Form 1095-A is a crucial document for individuals who have obtained health insurance coverage through the Health Insurance Marketplace. This form provides important information needed to complete your federal tax return, including details about your coverage, premium amounts, and any premium tax credits you may be eligible for. Below are three diverse examples that illustrate how Form 1095-A is utilized in different scenarios.
Maria and John, a married couple with two children, purchased a health insurance plan through the Health Insurance Marketplace. They qualify for a premium tax credit based on their household income.
Here’s how their Form 1095-A looks:
| Column | Description |
|---|---|
| 1 | Recipient’s Name: Maria & John Doe |
| 2 | Policy Number: 123456789 |
| 3 | Start Date: 01/01/2023 |
| 4 | End Date: 12/31/2023 |
| 5 | Monthly Premium Amount: $500 |
| 6 | Premium Tax Credit: $200 |
Maria and John will use the information from this form to claim their premium tax credit when filing their taxes, which will lower their overall tax liability.
Tom is a single individual who purchased health insurance through the Marketplace but does not qualify for a premium tax credit due to his income level.
His Form 1095-A would appear as follows:
| Column | Description |
|---|---|
| 1 | Recipient’s Name: Tom Smith |
| 2 | Policy Number: 987654321 |
| 3 | Start Date: 01/01/2023 |
| 4 | End Date: 12/31/2023 |
| 5 | Monthly Premium Amount: $400 |
| 6 | Premium Tax Credit: $0 |
Tom needs to report this information on his tax return, even though he isn’t eligible for a premium tax credit.
Sarah enrolled in the Marketplace in March 2023 but switched plans in July due to a change in her financial situation. This requires her to receive two separate 1095-A forms for the year.
Her forms will be issued as follows:
First Form (January - June):
| Column | Description |
|---|---|
| 1 | Recipient’s Name: Sarah Johnson |
| 2 | Policy Number: 111222333 |
| 3 | Start Date: 01/01/2023 |
| 4 | End Date: 06/30/2023 |
| 5 | Monthly Premium Amount: $450 |
| 6 | Premium Tax Credit: $150 |
Second Form (July - December):
| Column | Description |
|---|---|
| 1 | Recipient’s Name: Sarah Johnson |
| 2 | Policy Number: 444555666 |
| 3 | Start Date: 07/01/2023 |
| 4 | End Date: 12/31/2023 |
| 5 | Monthly Premium Amount: $500 |
| 6 | Premium Tax Credit: $200 |
Sarah will need to combine the information from both forms when filing her taxes to accurately report her coverage and any tax credits.