IRS Form 1095

IRS Form 1095 refers to a set of forms introduced by the IRS that are related to the Affordable Healthcare Act. Since the Affordable Healthcare Act’s inception, there have been three additional tax forms introduced by the IRS. These forms are 1095-A, 1095-B, and 1095-C. The forms outline what you could potentially end up paying in fees when you opt out of health insurance coverage. If someone purchased their health insurance coverage though the marketplace, the information on the IRS forms will provide details regarding whether or not you could benefit from a premium tax credit.

The Basics of Shared Responsibility Payment

If there is a gap of three months or longer where either you or any of your dependents are not covered by qualifying health care insurance, you might be required to pay an individual shared responsibility payment which is essentially a fine. If health care coverage is not offered by the company that employs you then you are a part of a specific group of people who are exempt from having to be a part of the Affordable Care Act by the IRS.

How to Know if You Need Form 1095 When Filing a Tax Return

Anyone who has health insurance coverage from their employer, some other non-marketplace entity, or a government program doesn’t need to file any 1095 form with their person tax return (even if, for some reason, they receive the 1095 form). However, anyone who has health insurance coverage run by either the state government or the federal government will have to fill out and submit Form 1095 A with their personal tax return. The type of 1095 form a person receives and has to submit will rely heavily on the kind of health insurance coverage that they had for that year.

Understanding Form 1095 A

On the IRS 1095 A form (also known as the Health Insurance Marketplace Statement) there is information regarding your federal taxes and what you need to do to file them annually. This applies to you if you have APTCs (advanced premium tax credit payments) on your insurance premium. From there, you take the information you put on the 1095 A form on the 8962 IRS form. This form compares the amount of tax credit you had used in the previous year and what you currently qualify for. Each household gets one 1095 A form if that household is enrolled in a private health care coverage plan and has multiple people enrolled on it.

The only reason why you might get several 1095 forms is if you switched your health care plan sometime during the tax year. This also applies to anyone who added a new member or removed someone on the health care plan. Any insurance company that takes part in a health insurance exchange needs to provide anyone who has their insurance with a 1095 A form.

On the 1095 A form, you must provide your name, how much coverage you have, the tax credits you receive, and whether or not you used those tax credits to cover the cost of your health insurance. Anyone who received an advanced payment of the premium tax credit (APTCs) is required by law to file form 1094 A. The purpose of filing the 1095 A form is to provide important information that is needed to reconcile the premium tax credit.

If there was any health insurance from the marketplace that was not covered with APTC, information on the 1095 A form can be used to get premium tax credits. The form 1095 A has to be sent to the recipient no later than February 1, 2016. This form can usually also be found online. If you were supposed to get form 1095 A and haven’t yet, call the federal or state marketplace that you originally got the health care coverage from.

Reasons to Form 1095 A

If you are filing a 1095 A form for the first time, there is plenty of information on the document to help you accurately report any financial assistance you might have received during the tax year and the type of health care insurance you have. If you plan to claim premium tax credits on your federal tax return (or another member of your household plans to do so), you need to provide this information on IRS Form 8962 (known as the Premium Tax Credit form). You need to keep your 1095 A form handy since you will use the information from this form to file the 8962 form. You also need to file a federal income tax return along with the 8952 form if you or anyone else in your household received advanced premium tax credits. You won’t be able to receive additional ATC or other reductions later on if you do not file this federal tax return.

What To Do If You Don’t Get A Form 1095 A

In the event that you did not receive your Form 1095 A either in your Covered California account or through the mail, you will need to fill out a dispute form or all Covered California at 800-300-1506. At this time, the dispute form is in English only. Spanish speakers or someone who speaks any other language can call 800-989-2199 to speak to someone at Covered California. Anyone who is not currently actively enrolled in Covered California won’t be able to access Form 1095 A online. To have a paper copy of this form mail to you, call Covered California at 800-989-2199. If you are enrolled in Covered California and have the catastrophic coverage plan (more commonly referred to as the minimum coverage place), you can get a copy of Form 1095-B or 1095-C sent to you from your health insurance company. Although you are not obligated to include this form in your taxes when filing, your insurance company must send you 1095-B for minimum coverage.

What If My Form 1095-A Isn’t Correct?

If for any reason the information included in Part III, Column B of Form 1095-A doesn’t look correct, call 800-989-2199 to speak to someone from Covered California. By calling that number you can also get directions on how to change the mistakes in the form before filing. If it’s information like your name, phone number, address, date of birth, or Social Security that isn’t right on Form 1095-A, you can call Covered California at the same telephone number listed above. If you believe the amount for the premium tax credits is wrong or that the incorrect months of coverage were list or not shown at all, you will need to fill out a dispute form.

When Will I Get a Correct Form 1095-A?

Once you have filed your dispute form, Covered California will get back to you in no later than 60 days regarding a correct form. If any of the revisions you request couldn’t be addressed or if more documentation is required to verify your dispute, Covered California will get in touch with you. Some examples of additional documents you might have to include are health insurance company invoices that provide any premium tax credits you got, the monthly premium rate you had, or the amount of premium tax credit you could receive. Filing your tax return before you get a correct 1095-A form could mean you’d need to amend your tax return. If you don’t get your correct 1095-A form before you have to file your return, you’ll need to include the original Form 1095-A with your tax return.

What is Form 1095-B?

If you have anyone family members in your household who use Medical Assistance, you will need to file form 1095-B. You are able to file your tax return before receiving this form. If you run a business and employee 50 or fewer full-time employees and provide them with a health care plan, you need to send form 1095-B to all of your employees. This form includes your coverage as well as coverage for any dependents you have. The purpose of this form is to confirm that you (and your dependents if you have them) have Minimal Essential Coverage. If there is any kind of coverage that wasn’t previously included on Form 1095-A or Form 1095-C, this information goes on Form 1095-B. The following entities are included on this form: government agencies (i.e. Medicare, Medicare Part A, TIRCARE, VA, CHIP) most insurance companies, and self-insured employers. Although typically this form must be filed by February 1, the date has been extended to March 31. On this form you will include the exact dates that anyone in your household received health insurance.

Form 1095-C: Employer-Provided Health Insurance Offer and Coverage:

Many large companies send form 1095-C to employees because they are large enough to be required to offer health coverage to anyone who works for them and will be penalized if they do not. This form is not like the other forms because on it, both offer of coverage and coverage itself (if the employee has their own self-insurance but accepts health insurance from their employee) are reported at the same time. Like Form 1095-B, this form usually needs to be filed before February 1, but can be filed as late as March 31. Many people who have to file this form already know the pertinent details of it and won’t have to look at a 1095-C form to finish filing their personal tax return. With Form 1095-C, you don’t have to wait until you receive it to file your personal tax returns. If you forgot certain information that needs to be added to Form 1095-C or don’t know something, either your insurance company or your boss should be able to help you.

On Form-1095-C, information regarding what type of health insurance coverage was offered to the employee must be included. Whether or not the employee accepted the health insurance coverage must also be stated on the form. Once again, this form will only be sent to employees who work at a company where a minimum of 50 people are employed full-time (or there are a number of workers that are equal to 50 full-time employees).

Amended Return Relief for Recipients of 1095-B and 1095-C Forms

If you are filing your personal tax return but have not yet received a Form 1095-B or form 1095-C, the best thing to do is try to include as much accurate information about your health insurance coverage as possible. List this information on your regular tax returns and get the information that you need by calling your employer as well as your insurance provider for any questions that you have.

Why You Have to File Form 1095-B or 1095-C 

Under the regulations put forth by the Affordable Care Act, you have to be able to prove that you have MEC (minimum essential coverage). You provide this information on either form 1095-B or form 1095-C.

On these forms, you provide information regarding what months out of the calendar year you received health care coverage. If you have dependents in your household, you must also include them on these forms. There could be a high penalization fee to pay if you have gone ten months or more without the proper health care coverage. If you have exemption status this does not apply to you. However, this rule also applies to any dependents you have in the household as well as your spouse.

In recent years, this fee you get for not having health insurance has risen considerably. This fee is called the “individual shared responsibility payment”. For example, this fee is $695 yearly for every adult in your house and $347.50 year for every child in your house.

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