IRS Form 1095-A

Fill out
Export or Print
Download your fillable IRS Form 1095-A in  PDF
IRS Form 1095-A

People willing to report specific data about registering in a qualified health plan should use IRS Form 1095-A. The Revenue Service needs that information for tax deduction purposes, so the form will help you summarize all the premiums acquired via Health Insurance Marketplace and other relevant information. The US citizens can also use this legal form to submit accurate tax return info, take a premium tax credit, and other relevant purposes.

With the form, you can reconcile your tax credit using the special advanced premium features that Marketplace offers to its users. For the taxpayers who have that kind of health coverage, there is an opportunity to get an extra tax credit, and that is the primary purpose for filing the 1095-A Form. If you don’t qualify for the premium tax credit, you will find the respective form extremely useful.

Deadline for submission

You need to deliver your annual report no later than February 28, 2021, to get 2020 coverage. And that is for filing in the paper; if you are filing online, the deadline period might be extended until March 31. All late or inappropriate format filings that come after these respective dates are recognized as void, so be careful. Furnishing the statement, make sure you don’t do it on one of the legal holidays, Saturday or Sunday. Otherwise, deliver your form by any closest business day.

Other IRS Forms for Individuals

In our collection, there are IRS forms for different taxpayers and life situations. Read what other forms you might need to file as an individual taxpayer.

How to Complete Form 1095-A

The whole form is divided into three sections, and each of them requires different information from the filer. So, when filling in the first part named “Recipient information,” you need to complete 15 empty fields. Here are step-to-step guidelines for filling out the Part I section:

Indicate Your State Jurisdiction

In the first line, fill in the data about the state where you have currently registered and Marketplace coverage info.

step 1 indicate your state jurisdiction filling out irs form 1095 a

Enter Policy Number

In the second line, the applicant needs to identify the policy number they are currently enrolled in.

step 2 enter policy number filling out irs form 1095 a

Identify Your Insurance Company

Write down the name of your insurance company to the next field.

step 3 identify your insurance company filling out irs form 1095 a

Provide Personal Data

Enter your personal data in lines 4 through 6. Ensure to fill in your own name and Social Security Number in the corresponding blank fields. Fill in the date of the birth in the fifth line if it is empty. If you are the recipient, it is because the Marketplace identified you during the enrollment process, and now you are considered to file the tax return records.

step 4 provide personal data filling out irs form 1095 a

Provide the Spouse’s Personal Info

Fill in lines number 7, 8, and 9 out the same way but with respect to your spouse’s data.

step 5 provide the spouse’s personal info filling out irs form 1095 a

Enter the Policy’s Effective Period

In fields number 10 and 11, you should indicate the start and the end policy dates.

step 6 enter the policy’s effective period filling out irs form 1095 a

Fill In Your Current Physical Address

Enter your full address in fields 12 through 15, including the name of your city, state, add ZIP.

step 7 fill in your current physical address filling out irs form 1095 a

Fill In the Second Section

The second section is called Covered individuals, and it consists of a 5×5 table that you are considered to complete.

step 8.1 fill in the second section filling out irs form 1095 a

Columns A through E requires filling out certain personal data of the applicant. In the mentioned sections, you should cover the individual name, SSN, date of birth, and the respective program coverage, as well as the program’s beginning and termination date, respectively. Ensure to fill out the info in the corresponding boxes.

Next up, you should also include your spouse’s info (if you have one). Please note that column C is supposed to be filled only if column B is empty. Fill out columns D and E based on the coverage beginning and termination date (only if the medical plan coverage had stopped during the previous financial year). Otherwise, if the coverage was in effect throughout the year, then indicate the last day of coverage – December 31, 2020.

The third part (and the last) is devoted to the coverage information, and there is yet another table you need to fill out.

step 8.2 fill in the second section filling out irs form 1095 a

The table has 13 Rows, 12 of which are headed with the respective months’ names, and the last one is called “Annual Totals.”

step 8.3 fill in the second section filling out irs form 1095 a

For completing these rows, you should enter the coverage information for each month and summarize all the numbers in row 23.

step 8.4 fill in the second section filling out irs form 1095 a

Also, there are three columns A through C, which you need to fill in as well. In Column A, you should enter the total monthly enrollment premiums for the policy in which the covered individuals enrolled, including only the premiums for essential health benefits.

step 8.5 fill in the second section filling out irs form 1095 a

In Column B, write down the applied Second-Lowest-Cost Silver Plan (SLCSP) premiums to compute monthly advance credit payments.

step 8.6 fill in the second section filling out irs form 1095 a

Finally, for the last column, you need to insert the customer’s number of advance credit payments you do each month.

step 8.7 fill in the second section filling out irs form 1095 a