The Affordable Care Act requires most Americans to have health insurance or be subject to a tax penalty.
In order to prove you had health insurance in 2015, you will receive one of the following tax forms:
IRS 1095-A Sent to you by the Marketplace if you purchased family or individual coverage through your state’s Marketplace (on-exchange).
IRS 1095-B Sent to you by your insurance carrier if you purchased family or individual coverage outside the Marketplace (off-exchange) or if you were covered on your employer’s plan (most employers).
IRS 1095-C Sent to you by your employer or plan sponsor if you were covered on a fully insured large group or self-funded employer-sponsored health plan.
You may also need to file one of the following with your 2015 federal income tax:
IRS 8962 If you collected a government subsidy to help pay for coverage.
IRS 8965 If you were exempt from the requirement to have health insurance in 2015.
IRS Form 1095-A – Health Insurance Marketplace Statement
You will receive Form 1095-A from the Marketplace if you purchased health insurance in 2015 through your state’s exchange (aka Marketplace).
Form 1095-A includes information about your coverage, who was covered, and when.
Part I of Form 1095-A includes details about you — your name, SSN, date of birth, etc. — and your 2015 coverage — the state where you bought it, the name of the insurance company, and the dates your coverage started and ended.
Part II lists the members of your household covered on your plan. Only those people who you told the Marketplace you would claim on your tax return will be listed here.
Part III details the following, by month:
- The premium you paid
- The premium of the second lowest cost silver plan (this will be used when you file your return to help calculate whether or not you received the right amount of subsidy)
- The amount of subsidy you received (referred to by the IRS as a premium tax credit or PTC).
Line 33 of Part III includes the sum of each column, giving you the annual totals of each — this will come in handy when you’re ready to file!
You will use the data included on Form 1095-A to complete Form 8962 — Premium Tax Credit (PTC).
IRS Form 1095-B – Health Coverage
You will receive Form 1095-B from your insurance carrier if you were covered in 2015 by a health insurance plan purchased outside of the Marketplace (“off-exchange”) or if you were covered on a group plan. The carriers have until March 31, 2016 to send the form.
The 1095-B details who in your household had coverage during 2015 and when. It also lists the employer (if an employer-sponsored plan) and the health insurance carrier for your coverage.
You do not need to attach the 1095-B to your tax return.
IRS Form 1095-C – Employer-Provided Health Insurance Offer and Coverage
You will receive a Form 1095-C from your employer or plan sponsor if you were employed by a large employer (one with 50 or more FTE employees) or by an employer who self-insures. Employers have until March 31, 2016 to send the form.
This form contains information about what coverage the employer offered, who was covered, and when. If you waived coverage, you will get Form 1095-C from your employer, showing that you were offered coverage.
IRS Form 8962 – Premium Tax Credit (PTC)
If you received a 1095-A, you must complete Form 8962 and submit it with your Form 1040, 1040A or 1040NR when you file your 2015 taxes.
The IRS will use Form 8962 to reconcile whether you received too much or too little in the way of a premium subsidy for your health insurance in 2015. If you collected too much, you may need to pay some or all of the money back. If you did not collect enough, you may get money back.
You also must file Form 8962 if you were eligible for a PTC but did not collect the subsidy in advance, and now want to claim it.
IRS Form 8965 – Health Coverage Exemptions
The Affordable Care Act’s individual mandate requires that most Americans have health insurance.
If you did not purchase health insurance in 2015 because you are exempt from the individual mandate, you must complete IRS Form 8965.
Important: if you have a Marketplace-granted coverage exemption you must provide an Exemption Certificate Number on Form 8965. It takes some time for the Marketplace to process exemptions, so don’t delay in submitting your request!
If you were uninsured for more than 3 months during 2015 and you did not have a valid exemption, you will be assessed a penalty tax when you file your 2015 tax return. The penalty increases for 2016:
|$325 per adult
$162.50 per child
Family Maximum of $975 OR 2% household income, whichever is GREATER
|$695 per adult
$347.50 per child
Family Maximum of $2,085 OR 2.5% of household income, whichever is GREATER
The IRS will deduct your penalty from any refund you are due. The penalty amount will be added to your tax bill if you owe money.
Please consult a tax professional for specific tax advice.