Who Sends Out 1095-A Forms and How to Handle Issues With Them

Health insurance and taxes are closely linked in the U.S., especially for those with coverage through the Health Insurance Marketplace. Form 1095-A provides details about a person’s health plan and any premium tax credits received. This form is essential for filing an accurate tax return and determining eligibility for tax benefits.

Errors or missing forms can delay tax filings or affect refunds, so it’s important to understand where these forms come from and how to address any issues.

Who Issues 1095-A

Form 1095-A is issued by the Health Insurance Marketplace, which includes both the federally facilitated Marketplace (HealthCare.gov) and state-based Marketplaces. Each Marketplace generates and distributes this form to individuals enrolled in a qualified health plan through their platform. The form is typically sent by January 31 of the following tax year.

Marketplaces compile the information on Form 1095-A using enrollment data from insurance providers. This includes monthly premiums, any advance premium tax credits applied, and the full cost of the plan before subsidies. As an intermediary between insurers and enrollees, the Marketplace ensures the accuracy of this data before issuing the form.

The IRS also receives copies of 1095-A forms from the Marketplaces to verify tax return information, particularly for those claiming the Premium Tax Credit. Discrepancies can lead to delays in processing returns or adjustments to refund amounts.

Who Receives 1095-A

Form 1095-A is sent to individuals who enrolled in a health insurance plan through the Health Insurance Marketplace at any point during the tax year. This applies whether they paid full premiums out of pocket or received advance premium tax credits. Even those with Marketplace coverage for only part of the year will receive the form reflecting their enrollment months.

Households with multiple members under the same policy typically receive a single 1095-A listing all enrollees. The form is addressed to the primary policyholder, who must use it when filing their tax return. If household members file separate returns, they may need to coordinate how they report the information, especially if premium tax credits were applied.

Those with employer-sponsored insurance, Medicare, Medicaid, or other government programs will not receive Form 1095-A, as those are reported on different forms, such as 1095-B or 1095-C. Individuals who purchased private health insurance directly from an insurer, rather than through the Marketplace, also will not receive this form, as their coverage was not eligible for premium tax credits.

Handling Missing or Incorrect Forms

Missing or inaccurate Form 1095-A can create complications when filing taxes, especially for those who received advance premium tax credits. If the form is not received by early February, checking online through a Health Insurance Marketplace account is the first step, as many states provide digital copies before mailing physical ones. If unavailable, contacting the Marketplace directly is necessary to confirm whether it was issued and sent to the correct address.

Errors on the form, such as incorrect premium amounts or missing household members, can affect the calculation of the Premium Tax Credit on Form 8962, potentially delaying refunds or resulting in unexpected tax liabilities. Taxpayers should request a corrected 1095-A through the Marketplace before submitting their return. The IRS advises against using an incorrect form, as it can trigger audits or additional documentation requests.

If a corrected form is delayed, taxpayers may need to request an extension using Form 4868 to avoid late filing penalties. However, any estimated tax liability should still be paid by the April deadline to prevent interest charges. If a return is filed with incorrect 1095-A data and later amended, Form 1040-X should be submitted with updated calculations.