The Affordable Care Act requires most U.S. citizens to have health coverage that meets a government standard — known as minimum essential coverage — or be subject to a potential tax penalty.
Starting in January 2016, health plan subscribers will get one or more 1095 tax forms depending on their plan. They’ll need this information as proof of coverage when filing their returns to the IRS — or they might have to pay a penalty.*
The forms apply to everyone with health coverage, except those who purchased a catastrophic plan through a health insurance marketplace such as Covered California. The form they’ll receive depends on the type of health plan they have:
Type of plan | Form |
---|---|
Individual and family through a marketplace |
1095-A |
Individual and family direct from carrier |
1095-B |
Small group (50 or fewer employees) |
1095-B |
Fully insured large group (more than 50 employees) | 1095-B and 1095-C |
Self-funded large group (more than 50 employees) | 1095-C |
Filing tax returns
When your employees fill out their tax returns, they should report any federal financial assistance they received toward health coverage. Additional tax forms will determine if the taxpayer receives a credit or owes payment. Subscribers will need to file Form 8962 to claim the premium tax credit or if advance payments were made to Kaiser Permanente.
Subscribers may have to pay a tax penalty if they:
- had a coverage gap lasting more than 3 months
- had more than one coverage gap in 2015
- can’t claim an exemption in 2015
Subscribers may receive corrected forms, so it’s important to use the most current forms to ensure accuracy of information. Also note that not filing a return could affect a subscriber’s eligibility for federal assistance.
Review our fact sheet and Q&A for more information on minimum essential coverage and employer reporting or see below for information on each form.