QUESTION

I received a Form 1095-A called the “Health Insurance Marketplace Statement” in the mail. What is it and what do I do with it?

Post enrollment issues | Individual Health Insurance |
ANSWER

Form 1095-A is the form that the health insurance Marketplace uses to report information about your Marketplace coverage to the IRS. The Marketplace is required to send all consumers with Marketplace coverage this form with information about your coverage and if applicable, any premium tax credits you received in prior years or will claim. If you received premium tax credits in advance, you’ll need this form to complete IRS Form 8962, which is the form you will use to reconcile the amount of any advance premium tax credits you received based on your projected income with what you should have received based on your actual income.

If you do not file a tax return and reconcile the premium tax credits for two consecutive years, you will not be eligible for premium tax credits in the future. Note, however, that this rule has been suspended until the IRS builds the systems necessary to enforce the requirement. Therefore, you won’t be denied premium tax credits if you failed to file taxes and reconcile your premium tax credits for coverage you had in 2023 or a prior year. (CMS, Guidance on Annual Redetermination and Re-enrollment for Marketplace Coverage for 2024 and Later Years, 26 C.F.R. § 1.36B-2; IRS, Questions and Answers on the Premium Tax Credit; HealthCare.gov, How to Use Form 1095-A; IRS, Questions and Answers about Health Care Information Forms for Individuals (Forms 1095-A, 1095-B, and 1095-C).)

Individuals with no coverage
Individuals with coverage
Coverage for small employers
Post enrollment issues