Printable blank Form 1095-A
What is form 1095-A?
Form 1095-A is the form for declaring the cost of health insurance and federal subsidy you receive. This subsidy or Premium Tax Credit (PTC) is necessary to make the cost of healthcare cheaper.
What I need form 1095-A for?
- To provide the government with information about federal subsidy and health insurance;
- If you bought a plan on the health marketplace, the healthcare coverage would be cheaper for you;
- Note that PTC is paid by the government in advance each month, therefore be sure to fill the form on time.
Organizations that work with form 1095-A
Health insurance providers.
Related Form 1095-A Tax Documents
IRS Form 1095-A Resources
- Download 1095-A form blank
- Instructions for the Requester of Form 1095-A
- How to get Form 1095-A
- How to fill out Form 1095-A
Relevant to 1095-A form 2021
How to fill out a 1095-A form?
Step 1: Click the "Fill Out Form" button to get a fillable version.
Step 2: In the first section, you need to provide your personal information, such as Marketplace identifier, name, the name of your spouse, address, policy start date, and so on.
Step 3: The second section is dedicated to covered individuals. Write down the covered individual’s name, their SSN, date of birth, coverage start and termination dates.
Step 4: In the third part, there’s more information on coverage. Here you need to fill the following information for each month: enrollment premium, second lowest-cost silver plan premium or the advance payment of premium tax credit.
Step 5: Once you completed a 1095-A form, click the "Done" button to download it.
FAQ: Let’s Go Through Form 1095-A Popular Questions
How to get 1095-A?
You can download a fillable 1095-A form from PDFLiner. If you are looking for your completed Form 1095-A, you would need to log in to your personal account at HealthCare.gov and find your copy of the form there.
Can I fill out my own 1095-A?
No, you can't fill out your own 1095-A. You should request a copy of your Form 1095-A from a federally facilitated Marketplace, or simply log in into your HealthCare.gov account and get your Health Insurance Marketplace Statement there. Only Marketplaces are allowed to fill out Form 1095-A.
Do I have to put 1095-A on my taxes?
Yes, you should add your Form 1099-A when you file your taxes. The form is being used to find out if there is any difference between the amount you qualify for and used premium tax credit.
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