What agents and their clients need to know about IRS Form 1095-A

Form 1095-A, or the Health Insurance Marketplace Statement, is one of your first opportunities to provide year-round value to your clients.

Here’s some information on this health insurance tax form and what you can do for your clients this tax season through your HealthSherpa account.

What is a 1095-A?

Both the federally-funded Marketplace and state-based Marketplaces (FFM and SBM, respectively) use Form 1095-A to report information on enrollments in a qualified health plan (QHP). For every Marketplace health insurance enrollment, a copy of this form is sent to:

1. The IRS to report on who enrolled in a QHP through the Marketplace.
2. Individuals, so they can complete Form 8962 to figure out their premium tax credit (PTC), reconcile it with any advance payments of the premium tax credit (APTC), and file an accurate federal income tax return.

Form 1095-A includes the identifying information about the client and any other individuals covered by the health insurance plan, as well as information on the type and duration of coverage. You can find an example Form 1095-A here and an example Form 8962 here from irs.gov.

Your clients will soon begin to receive Form 1095-A’s through the mail, but you also can download them today on behalf of your clients through your HealthSherpa agent account.

How can agents service clients with Form 1095-A?

Download Form 1095-A to share with your clients. If you have enabled EDE in your account, you can do this by clicking into a specific Client and scrolling down to their ‘Application History.’

Note: You can also download Form 1095-A even if you did not help the client enroll in their prior year’s coverage. Simply click ‘Search Marketplace’ in the top right of your HealthSherpa account and fill out the following form with their information from last year’s application.

Check that the information listed on your client’s 1095-A is correct. Most of this information should be visible in your Clients list, and you can use this tool to confirm their Second Lowest Cost Silver Plan (SLCSP). If anything on the 1095-A is incorrect, either you or your client will need to call the appropriate Marketplace to correct any mistakes. We’ve included FFM and state-based Marketplace contact information below, and you can find SBM information here.

Explain how completing Form 8962 may affect how much they owe. See below for more information.

What do clients need to know about the Form 1095-A, Form 8962, and their taxes?

These are the main points to cover with your clients:

1. Form 1095-A is an informational document they will use to complete Form 8962.
2. The client should complete Form 8962 because they were covered in a qualified health plan (QHP) through a Marketplace and:
   • Plan to take the PTC
   • Received an APTC for someone in their tax family
   • Received an APTC for someone they told the Marketplace would be in their tax family, but will not be included in the tax family
3. Form 1095-A shows the months of coverage purchased through the Marketplace and any APTC paid by the federal government to the insurance company throughout the year to help cover the client’s monthly premium.
4. As part of their tax preparation, the client should check that their form 1095-A is accurate (e.g. is the right health insurance company listed?)
5. When the client applied for 2019 coverage (either during Open Enrollment or a Special Enrollment Period), the Marketplace used the client’s projected income and their household members to determine eligibility for and the amount of APTC. If either the income or household size changed during 2019 and it was not promptly reported to the Marketplace, the amount of APTC paid may be different from the amount of PTC the client can take on their tax return. In other words, they may have paid too much or too little for their health coverage.

Example 1095-A client outreach

Not sure how to tie this all together? Feel free to use this example outreach as a first step:

Subject: Health insurance and your taxes

Hello [Client Name],

You should receive a 1095-A tax form soon in the mail. Please let me know if you want a copy of it earlier — as your insurance agent, I’m able to download your form and share it with you.

In general, people who were covered by a Marketplace health insurance in 2021 and got reductions in their monthly insurance premiums need to use this document to fill out another form (8962) when they file their taxes. This is how the IRS checks whether they paid the right amount throughout the year for each individual or family’s health insurance.

I am not a tax professional, but I would be happy to answer questions about how to use this document when you file your taxes.

Sincerely,

[Agent Name]

Other Form 1095-A FAQ:

Are there other 1095’s?

• Yes, there is also Form 1095-B and Form 1095-C. Individuals receive different forms based on their type of coverage.
  • Form 1095-A goes out to individuals that had Marketplace coverage.
  • Form 1095-B goes out to individuals that were covered by “minimum essential coverage”. This means the insurance company provided a minimum level of benefits that meet the requirements of the Affordable Care Act (ACA). Examples include: employer-sponsored coverage for retirees and COBRA coverage for terminated employees, Medicare Part A, Medicare Advantage, Medicaid, the Children’s Health Insurance Program (CHIP), Tricare for military members, veterans medical benefits, plans for Peace Corps volunteers, and individuals working for small businesses.
  • Form 1095-C is sent by large employer that are required to offer insurance directly to the IRS and their employees.

Wasn’t the individual mandate repealed? Do I need to fill out this form? 

• The individual mandate (also known as a tax penalty for being uninsured) was a part of the Affordable Care Act (ACA). The December 2017 tax legislation repealed the tax penalty and is no longer mandatory for most states as of the 2019 filing season. Your client still needs to complete Form 8962 if they either received advanced payments of premium tax credits throughout 2021, or want the premium tax credit applied to their income tax return.