Form 1095-A, Health Insurance Marketplace Statement
Form 1095-A reports coverage bought through the Health Insurance Marketplace and the advance premium tax credit paid on your behalf. Fill in the official IRS PDF below and download it.
This is the genuine IRS PDF, unmodified. Source: IRS official page.
What is 1095-A?
Form 1095-A, Health Insurance Marketplace Statement, is issued by the Marketplace to people who enrolled in a qualified health plan through it. It lists who was covered, the months of coverage, the monthly premiums, the premium for the second lowest cost Silver plan, and any advance payments of the premium tax credit.
You need the numbers on this form to complete Form 8962, which reconciles the advance credit you received with the premium tax credit you actually qualify for on your return. The Marketplace files the original with the IRS; the copy you receive is for your records and your tax return.
Who files 1095-A?
- Health Insurance Marketplaces file it with the IRS and furnish copies to enrollees
- Anyone who bought a qualified health plan through the Marketplace receives one
- Households claiming or reconciling the premium tax credit need it to fill out Form 8962
- Tax preparers reconstructing a client’s Marketplace coverage record
How to fill out 1095-A
- Complete Part I with the recipient’s information, the Marketplace policy number, and the coverage start and end dates.
- List each covered individual in Part II with their SSN or date of birth and coverage dates.
- Fill in Part III month by month: the enrollment premium, the second lowest cost Silver plan premium, and any advance premium tax credit paid.
- Check the totals against your Marketplace account, then download the finished PDF.
- Use the monthly amounts to complete Form 8962 with your federal return. Do not attach Form 1095-A itself to the return.
Get 1095-A
IRS publishes 1095-A as a flat PDF with no built-in form fields, so there is no quick-fill form here. Open it in the editor to type directly onto the pages, tick boxes and sign, or download the official blank and complete it in your PDF reader or by hand.
Frequently asked questions
Do I attach Form 1095-A to my tax return?
No. Keep it with your records and use its monthly amounts to fill out Form 8962, Premium Tax Credit, which is what gets filed with your return.
What if my Form 1095-A is wrong or never arrived?
Contact the Marketplace that issued your coverage. It can correct the form or resend it, and most Marketplaces also post an electronic copy in your online account.
How is 1095-A different from 1095-B and 1095-C?
Form 1095-A covers Marketplace plans only. Form 1095-B comes from insurers and other coverage providers, and Form 1095-C comes from large employers. Only the 1095-A feeds into the premium tax credit reconciliation.