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About Form 1095-A, Health Insurance Marketplace Statement | Internal Revenue Service

Information about Form 1095-A, Health Insurance Marketplace Statement, including recent updates, related forms and instructions on how to file. Form 1095-A is used to report certain information to the IRS about individuals who enroll in a qualified health plan through the Marketplace.

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About Form 1095-A, Health Insurance Marketplace Statement | Internal Revenue Service

Summary: Form 1095-A is a statement provided by the Health Insurance Marketplace to individuals who enrolled in a qualified health plan. It contains essential information required to complete Form 8962, Premium Tax Credit (PTC), when filing a federal tax return.

Form 1095-A, Health Insurance Marketplace Statement, is issued by the Marketplace to report enrollment information for qualified health plans. This document is provided for informational purposes; individuals cannot complete this form themselves. Recipients must use the data provided on the form—including monthly premiums, the second lowest cost silver plan (SLCSP) premium, and any advance payments of the premium tax credit—to reconcile their tax liability and claim the premium tax credit on Form 8962. The form includes instructions for handling corrected or voided statements and guidance on how to resolve discrepancies by contacting the Marketplace Call Center.

Document outline

1. Part I: Recipient Information (Lines 1-15) 2. Part II: Covered Individuals (Lines 16-20) 3. Part III: Coverage Information (Lines 21-33) 4. Instructions for Recipient 5. VOID and CORRECTED Form Procedures 6. Column Definitions (A: Monthly Premiums, B: SLCSP, C: Advance Credit Payments) 7. Contacting the Marketplace Call Center

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