Department of the Treasury
Internal Revenue Service
Instructions for Form 1095-A
Health Insurance Marketplace Statement
Section references are to the Internal Revenue Code
How To File
unless otherwise noted.
Electronic filing. You must submit the information to the
IRS electronically. Submit the information through the
Department of Health and Human Services Data Services
For the latest information about developments related to
Form 1095-A and its instructions, such as legislation
enacted after they were published, go to
Statements To Individuals
Furnishing required information to the individual.
Marketplaces use Form 1095-A to furnish the required
statement to recipients. A separate Form 1095-A must be
Form revisions. The language “Do not attach to your tax
furnished for each policy and the information on the Form
return. Keep for your records.” was inserted on the Form
1095-A should relate only to that policy. If two or more tax
1095-A under the title of the form.
filers are enrolled in one policy, each tax filer receives a
statement reporting coverage of only the members of that
tax filer's tax household. See the instructions for line 4 for
For information related to the Affordable Care Act, visit
more information about who is a recipient. Don't furnish a
Form 1095-A for a catastrophic health plan or a
For additional information related to Form 1095-A, visit
stand-alone dental plan. See the instructions for Part III,
On Form 1095-A statements furnished to recipients,
filers of Form 1095-A may truncate the social security
number (SSN) of an individual receiving coverage by
showing only the last four digits of the SSN and replacing
Purpose of Form
the first five digits with asterisks (*) or Xs. Truncation isn't
allowed on forms filed with the IRS.
Form 1095-A is used to report certain information to the
IRS about individuals who enroll in a qualified health plan
Statements must be furnished to recipients on paper by
through the Health Insurance Marketplace. Form 1095-A
mail, unless a recipient affirmatively consents to receive
is also furnished to individuals to allow them to take the
the statement in an electronic format. If mailed, the
premium tax credit, to reconcile the credit on their returns
statement must be sent to the recipient’s last known
with advance payments of the premium tax credit
permanent address, or if no permanent address is known,
(advance credit payments), and to file an accurate tax
to the recipient’s temporary address.
Consent to furnish statement electronically. The
requirement to obtain affirmative consent to furnish a
Who Must File
statement electronically ensures that statements are sent
Health Insurance Marketplaces must file Form 1095-A to
electronically only to individuals who are able to access
report information on all enrollments in qualified health
them. A recipient may provide his or her consent on paper
plans in the individual market through the Marketplace. Do
or electronically, such as by e-mail. If consent is provided
not file a Form 1095-A for a catastrophic health plan or a
on paper, the recipient must confirm the consent
separate dental policy (called a “stand-alone dental plan”
electronically. An electronic statement may be furnished
in these instructions).
by e-mail or by informing the recipient how to access the
statement on a Marketplace’s website (for example, in the
When To File
recipient's Marketplace account).
File the annual report with the IRS and furnish the
statements to individuals on or before January 31, 2017,
for coverage in calendar year 2016.
The requirement to furnish a statement to individuals
Part I—Recipient Information
will be met if the Form 1095-A is properly addressed and
Line 1. Enter the Marketplace state name or
mailed or furnished electronically (if the recipient has
consented to electronic receipt) on or before the due date.
If the regular due date falls on a Saturday, Sunday, or
Line 2. Enter the number the Marketplace assigned to
legal holiday, furnish the statement by the next business
the policy. If the policy number is greater than 15
day. A business day is any day that isn't a Saturday,
characters, only enter the last 15 characters.
Sunday, or legal holiday.
Line 3. Enter the name of the issuer of the policy.
Sep 01, 2016
Cat. No. 63016Q