Why on Earth do we need more IRS forms?
Great question! It’s because most Americans have a mandate to obtain health insurance imposed by the Affordable Care Act (ACA). Failure to comply means you might get penalized, so it’s important to have a way to prove you had insurance.
Yet there are literally hundreds of different sources for health insurance, such as private health insurance companies, the Exchanges like Covered California, and government programs like Medicare and Medi-Cal. Plus there are thousands of different kinds of health insurance plans, of varying quality. The only way the IRS can know whether or not you had health insurance that meets the ACA standards is if they are notified.
So the IRS created new forms – 1095 forms – that your insurance provider is responsible to submit to prove if and when you had coverage.
What are the 1095 Forms?
There are three versions of the 1095 Form, depending on who is providing the health insurance – Covered California (or another exchange), an insurer or your self-insured employer.
- Form 1095-A (Marketplace) applies if you purchased health insurance through Covered California or another state or federal exchange. This form will be sent out by Covered California or the exchange. You need to have a Form 1095-A to file your taxes if you got insurance coverage for any part of the year from Covered California (or a difference exchange).
It includes information about any subsidies you might have qualified for. Here is more information about Form 1095-A.
- Form 1095-B, Health Coverage is the most common form. It applies if –
– You got your health insurance from an employer-sponsored plan, or
– You bought it yourself (but not from an exchange or Covered California) or
– You have coverage through Medicare, Medi-Cal or the VA
If you are on Medi-Cal or Medicare, here is more information about the 1095-B form. If you get your health care from the Veterans Administration, here is more info from the VA about the 1095-B form.
You do not need Form 1095-B to file your income taxes but you should definitely follow up for a copy to check it for accuracy. Why? Because if the form erroneously indicates that you failed to maintain insurance for a part of the year, you may be subject to a penalty.
3.) Form 1095-C, Employer-Provided Health Insurance, applies only if your insurance coverage was provided by an employer with more than 50 employees. Here is more information from TurboTax on who has to file the form. You do not need Form 1095-C to file your income taxes but you should definitely follow up for a copy to check it for accuracy.
What if you didn’t get your 1095 form?
The form should have been sent out by whoever insured you – a health insurance company, your employer (if self-insured) or a government agency. If you didn’t get a form, you should contact the insurer:
- Covered California:
If you didn’t receive a copy of your Form 1095-A, or if it was inaccurate, contact Covered California at 800-300-1506. You must have this form to file your income taxes.
- Medi-Cal:
If you didn’t receive a copy of your 1095-B form, need a reprint, or it was inaccurate, contact your county human or social services office.
- Medicare:
If you didn’t receive a copy of your 1095-B form, need a reprint, or it was inaccurate, contact Medicare at: 1-800-MEDICARE (1-800-633-4227)
- Veterans Administration:
If you didn’t receive a copy of your 1095-B form, call 1-877-222-VETS (8387).
- Group health insurance from your job:
If you didn’t receive a copy of your 1095-B form, contact your employer.
- Directly from a health insurer (not Covered CA or an Exchange)
If you didn’t receive a copy of your 1095-B form, contact your health insurance company.
- From a “self-insured” or “large” employer:
If you didn’t receive a 1095-C form, contact HR or Benefits at work.
What if you got insurance from multiple sources during the year?
You will get multiple 1095 forms! Here are some examples.
Example 1:
In early 2015, Jamie worked for a New York Fortune 500 company who “self-insured.” In May, she was laid off. She decided it was time to move back home to Pasadena, CA and try to get a job there. Once she arrived, she immediately contacted Covered California. Her income was non-existent so she qualified for Medi-Cal. In October, she got a job with a small property management firm and remained there for the rest of the year. They didn’t provide any health benefits. Her income was higher so she knew she no longer qualified for Medi-Cal. She contacted Covered California and got an insurance plan with a subsidy based on her new estimated income.
How many 1095 Forms will Jamie receive?
Three. Her self-insured employer will send her a 1095-C, Medi-Cal will send her a 1095-B and Covered California will send her a 1095-A.
Example 2:
Liberty retired from her position as an educator in 2014, and promptly signed up for Medicare. During the entire year of 2015, her insurance was through Medicare
How many 1095 Forms will Liberty receive?
One. Liberty will receive a 1095-B from Medicare.
Example 3:
Chris is a waiter in a mom-and-pop restaurant. He doesn’t get health insurance from his employer. In January 2015 he purchased insurance through Covered California, and he got a subsidy because his income was so low. In August, the County had to re-pipe the sewer line that ran in front of the restaurant, tearing up the street. Business slowed down, so Chris’s employer cut his hours back. He could no longer afford his Covered California premium, even with the subsidy. He called Covered California and explained. They told him that with his lower income, he qualified for Medi-Cal. So he switched to Medi-Cal in September. But in late October, the sewer project was completed and by November, business was booming again. Chris went back to full-time. He started making too much money to qualify for Medi-Cal anymore, so he called Covered California and got a subsidized plan again.
How many 1095 Forms will Chris receive?
Two. Chris will receive a 1095-A form from Covered California and a 1095-B from Medi-Cal.
Example 4:
Mia and Max, her young son, live in a future California that’s just around the corner! They enjoy universal healthcare with a Medicare for All-type system that was established as a next step to the Affordable Care Act – an “ACA 2.0.” Mia, who remembers very well the hassles of private health insurance, is so happy that all doctors are included for coverage, and she doesn’t have to pay any high deductibles or co-pays anymore. She knows that Medicare for All will bring her son, Max, the healthcare security that her parents only dreamed of (until they turned 65 and got on Medicare for Seniors).
How many 1095 Forms will Mia receive, no matter whether she’s employed or changes jobs, or has her own business, or how much she earns, or moves?
None. Neither Mia nor her employers will have to deal with proving to the IRS that she had health insurance.
Just a thought from the HEAL Team:
Now that the mandate to maintain health insurance is enforced by the IRS, everyday people and businesses are confronted with a huge – and absolutely unnecessary – administrative burden as part of their already crazy and complicated income tax filings.
It’s totally freaking ridiculous. If you agree with HEAL California that health care should be universal, high quality, easy and affordable, and not a hassle, join us. Together, we will win!
And by the way, don’t think the hassles stop here! 1095 forms are only the beginning. Stay tuned for more blogs on taxes and the ACA.
Sorry, but we have to put a disclaimer here: