What to Know About Health Coverage Information Statements You May Receive in 2017

obamacare

Many individuals will receive ACA information statements from their employer or coverage provider by early March in 2017 about their 2016 health insurance coverage:

  • Form 1095-B, Health Coverage
  • Form 1095-C, Employer-Health Insurance Offer and Coverage

 

Here is information about these forms:

1095-B
Sent to Individuals who had health coverage for themselves or their family members that is not reported on Form 1095-A or Form 1095-C.
Sent by Health Coverage Providers –

  • Insurance companies outside the Marketplace
  • Government agencies such as Medicare or CHIP
  • Employers who provide certain kinds of health coverage, which is sometimes referred to as “self-insured coverage,” but are not required to send Form 1095-C.

Other coverage providers

What to do with

This Form

This form provides information about your 2016 health coverage.

Use Form 1095-B for information on whether you and your family members had health coverage that satisfies the individual shared responsibility provision.

  • If Form 1095-B shows coverage for you and everyone in your family for the entire year, check the full-year coverage box on your tax return.
  • If there are months when you or your family members did not have coverage, determine if you qualify for an exemption or must make an individual shared responsibility payment.

You don’t need to wait for your Form 1095- B to file your tax return. Do not attach Form 1095-B to your tax return – keep it with your tax records. Contact the issuer if you have questions about your Form 1095-B.

 

1095-C
Sent to Certain employees of applicable large employers
Sent by Applicable large employers – generally those with 50 or more full-time employees, including full-time equivalent employees
What to do with

This Form

Form 1095-C provides information about the health coverage offered by your employer in 2016 and, in some cases, about whether you enrolled in this coverage.

Use Form 1095-C to help determine your eligibility for the premium tax credit.

  • If you enrolled in a health plan in the Marketplace, you may need the information in Part II of Form 1095-C to help determine your eligibility for the premium tax credit.
  •  If you did not enroll in a health plan in the Marketplace, the information in Part II of your Form 1095-C is not relevant to you.

 

Use Form 1095-C for information on whether you or any family members enrolled in certain kinds of coverage offered by your employer – sometimes referred to as “self-insured coverage”.

  • If Form 1095-C shows coverage for you and everyone in your family for the entire year, check the full-year coverage box on your tax return.
  • If there are months when you or your family members did not have coverage, determine if you qualify for an exemption or must make an individual shared responsibility payment.

You don’t need to wait for your Form 1095- C to file your tax return. Do not attach Form 1095-C to your tax return – keep it with your tax records. Contact the issuer if you have questions about your Form 1095-B.

 

If you enrolled in coverage through the Marketplace, you will receive a Form Form 1095-A, Health Insurance Marketplace Statement. For more information about this form, see the Health Care Information Forms for Individuals questions and answers on IRS.gov/aca.

 

Chart Explains How the Health Care Law Affects You

As you prepare to file your 2016 tax return, review this chart to see how the health care law affects you.

IF YOU… THEN YOU…
 

Are a U.S. citizen or a non-U.S. citizen living in the United States

 

Must have qualifying health care coverage, qualify for a health coverage exemption, or make a payment when you file your income tax return.

 

Had coverage or an employer offered coverage to you in the previous year

 

Will receive one or more of the following forms;

This information will help you complete your tax return.

Had health coverage through an employer or under a government program – such as Medicare, Medicaid and coverage for veterans – for the entire year Just have to check the full-year coverage box on your Form 1040 series return and do not have to read any further.
Did not have coverage for any month of the year Should check the instructions to Form 8965, Health Coverage Exemptions, to see if you are eligible for an exemption.
Were eligible for an exemption from coverage for a month Must claim the exemption or report an exemption already obtained from the Marketplace by completing Form 8965, Health Coverage Exemptions, and submitting it with your tax return.
Did not have coverage and were not eligible for an exemption from coverage for any month of the year Are responsible for making an individual shared responsibility payment when you file your return.
Are responsible for making an individual shared responsibility payment Will report it on your tax return and make the payment with your income taxes.
Need qualifying health care coverage for the current year Can visit HealthCare.gov to find out about the dates of open and special enrollment periods for purchasing qualified health coverage.
Enroll in health insurance through the Marketplace for yourself or someone else on your tax return. Might be eligible for the premium tax credit.

 

Received the benefit of more advance payments of the premium tax credit than the amount of credit for which you qualify on your tax return Will repay the amount in excess of the credit you are allowed subject to a repayment cap.
Did not enroll in health insurance from the Marketplace for yourself or anyone else on your tax return Cannot claim the premium tax credit.

 

Are eligible for the premium tax credit Can choose when you enroll in coverage to get premium assistance sent to your insurer each month to lower your monthly payments or get all the benefit of the credit when you claim it on your tax return.
Are claiming the premium tax credit and did not benefit from advance payments of the premium tax credit Must file a tax return and IRS Form 8962Premium Tax Credit (PTC) and claim the credit on the line labeled – Net premium tax credit.
Choose to get premium assistance when you enroll in Marketplace coverage Will have payments sent on your behalf – to your insurance provider. These payments are called advance payments of the premium tax credit.
Get the benefit of advance payments of the premium tax credit and experience a significant life change, such as a change in income or marital status Should report these changes in circumstances to your Marketplace when they happen.
Get the benefit of advance payments of the premium tax credit Will report the payments on your tax return and reconcile the amount of the payments with the amount of credit for which you are eligible.