Tax Forms and Filing

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

  1. The federal IRS Form 1095-A Health Insurance Marketplace Statement.
  2. The California Form FTB 3895 California Health Insurance Marketplace Statement.

These forms are used when you file your federal and state tax returns to:

  • Calculate your tax refund or credit 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.

Please consult the California Franchise Tax Board, the Internal Revenue Service, or a tax advisor if you have questions about your specific forms, penalty amount, or tax return.

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