What is Form 1095-A?

You will need your Form 1095-A when you prepare your federal income tax return for 2016.

Covered California will send your Form 1095-A to the mailing address listed in your account by January 31, 2017. Your form will also be available in your account for you to view or print. Login to your Covered California account and click on the “Documents and Correspondence” section.

What is it?

Your Form 1095-A shows the amount the Internal Revenue Service (IRS) paid to your insurance company in 2016 to help you with the cost of your health coverage. The amount paid was based on the most recent household income and size information you provided to Covered California. If that information changed during the year and you did not report the change to Covered California, you may have paid too much or too little for your health coverage.

If you enrolled in a health plan through Covered California but did not receive financial help, you will still receive a Form 1095-A to show you the months you had health insurance through Covered California.

What do I do with Form 1095-A?

Save this form — you will need it when you prepare your taxes for 2016. Similar to a W-2, a Form 1095-A is one of the things that will determine the amount of taxes you will pay or the refund you receive. You’ll use it to fill out IRS Form 8962. Form 8962 is an IRS form to “reconcile” the tax credits your health insurance company received based on your estimated income with the amount that you qualify for based on your actual income, as reported on your federal tax return. For more information about IRS Form 8962, please visit: www.irs.gov/aca.

For help with your taxes, consult a tax preparer. Most tax preparers are ready to assist you with this form and the tax requirements. You may be able to get free help filing your taxes, including free software programs or in-person assistance. Go to www.irs.gov/freefile or www.irs.gov/VITA.

What if I didn’t get a Form 1095-A?

If you did not receive a Form 1095-A in the mail or in your Covered California account by January 31, 2017, complete the dispute form or contact Covered California at (800) 300-1506. The dispute form is currently only available in English. For assistance in Spanish or any other language, please contact Covered California at (800) 300-1506.

Please note: If you are no longer an active member of Covered California, you will not be able to access your Form 1095-A in your online account. Please contact Covered California at (800) 300-1506 to request a paper copy if you do not receive it by January 31, 2017.

Covered California members who enrolled in a minimum coverage plan (also known as catastrophic coverage) in 2016 will receive a Form 1095-B or 1095-C directly from their health insurance company.

What if my Form 1095-A is incorrect?

If the information below is incorrect on your Form 1095-A, please contact the Covered California Service Center at (800) 300-1506 to provide the right information and receive a corrected Form 1095-A, or receive directions on how to make the necessary changes before filing your taxes.

  • The amount listed in Part III, Column B of your 1095-A form, the Monthly second-lowest cost silver plan (SLCSP) premium.
  • Your name.
  • Your date of birth.
  • Your Social Security number.
  • Your address.

If the following information is incorrect on your Form 1095-A, complete the dispute form. (The dispute form is currently only available in English. For assistance in Spanish or any other language, please contact Covered California at [800] 300-1506.)

  • Incorrect amount of premium tax credits.
  • Wrong months of coverage listed or not shown for covered individuals.
  • Missing household members or incorrect names.
  • Health coverage was terminated.

When will I receive a corrected Form 1095-A?

Covered California will respond to you within 60 days of the date of submission of the Form 1095-A dispute form and issue a corrected form. If the changes you requested cannot be verified or if supporting documentation is needed, you will be contacted by Covered California. Supporting documents could include invoices from your health insurance company that show the amount of premium tax credits you received and the monthly premium you paid or how much premium tax credit you were eligible for, shown in Covered California notices.

If you file your tax return before you receive your corrected Form 1095-A from Covered California, you may have to file an amendment to your tax return. If you do not get a new, corrected Form 1095-A before you are required to file your taxes, you must use the original Form 1095-A that Covered California sent you to complete Form 8962 and file your tax return.

What is the difference between Form 1095-A, B and C?

  • Form 1095-A, Covered California Statement. Covered California sends this form to individuals who enrolled in coverage with Covered California (except for individuals who enrolled in a minimum coverage/catastrophic plan. These individuals will receive a Form 1095-B or 1095-C directly from their health insurance company).
  • Form 1095-B, Health Coverage. Health insurance companies outside of Covered California and agencies such as Medi-Cal send this form to individuals they cover, with information about who was covered and when.
  • Form 1095-C, Employer-Provided Health Insurance Offer and Coverage. Employers that offer health coverage referred to as “self-insured coverage” send this form to individuals they cover, with information about who was covered and when.

What if I received an incorrect Form 1095-B or 1095-C?

Medi-Cal, Medicare, employers and health insurance companies will issue Form 1095-B and 1095-C. If you have questions about your Form 1095-B or 1095-C, please contact the sender. Covered California will not be able to resolve disputes for forms sent by any other source.

Covered California for Small Business health plan members may receive an IRS Form 1095-B or 1095-C. We encourage you to check with your health insurance company or employer if you have questions about these forms.

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