Tax Forms and Filing

During tax season, Covered California sends two forms to members:

1. The federal IRS Form 1095-A Health Insurance Marketplace Statement

This form is used to:

  • Provide information for your federal taxes.
  • Calculate the amount of Premium Tax Credit you received, any credit you may be due after filing, or the tax amount you owe.
  • Show that you were insured so that you don’t pay a state penalty for the months you were covered. 

Didn’t receive IRS Form 1095-A? Call us at (800) 300-1506.

Get more information about your federal taxes (Form 1095-A).

2. The California Form FTB 3895 California Health Insurance Marketplace Statement

This form is used to:

  • Calculate your tax refund or credit or the tax amount you owe for the California Premium Assistance Subsidy.
  • Show that you were insured so that you don’t pay a state penalty for the months you were covered. 
  • Provide other information about your health coverage.

Didn’t receive FTB 3895? Call us at (800) 300-1506.

Resources

For information about your state taxes (Form FTB 3895), see State Tax Filing. For federal taxes, see Federal Tax Filing.

For information on limits to what you may need to repay to the Franchise Tax Board or the Internal Revenue Service, see Financial Help Repayment Limits.

For other information, see: Where to Find Your Forms, Errors on your forms?, and If You Didn’t Receive Your Tax Forms.

Please consult the California Franchise Tax Board, the Internal Revenue Service, or a tax advisor if you have questions about how to use these forms when preparing your taxes, penalty amount, or tax return.

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