State Tax Filing
In early 2021, some people were given more financial help than they were entitled to. They may have to pay this extra money back when they file their taxes. The government refers to paying back subsidies you earned in advance as “reconciliation.” Learn More
At the beginning of each year, Covered California sends the Form FTB 3895: California Health Insurance Marketplace Statement. This for is sent to all enrolled members for each health plan you were enrolled in through Covered California.
Form FTB 3895 lists under “Covered Individuals” everyone in your household who was enrolled in a specific plan, including when coverage began and ended. If you changed to another plan during the year, you will receive a different Form FTB 3895 with information for that plan.
Under “Coverage Information,” the form lists for each month of the year:
- The cost of your monthly premium.
- The cost of the premium for the second-lowest-cost Silver plan premium available where you live.
- How much state subsidy (called the Premium Assistance Subsidy) you received that month.
Follow these steps to reconcile your state subsidy.
Reconciling Your State Premium Assistance Subsidy on Form FTB 3849
1. Get Form FTB 3895 by mail or online from Covered California.
Your tax forms are available by signing in to your account and accessing your online mailbox. If you told Covered California that you prefer communications by mail, you should have also received a copy of the form. Didn’t receive Form FTB 3895 or can’t find it in your account? Call us at (800) 300-1506.
2. Make sure your Form FTB 3895 is correct.
Verify information about your health plan and household members on Parts I and II of the form. See any errors? Call us.
3. Fill out Form FTB 3849 to determine how much state Premium Assistance Subsidy you need to pay back.
Form 3849 instructs you to enter your monthly premium, the cost of the premium for the second-lowest-cost Silver plan premium available where you live, and how much state subsidy (called the Premium Assistance Subsidy) you received that month.
You can find this information on Form 3895, which Covered California sent you, under “Coverage Information.”
Didn’t receive Form 3895? Call us at (800) 300-1506.
4. Use Form FTB 3853 to determine if you owe an individual shared responsibility penalty or to claim exemptions from the state individual health coverage mandate on your California state tax return.
Some individuals may have been instructed to complete the Marketplace Coverage Affordability Worksheet to find their lowest-cost Bronze plan and second-lowest-cost Silver plan premiums. To find these amounts, use our calculator.
Enter the gross monthly premium for the second-lowest-cost Silver and Bronze plan in the form.
For a new copy of Form 3849, contact our service center.
Your situation may vary, and the information above is not intended as tax advice. 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, your penalty amount, or your tax return.
Many people may also need to reconcile the amount of APTC they received with the IRS.
If you need help, please contact the Covered California Service Center. Representatives can help you calculate the second-lowest-cost Silver plan premium amount but cannot provide tax advice. To view the forms referenced here and get more detailed instructions for how to complete these forms, use the California Franchise Tax Board forms finder.
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