provides information about your coverage, which is necessary for tax filing. Here are seven documents that are similar to the 1095-A form, each serving a specific purpose in relation to health insurance and tax reporting:

IRS 1095-B: This form provides information about minimum essential coverage. It is issued by health insurance providers to show that you had health insurance for the year.
IRS 1095-C: Employers with 50 or more full-time employees use this form. It details the health insurance coverage offered to employees and whether it meets the Affordable Care Act's requirements.
Form 8962: This form is used to calculate the Premium Tax Credit. It relies on information from the 1095-A form to determine eligibility for the credit.
Form 1040: This is the standard individual income tax return form. It requires information from the 1095-A and other health insurance forms to report health coverage on your tax return.
Form 1099-H: This form is used for health coverage tax credit. It provides information about the amount of premium assistance you received for qualified health insurance.
Form 8885: This form is for the Health Coverage Tax Credit. It helps you claim the credit for certain individuals who qualify based on their employment status.
Form 8965: This form is used to claim a health coverage exemption. It helps you report that you qualify for an exemption from the Affordable Care Act’s individual mandate.

Dos and Don'ts

When filling out the IRS 1095-A form, it's important to get it right. Here’s a simple list of things to do and things to avoid.

Do double-check your personal information for accuracy.
Do ensure that you include all months of coverage.
Do keep a copy of the form for your records.
Do use the instructions provided by the IRS for guidance.
Do reach out to your health insurance provider if you have questions.

Don't leave any sections blank; fill out everything that applies.
Don't forget to report any changes in your coverage.
Don't submit the form late; be mindful of deadlines.
Don't rely solely on memory; refer to documents for accurate details.
Don't hesitate to ask for help if you're unsure about something.

Misconceptions

The IRS 1095-A form can be confusing for many. Here are four common misconceptions about this form, along with clarifications.

Misconception 1: The 1095-A is only for people who received health coverage through the Marketplace.

This is not entirely accurate. While the 1095-A is primarily issued to those who enrolled in a health plan through the Health Insurance Marketplace, it can also be relevant for individuals who might have had a change in their coverage status or are claiming premium tax credits.

Misconception 2: You don’t need the 1095-A if you didn’t receive any premium tax credits.

Even if you did not receive premium tax credits, you may still need the 1095-A to report your health coverage on your tax return. It serves as proof of your insurance status.

Misconception 3: The information on the 1095-A is always correct.

It’s essential to verify the information on your 1095-A. Mistakes can happen, and if you find any discrepancies, you should contact the Marketplace for corrections.

Misconception 4: You can file your taxes without the 1095-A.

Filing your taxes without the 1095-A can lead to delays or issues with your return. It is advisable to wait until you receive the form before filing, as it contains critical information needed for accurate reporting.

Key takeaways

The IRS 1095-A form is an important document for individuals who have purchased health insurance through the Health Insurance Marketplace. Here are some key takeaways to consider when filling out and using this form:

Purpose of the Form: The 1095-A form provides information about your health coverage, including the months you were covered and the amount of premium tax credits you received.
Required for Tax Filing: You must include the information from your 1095-A when filing your federal income tax return, especially if you received premium tax credits.
Accuracy is Crucial: Ensure that all information on the form is accurate. Any discrepancies can lead to delays in processing your tax return or issues with your tax credits.
Obtain from Marketplace: If you do not receive your 1095-A form by mid-February, contact the Health Insurance Marketplace to request a copy. It is essential to have this form before filing your taxes.