Under the Affordable Care Act (ACA), health coverage reporting has become an essential part of the tax filing process for individuals, employers, and insurance providers. Forms 1095-A, 1095-B, and 1095-C are crucial documents issued by different entities to report health insurance coverage during the tax year. These forms provide proof that you had minimum essential coverage (MEC) and help determine whether you qualify for the Premium Tax Credit or are subject to the individual shared responsibility penalty (in states where it still applies).
This detailed guide will explain the differences between the forms, who receives them, what to do with them, and how they relate to ACA compliance and your tax return.
What Are the 1095 Forms?
Forms 1095-A, 1095-B, and 1095-C are all informational returns related to health insurance coverage. They are provided to the IRS and to individuals to report months of coverage and other relevant details.
- Form 1095-A: Sent by Health Insurance Marketplaces to individuals who enrolled in Marketplace plans.
- Form 1095-B: Sent by insurance providers or small employers (under 50 employees) to confirm minimum essential coverage.
- Form 1095-C: Sent by applicable large employers (ALEs) with 50 or more full-time employees, detailing the health coverage offered to employees.
Form 1095-A: Health Insurance Marketplace Statement
Form 1095-A is issued by federal or state health insurance Marketplaces to individuals who purchased health coverage through the exchange. It’s essential for calculating and reconciling the Premium Tax Credit (PTC) on Form 8962.
Key Sections of Form 1095-A
- Part I: Subscriber and Marketplace information
- Part II: Coverage household (names of covered individuals)
- Part III: Monthly premiums, SLCSP (second lowest cost silver plan), and advance premium tax credits (APTC)
What to Do With Form 1095-A
- Use the information to complete Form 8962 for reconciling your Premium Tax Credit
- Include any overpayment or underpayment of the APTC in your tax calculation
- Keep a copy for your records
Failure to file Form 8962 when you received advance premium credits can delay your refund or lead to the rejection of your return.
Form 1095-B: Health Coverage Statement
Form 1095-B is typically issued by insurance carriers (including Medicaid, CHIP, and some employer plans) or small employers providing self-insured coverage. It verifies that you, your spouse, and dependents had minimum essential coverage for some or all months of the year.
Key Sections of Form 1095-B
- Part I: Responsible individual (usually the policyholder)
- Part II: Issuer information (insurance company or provider)
- Part III: Coverage provider details
- Part IV: Covered individuals and months of coverage
How It Impacts Tax Filing
- In most cases, no action is required if you had full-year coverage.
- Keep it for your records in case the IRS requests documentation for proof of coverage.
- Some states (like California, New Jersey, Massachusetts) still require proof of health coverage on state tax returns, so Form 1095-B remains relevant at the state level.
Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Form 1095-C is issued by applicable large employers (ALEs), defined as those with 50 or more full-time employees. It provides information about health insurance offered by the employer to the employee and whether the offer meets the ACA’s affordability and coverage standards.
Key Sections of Form 1095-C
- Part I: Employee and employer information
- Part II: Details about the offer of coverage, including affordability
- Part III: (only for self-insured employers) Lists covered individuals and months of coverage
How to Use It
- Verify that your employer complied with ACA requirements
- Ensure your coverage information is correct
- Use as proof of coverage for state tax purposes, if applicable
Do You Need to Attach These Forms to Your Tax Return?
No. You do not need to attach Forms 1095-A, 1095-B, or 1095-C to your tax return when filing. However:
- You must use Form 1095-A to complete Form 8962 and reconcile the Premium Tax Credit
- Keep all 1095 forms with your tax records in case the IRS requires verification
What If You Didn’t Receive a 1095 Form?
You may not receive a Form 1095-B or 1095-C if you had full-year coverage and your provider or employer is not required to issue one unless you request it. For Form 1095-A, however, if you don’t receive it, log in to your Marketplace account to download it or contact the exchange where you enrolled.
Individual Shared Responsibility Penalty (State-Level)
While the federal penalty for not having minimum essential coverage was reduced to $0 starting in 2019, several states have reinstated their own mandates, including:
- California
- Massachusetts
- New Jersey
- Rhode Island
- Vermont (administrative requirement, not monetary)
- District of Columbia
If you live in one of these states, your 1095 form(s) may still be necessary to avoid a state-level penalty.
ACA Compliance for Employers
Large employers are required to file Forms 1094-C and 1095-C with the IRS and provide employees with a copy of 1095-C. Failure to provide these forms or inaccuracies can result in penalties under the ACA’s Employer Shared Responsibility provisions.
Frequently Asked Questions (FAQs)
Do I need all three 1095 forms?
No. You will receive only the form(s) relevant to your coverage. Most individuals receive only one of the three, depending on how they were insured during the year.
Can I file my taxes without a 1095 form?
Yes—especially if you did not receive advanced premium credits. If you got Form 1095-A, however, you must wait to receive it and use it to complete Form 8962.
What if my 1095 form is incorrect?
Contact the issuer—your Marketplace, insurance company, or employer—to request a corrected version before filing.
Conclusion: Keeping Up with Health Coverage Reporting
Understanding the differences among Form 1095-A, 1095-B, and 1095-C is key to staying compliant with ACA regulations and filing your tax return accurately. These forms verify your health coverage and determine whether you qualify for tax credits or owe penalties. While they don’t need to be submitted with your return, they provide the documentation needed to reconcile your tax situation.
If you’ve received one or more of these forms, be sure to verify the information, use them where required, and keep them in your records for at least three years. For complex situations, such as multi-state coverage or multiple employers, consulting a tax professional can help ensure you remain in full compliance.
