Federal Tax Filing: IRS Form 1095-A
Covered California will send IRS Form 1095-A Health Insurance Marketplace Statement to all enrolled members. It is used to fill out IRS Form 8962 Premium Tax Credit as part of your federal tax return.
1. Get Form IRS Form 1095-A by mail.
Did not receive Form FTB 3895 by mail? Call us.
2. Make sure your form IRS Form 1095-A is correct. If not, call us.
Verify basic information about your health plan and household members on Parts I and II of the form. See errors? Call us.
Make sure the premium for your second lowest cost Silver plan (SLCSP) is correct. Use our calculator to find the second lowest silver plan.
3. Fill out IRS Form 8962 to calculate the amount of Premium Tax Credit you received in advance and the amount that you were entitled to.
Use this calculator to find the is amount of the second-lowest-cost Silver plan premium second- lowest-cost Silver plan where you live.
If you need help, please contact the Covered California Service Center. Representatives cannot provide tax advice.
For information about your state taxes (Form FTB 3895), see State 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.
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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