Tax Filings and Forms

During tax season, Covered California sends two forms to members:

1. The federal IRS Form 1095-A Health Insurance Marketplace Statement.
2. The California Form FTB 3895 California Health Insurance Marketplace Statement. Use the California Franchise Tax Board forms finder to view this form.

These forms are used when you file your federal and state tax returns to:

• Calculate your tax refund or credit or the tax amount you owe.
• Show that you were insured so that you don’t pay a state penalty for the months you were covered.

Please consult the California Franchise Tax Board, the Internal Revenue Service, or a tax advisor if you have questions about your specific forms, penalty amount, or tax return.

IRS Form 1095-A

You will need your Form 1095-A when you prepare your federal income tax return.

Your Form 1095-A shows the amount the Internal Revenue Service (IRS) paid to your insurance company to lower the cost of your health coverage. The amount paid was based on the most recent household size and income information you provided to Covered California. If that information changed during the year and you did not report the change to Covered California, you may have paid too much or too little for your health coverage. Below, are answers to common questions about IRS Form 1095-A.

What do I do with Form 1095-A?
You will need it when you prepare your taxes. Similar to a W-2, a Form 1095-A is one of the things that will determine the amount of taxes you will pay or the refund you receive. You will use it to fill out IRS Form 8962. Form 8962 is an IRS form to “reconcile” the tax credits your health insurance company received based on your estimated income with the amount that you qualify for based on your actual income, as reported on your federal tax return.

Get more information about IRS Form 8962 on the IRS website.

For help with your taxes, consult a tax preparer. Most tax preparers are ready to assist you with this form and the tax requirements. You may be able to get free help filing your taxes, including free software programs or in-person assistance. Find out if you qualify to use Free File, the IRS’s free tax-filing software, or VITA, the IRS’s program for free tax preparation.

What if I didn’t get a Form 1095-A?

If you have not received a Form 1095-A in the mail or in your Covered California account, complete the dispute form or contact Covered California at (800) 300-1506. The dispute form is currently only available in English. For assistance in Spanish or any other language, please contact Covered California at (800) 989-2199.

Current Members: Log in to your Covered California account. Go to “More Actions” in the bottom right corner of the web page. Click “Secure Mailbox.”

Past members: Log in to your Covered California account. Go to “More Actions” in the bottom right corner of the web page. Click “View Past Application.” Select “Documents and Correspondence.”

Covered California members who enrolled in a minimum coverage plan (also known as catastrophic coverage) may receive a Form 1095-B or 1095-C directly from their health insurance company. Health insurance companies are not required to send a 1095-B for catastrophic coverage and this form is not required to file your taxes.

What if my Form 1095-A is incorrect?

If the information below is incorrect on your Form 1095-A, please contact the Covered California Service Center at (800) 989-2199 to provide the right information and receive a corrected Form 1095-A, or receive directions on how to make the necessary changes before filing your taxes.

• Your name.
• Your date of birth.
• Your Social Security number.
• Your address.

If the following information is incorrect on your Form 1095-A, complete the dispute form. (The dispute form is currently only available in English. For assistance in Spanish or any other language, please contact Covered California at (800) 989-2199.

• Incorrect amount of premium tax credits.
• Wrong months of coverage listed or not shown for covered individuals.
• Missing household members or incorrect names.
• Health coverage was terminated.

When will I receive a corrected Form 1095-A?

Covered California will respond to you within 60 days of the date of submission of the Form 1095-A dispute form and issue a corrected form.

If you file your tax return before you receive your corrected Form 1095-A from Covered California, you may have to file an amendment to your tax return. If you do not get a new, corrected Form 1095-A before you are required to file your taxes, you must use the original Form 1095-A that Covered California sent you to complete Form 8962 and file your tax return.

What is the difference between Form 1095-A, Form 1095-B and Form 1095-C?

• Form 1095-A, Covered California Statement: Covered California sends this form to individuals who enrolled in coverage with Covered California (except for individuals who enrolled in a minimum coverage/catastrophic plan. These individuals may receive a Form 1095-B or 1095-C directly from their health insurance company).
• Form 1095-B, Health Coverage: Health insurance companies outside of Covered California and programs such as Medi-Cal send this form to individuals they cover, with information about who was covered and when.
• Form 1095-C, Employer-Provided Health Insurance Offer and Coverage: Large employers send this form to their employees. It states the health coverage that was offered (if any) and the months in which it was offered.

What if I received an incorrect Form 1095-B or 1095-C?

Medi-Cal, Medicare, employers and health insurance companies will issue Form 1095-B and 1095-C. If you have questions about your Form 1095-B or 1095-C, please contact the sender. Covered California will not be able to resolve disputes for forms sent by any other source.

Covered California for Small Business health plan members may receive an IRS Form 1095-B or 1095-C. We encourage you to check with your health insurance company or employer if you have questions about these forms.

Source:
Covered California