Q. What are the tax forms associated with health insurance, and where do I get them?
A. There are three different forms that are used by exchanges, employers, and health insurance companies, to report health insurance coverage to the IRS. And there are two health insurance-related forms that some tax filers need to complete when they file their return.
If you have specific questions about your situation, consult a tax advisor or the Volunteer Income Tax Assistance Program. Here’s an overview of the new forms that Americans have been receiving since early 2015:
It includes information about the cost of your plan, the cost of the second-lowest-cost Silver plan (benchmark plan) in your area, any premium subsidy that was paid on your behalf during the year, the months you had coverage, and which household members had coverage under the plan. Form 1095-A is your proof that you had health insurance coverage during the year, and it’s 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 if you 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 shouldn’t file your tax return 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 by early-mid February (by email, regular mail, or both, depending on the preference you indicated when you enrolled). If delivery of your 1095-A is delayed or the information on it is incorrect, you can contact your exchange.
(For the 2020 tax year, due to COVID-19, the rules were different. People who received excess premium tax credits in 2020 did not have to repay them to the IRS, and did not even have to file Form 8962 at all, unless they needed to claim additional premium tax credits. But that was for 2020 only, and the normal rules are back in place for 2021 and future years.)
Form 1095-B is sent out by health insurance carriers, government-sponsored plans such as Medicare, Medicaid, and CHIP, and self-insured small employers (large employers, including those that are self-insured, send out Form 1095-C instead). This form is mailed to the IRS and to the insured member. If you buy your own coverage outside the exchange, you’ll receive Form 1095-B instead of Form 1095-A (you may have to request Form 1095-B if you want it, as it may not be sent to you automatically the way it was in the past).
Form 1095-B essentially just shows who was covered, and which months of the year they had coverage. Premium subsidies aren’t available for plans that send a 1095-B. And there’s no longer a penalty for being without health insurance (unless you’re in a state that has its own individual mandate penalty) so having proof of coverage isn’t as important as it was prior to 2019. Some states still impose a penalty for being uninsured, but unless you’re in one of those states, Form 1095-B is no longer necessary.
Some entities that used to send Form 1095-B — such as some states’ Medicaid agencies — are no longer sending this form (see IRS regulations about this). This is because people in most states no longer need to prove that they had coverage during the year, and there is no longer a box on the federal tax return asking whether the tax filer had health insurance.
Form 1095-C is sent out by large employers who 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 sent to the IRS and to full-time employees (30+ hours per week). It’s 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 opted to be uninsured, Form 1095-C is generally not necessary when you’re filing your taxes. (As is the case for Form 1095-B, you may need proof of health insurance coverage if you’re in a state that imposes a penalty for being uninsured; Form 1095-C will serve as that proof.)
Which form will you receive?
Most people will only receive one of those three forms. But there are some circumstances where you might receive more than one.
For example, if you work for a large company and have access to coverage from your employer, but you opted to buy coverage in the exchange instead, you’d receive Forms 1095-A and 1095-C. The 1095-C would indicate that you were offered employer-sponsored coverage, even though you declined it.
(Note that if you rejected an employer’s offer of coverage and enrolled in a marketplace plan instead, marketplace subsidies are not available if the employer’s plan was considered affordable and would have provided minimum value. If you receive both a 1095-A and a 1095-C for the same months of the year, you’ll want to consult with a CPA to make sure that your premium tax credit is correctly reconciled.)
And if you switched from an individual plan to a plan offered by a large employer mid-year, you’ll end up with a form from each of them. Whatever forms you receive are also received by the IRS, so everyone is on the same page.
Forms 1095-A, B, and C may be delivered electronically or on paper, depending on whether you opted in for electronic delivery. You’ll use the information on the form to complete your tax return, but you keep it with your records (don’t attach it to your tax return.)
When will my Form 1095 arrive?
For 2016 coverage and beyond, the deadline for exchanges, health insurers, and employers to send out the forms is January 31 of the following year. But every year thus far, the IRS has granted a deadline extension for the distribution of Form 1095-B and 1095-C. The deadline to distribute 2021 forms was pushed 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. They sometimes take a while to arrive, so it may have been February before you received yours; as noted above, you can log into your exchange account online and see your 1095-A if you didn’t receive it in the mail or have 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 get your form in a timely manner, you can contact the exchange, your health insurance carrier, or your employer, depending on who should be sending you a form.
Most Americans don’t have to do anything on their tax returns pertaining to health insurance (for 2014 through 2018 tax years, most people were able to simply check the box for “full-year health care coverage” on their tax return and carry on; that box is no longer part of the federal tax return, as there’s no longer a federal penalty for being uninsured, 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 have to complete Form 8962 with your tax return.
If you received a subsidy and fail to complete Form 8962, you won’t be able to continue receiving a subsidy going forward, so this form is essential for the millions of people who are receiving premium subsidies in the exchange. And if you paid full price for a marketplace plan during the year and are eligible for the premium tax credit (or if you received some premium tax credit but are eligible for more), you’ll use Form 8962 to claim your premium tax credit. The information on Form 1095-A is used to complete Form 8962.
For people who didn’t have minimum essential coverage at any point between 2014 and 2018, Form 8965 was used to claim exemptions from the individual mandate penalty, if applicable. Exemptions granted by the IRS are no longer necessary (as there’s no longer a federal penalty for being uninsured), so this form is no longer needed for current tax returns. But some states have their own individual mandates now, and residents can access state tax forms for claiming exemptions. The health insurance exchanges can also still provide exemptions from the individual mandate, which are necessary in order to enroll in a catastrophic health plan if you’re 30 or older (note that the exchanges use their own form for this; it’s not a tax form).
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 opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.