Instructions for IRS Form 1095-A "Health Insurance Marketplace Statement"

This document contains official instructions for IRS Form 1095-A, Health Insurance Marketplace Statement - a tax form released and collected by the Internal Revenue Service (IRS), a subdivision of the U.S. Department of the Treasury. An up-to-date fillable IRS Form 1095-A is available for download through this link.

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2020
Department of the Treasury
Internal Revenue Service
Instructions for Form 1095-A
Health Insurance Marketplace Statement
Section references are to the Internal Revenue Code
Statements to Individuals
unless otherwise noted.
Furnishing required information to the individual.
Future Developments
Marketplaces use Form 1095-A to furnish the required
statement to recipients. A separate Form 1095-A must be
For the latest information about developments related to
furnished for each policy, and the information on the Form
Form 1095-A and its instructions, such as legislation
1095-A should relate only to that policy. If two or more tax
enacted after they were published, go to
IRS.gov/
filers are enrolled in one policy, each tax filer receives a
Form1095A.
statement reporting coverage of only the members of that
Additional Information
tax filer's tax family (a tax family may include the tax filer,
the tax filer’s spouse if the tax filer is filing a joint return
For information related to the Affordable Care Act, visit
with his or her spouse, and the tax filer’s dependents).
IRS.gov/Affordable-Care-Act.
See the instructions for line 4 for more information about
For additional information related to Form 1095-A, visit
who is a recipient. Don't furnish a Form 1095-A for a
IRS.gov/Affordable-Care-Act/Individuals-And-Families/
catastrophic health plan or a stand-alone dental plan. See
Health-Insurance-Marketplace-Statements.
the instructions for Part III, column A.
On Form 1095-A statements furnished to recipients,
General Instructions
filers of Form 1095-A may truncate the social security
number (SSN) of an individual receiving coverage by
Purpose of Form
showing only the last four digits of the SSN and replacing
the first five digits with asterisks (*) or Xs. Truncation isn't
Form 1095-A is used to report certain information to the
allowed on forms filed with the IRS.
IRS about individuals who enroll in a qualified health plan
through the Health Insurance Marketplace. Form 1095-A
Statements must be furnished to recipients on paper by
is also furnished to individuals to allow them to take the
mail, unless a recipient affirmatively consents to receive
premium tax credit, to reconcile the credit on their returns
the statement in an electronic format. If mailed, the
with advance payments of the premium tax credit
statement must be sent to the recipient’s last known
(advance credit payments), and to file an accurate tax
permanent address, or if no permanent address is known,
return.
to the recipient’s temporary address.
Consent to furnish statement electronically. The
Who Must File
requirement to obtain affirmative consent to furnish a
Health Insurance Marketplaces must file Form 1095-A to
statement electronically ensures that statements are sent
report information on all enrollments in qualified health
electronically only to individuals who are able to access
plans in the individual market through the Marketplace. Do
them. A recipient may provide his or her consent on paper
not file a Form 1095-A for a catastrophic health plan or a
or electronically, such as by email. If consent is provided
separate dental policy (called a “stand-alone dental plan”
on paper, the recipient must confirm the consent
in these instructions).
electronically. An electronic statement may be furnished
by email or by informing the recipient how to access the
When To File
statement on a Marketplace’s website (for example, in the
File the annual report with the IRS and furnish the
recipient's Marketplace account).
statements to individuals on or before February 1, 2021,
for coverage in calendar year 2020.
Specific Instructions
The requirement to furnish a statement to individuals
will be met if the Form 1095-A is properly addressed and
Part I—Recipient Information
mailed or furnished electronically (if the recipient has
consented to electronic receipt) on or before the due date.
Line 1. Enter the Marketplace state name or
If the regular due date falls on a Saturday, Sunday, or
abbreviation.
legal holiday, furnish the statement by the next business
Line 2. Enter the number the Marketplace assigned to
day. A business day is any day that isn't a Saturday,
the policy. If the policy number is greater than 15
Sunday, or legal holiday.
characters, enter only the last 15 characters.
How To File
Line 3. Enter the name of the issuer of the policy.
Electronic filing. You must submit the information to the
Line 4. Enter the name of the recipient of the statement.
IRS electronically. Submit the information through the
This should be the person identified at enrollment as the
Department of Health and Human Services Data Services
tax filer (the person who is expected to file a tax return, to
Hub.
Oct 07, 2020
Cat. No. 63016Q
2020
Department of the Treasury
Internal Revenue Service
Instructions for Form 1095-A
Health Insurance Marketplace Statement
Section references are to the Internal Revenue Code
Statements to Individuals
unless otherwise noted.
Furnishing required information to the individual.
Future Developments
Marketplaces use Form 1095-A to furnish the required
statement to recipients. A separate Form 1095-A must be
For the latest information about developments related to
furnished for each policy, and the information on the Form
Form 1095-A and its instructions, such as legislation
1095-A should relate only to that policy. If two or more tax
enacted after they were published, go to
IRS.gov/
filers are enrolled in one policy, each tax filer receives a
Form1095A.
statement reporting coverage of only the members of that
Additional Information
tax filer's tax family (a tax family may include the tax filer,
the tax filer’s spouse if the tax filer is filing a joint return
For information related to the Affordable Care Act, visit
with his or her spouse, and the tax filer’s dependents).
IRS.gov/Affordable-Care-Act.
See the instructions for line 4 for more information about
For additional information related to Form 1095-A, visit
who is a recipient. Don't furnish a Form 1095-A for a
IRS.gov/Affordable-Care-Act/Individuals-And-Families/
catastrophic health plan or a stand-alone dental plan. See
Health-Insurance-Marketplace-Statements.
the instructions for Part III, column A.
On Form 1095-A statements furnished to recipients,
General Instructions
filers of Form 1095-A may truncate the social security
number (SSN) of an individual receiving coverage by
Purpose of Form
showing only the last four digits of the SSN and replacing
the first five digits with asterisks (*) or Xs. Truncation isn't
Form 1095-A is used to report certain information to the
allowed on forms filed with the IRS.
IRS about individuals who enroll in a qualified health plan
through the Health Insurance Marketplace. Form 1095-A
Statements must be furnished to recipients on paper by
is also furnished to individuals to allow them to take the
mail, unless a recipient affirmatively consents to receive
premium tax credit, to reconcile the credit on their returns
the statement in an electronic format. If mailed, the
with advance payments of the premium tax credit
statement must be sent to the recipient’s last known
(advance credit payments), and to file an accurate tax
permanent address, or if no permanent address is known,
return.
to the recipient’s temporary address.
Consent to furnish statement electronically. The
Who Must File
requirement to obtain affirmative consent to furnish a
Health Insurance Marketplaces must file Form 1095-A to
statement electronically ensures that statements are sent
report information on all enrollments in qualified health
electronically only to individuals who are able to access
plans in the individual market through the Marketplace. Do
them. A recipient may provide his or her consent on paper
not file a Form 1095-A for a catastrophic health plan or a
or electronically, such as by email. If consent is provided
separate dental policy (called a “stand-alone dental plan”
on paper, the recipient must confirm the consent
in these instructions).
electronically. An electronic statement may be furnished
by email or by informing the recipient how to access the
When To File
statement on a Marketplace’s website (for example, in the
File the annual report with the IRS and furnish the
recipient's Marketplace account).
statements to individuals on or before February 1, 2021,
for coverage in calendar year 2020.
Specific Instructions
The requirement to furnish a statement to individuals
will be met if the Form 1095-A is properly addressed and
Part I—Recipient Information
mailed or furnished electronically (if the recipient has
consented to electronic receipt) on or before the due date.
Line 1. Enter the Marketplace state name or
If the regular due date falls on a Saturday, Sunday, or
abbreviation.
legal holiday, furnish the statement by the next business
Line 2. Enter the number the Marketplace assigned to
day. A business day is any day that isn't a Saturday,
the policy. If the policy number is greater than 15
Sunday, or legal holiday.
characters, enter only the last 15 characters.
How To File
Line 3. Enter the name of the issuer of the policy.
Electronic filing. You must submit the information to the
Line 4. Enter the name of the recipient of the statement.
IRS electronically. Submit the information through the
This should be the person identified at enrollment as the
Department of Health and Human Services Data Services
tax filer (the person who is expected to file a tax return, to
Hub.
Oct 07, 2020
Cat. No. 63016Q
claim other family members as dependents, and who, if
Column A. Enter the total monthly enrollment premiums
qualified, would take the premium tax credit for the year of
for the policy in which the covered individuals enrolled.
coverage for his or her tax family). If the tax filer can't be
Include only the premiums allocable to essential health
identified from the information provided at enrollment (for
benefits. If a covered individual is enrolled in a
example, because no financial assistance was
stand-alone dental plan, include the portion of the
requested), enter the name of the primary applicant for the
premiums for the stand-alone dental plan that is allocable
coverage.
to pediatric dental coverage in the total monthly
enrollment premiums. If more than one Form 1095-A is
Line 5. Enter the social security number (SSN) for the
filed for coverage of the recipient’s family for the same
recipient shown on line 4.
months because, for example, a family member enrolled
Line 6. Enter the recipient’s date of birth only if line 5 is
in a separate policy, include the portion of the premium for
blank.
pediatric dental coverage in the amount in column A on
only one Form 1095-A. If more than one tax filer is
Lines 7, 8, and 9. Enter information about the recipient’s
enrolled in a policy, report on each tax filer's Form 1095-A
spouse, if the recipient has one, if advance credit
only those enrollment premiums allocated to that tax filer.
payments were made for the coverage. Enter this
If a policy is terminated by an issuer for nonpayment of
information even if the advance credit payments were not
premiums, enter -0- for a month in which the covered
made for the spouse's coverage. Enter a date of birth only
individuals have coverage but the premiums are not fully
if line 8 is blank.
paid (generally, the first month of a grace period). If one or
Line 10. Enter the date that coverage under the policy
more covered individuals terminate coverage before the
started. If the policy was in effect at the start of the year,
last day of a month, the amount reported in this column
enter 1/1/2020.
should not include any amount of the monthly enrollment
Line 11. Enter the date of termination if the policy was
premium that was refunded. If the issuer provided a
terminated during the year. If the policy was in effect at the
premium credit for one or more months, the amount
end of the year, enter 12/31/2020.
reported in this column should be the amount of the
monthly enrollment premium as reduced by any premium
Lines 12–15. Enter the recipient's address.
credit.
Part II—Covered Individuals
Column B. Enter the premiums for the applicable second
Enter on lines 16 through 20 and columns A through E
lowest cost silver plan (SLCSP) that was used as a
information for each individual covered under the policy,
benchmark to compute monthly advance credit payments.
including the recipient and the recipient's spouse, if
If advance payments were made, the applicable SLCSP
covered. If advance credit payments were not made for
for a month is the SLCSP that applies to individuals in Part
II who were identified at enrollment as members of the tax
any coverage under the policy and a tax family cannot be
filer's tax family (the tax filer, the tax filer's spouse if the tax
identified, enter in Part II information for all covered
filer is filing a joint return with his or her spouse, and any
individuals. If advance credit payments were made for the
coverage or a tax family can be identified, enter in Part II
dependents of the tax filer) and who are enrolled in the
information only for covered individuals whom the tax filer
coverage on the first day of the month and are not eligible
certified at enrollment would be a part of the tax filer's tax
for other health coverage for that month. However, if an
family. Information about individuals enrolled in the same
individual enrolls in coverage and the enrollment is
policy as the tax filer’s tax family who are not members of
effective on the date of the individual's birth, adoption,
that tax family, including children, must be reported on a
placement in foster care, or on the effective date of a court
order, the individual should be considered to have
separate Form 1095-A.
enrolled on the first day of the month for purposes of the
For each line, enter a date of birth in column C only if
applicable SLCSP premium reported in column B. If all
column B is blank. Enter in column D the date the
covered individuals enroll after the first of the month, and
coverage started for the individual. Enter in column E the
no individual's coverage is effective on the date of the
date of termination if the individual's coverage was
individual's birth, adoption, placement in foster care, or on
terminated during the year. If the coverage was in effect at
the effective date of a court order, enter -0- in column B
the end of the year, enter 12/31/2020.
for that month. If more than one Form 1095-A is filed for
If there are more than 5 covered individuals,
coverage of a tax filer’s family for the same month (for
complete one or more additional Forms 1095-A,
example, because members of the family were split
TIP
Part II.
among several policies), enter the SLCSP premium that
applies to all the family members who were enrolled in any
policy on the first of the month and who were not eligible
Part III—Coverage Information
for other health coverage for that month. Enter this SLCSP
Enter information in Part III, lines 21 through 32, for each
premium in column B on each Form 1095-A.
month of coverage. This information is determined on a
In some cases, the information provided at enrollment
monthly basis and may change during the year if there is a
may not indicate which covered individuals are members
change in enrollment or other circumstances that affect
of the recipient's family and are not eligible for other health
eligibility for, or the amount of, the premium tax credit.
coverage. (Such information may not be provided, for
Total the amounts on lines 21 through 32 and enter on
example, because no financial assistance was
line 33.
requested.) If this is the case, and if the Marketplace has
-2-
Instructions for Form 1095-A (2020)
provided a tool for determining the applicable SLCSP
discovering that information reported is incorrect. Check
premium for the year of coverage at the time of filing the
the corrected box on the top of the form.
tax return, leave column B blank. If the Marketplace has
Privacy Act and Paperwork Reduction Act Notice.
not provided a tool for determining the applicable SLCSP
We ask for the information on this form to carry out the
premium, enter the premiums for the SLCSP that would
Internal Revenue laws of the United States. You are
apply to all individuals identified in Part II as covered for
required by the Internal Revenue Code to give us the
the month.
information. We need it to ensure that taxpayers are
If a policy is terminated by an issuer for nonpayment of
complying with these laws and to allow us to figure and
premiums and advance credit payments are made,
collect the right amount of tax.
enter -0- for a month in which the covered individuals
have coverage but the premiums are not paid (generally,
You are not required to provide the information
the first month of a grace period). However, if an individual
requested on a form that is subject to the Paperwork
enrolled on the first day of a month terminates coverage
Reduction Act unless the form displays a valid OMB
before the last day of the month, the individual should be
control number. Books or records relating to a form or its
considered to have been enrolled for the entire month for
instructions must be retained as long as their contents
purposes of the applicable SLCSP premium reported in
may become material in the administration of any Internal
column B.
Revenue law. Generally, tax returns and return
information are confidential, as required by IRC section
Column C. Enter the amount of advance credit payments
6103.
for the month. If more than one Form 1095-A is filed for
coverage of a tax filer’s family for the same months, enter
The time needed to complete and file this form will vary
only the advance credit payment amount allocated to the
depending on individual circumstances. The estimated
policy reported on this Form 1095-A. If the tax filer’s family
average time is:
is also enrolled in a stand-alone dental plan, any advance
credit payments allocated to the stand-alone dental plan
Preparing the form
.3 min.
. . . . . . . . . . . .
should be added to the advance credit payments
allocated to one of the policies reported on a Form
1095-A.
If you have comments concerning the accuracy of
these time estimates or suggestions for making this form
Void Statements
simpler, we would be happy to hear from you. You can
If a Form 1095-A was sent for a policy that shouldn't be
send us comments from IRS.gov/FormComments. Or you
reported on a Form 1095-A, such as a stand-alone dental
can write to the Internal Revenue Service, Tax Forms and
plan or a catastrophic health plan, send a duplicate of that
Publications Division, 1111 Constitution Ave. NW,
Form 1095-A and check the void box at the top of the
IR-6526, Washington, DC 20224. Don't send the form to
form. Provide this information to the IRS and to the
this office.
recipient of the statement as soon as possible after
discovering that the statement was sent in error.
Correction to Information Reported
Report corrected information on the Form 1095-A to the
IRS and to the recipient as soon as possible after
-3-
Instructions for Form 1095-A (2020)
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