The Health Insurance Marketplace

Health care insurance purchased through the Marketplace

If you purchased health care insurance through the Marketplace, you should receive a Form 1095-A, Health Insurance Marketplace Statement, at the beginning of the tax filing season. The information shown on Form 1095-A helps you complete your federal individual income tax return. If Form 1095-A shows coverage for you and everyone in your family for the entire year, check the full-year coverage box on your tax return. Among other things, Form 1095-A reports the total monthly health insurance premiums paid to the insurance company you selected through the Marketplace. It lists the amount of premium assistance you received in the form of advance payments of the premium tax credit that were paid directly to your insurance company, if any. If you received a Form 1095-A with incorrect information, see our Corrected, Incorrect or Voided Forms 1095-A questions and answers to find out how it affects your taxes.

If you chose to have advance payments of the premium tax credit paid directly to your insurance company, you must complete Form 8962, Premium Tax Credit and file a federal income tax return, even if you are otherwise not required to file. You are required to reconcile — or compare — these payments to the premium tax credit you’ll compute for your tax return. Even if you did not choose to receive advance payments, you must file a federal income tax return to claim the premium tax credit. Filing your return without reconciling your advance payments will delay your refund and may affect future advance credit payments. See below for more information regarding the effect of failing to reconcile advance payments of the premium tax credit.

If you purchased coverage through the federally facilitated Marketplace and you set-up a HealthCare.gov account, you can get a copy of Form 1095-A, Health Insurance Marketplace Statement online from your account. Visit your Marketplace’s website to find out the steps you need to follow to get a copy of your Form 1095-A online. You can use either the information from your online account, if it is available, or the Form 1095-A that is mailed to you to complete your tax return.

Failing to file tax returns will prevent advance payments in the next year

The IRS reminds taxpayers who received advance payments of the premium tax credit that they should file their tax return timely to ensure they can receive advance payments next year from their Marketplace.

If advance payments of the premium tax credit were paid on behalf of you or an individual in your family, and you do not file a tax return reconciling those payments, you will not be eligible for advance payments of the premium tax credit or cost-sharing reductions to help pay for your Marketplace health insurance coverage in the next year. This means you will be responsible for the full cost of your monthly premiums and all covered services. In addition, we may contact you to pay back some or all of the advance payments of the premium tax credit.

Marketplaces will determine eligibility for advance tax credit payments and cost-sharing reductions for the coverage year in the fall before the new coverage year starts. You will substantially increase your chances of avoiding a gap in receiving this help if you electronically file your tax return with Form 8962 by the due date of your return.

If you have a question about the information shown on your Form 1095-A, or about receiving Form 1095-A, or about a letter you received, contact your Marketplace as shown in the table below or visit HealthCare.gov/taxes.

Marketplace contact information

Visit our Health Insurance Marketplace Statements page for more information about Form 1095-A.

Purchasing health care coverage through the Marketplace and reporting changes

Each year the Health Insurance Marketplace has an open enrollment period and special enrollment periods for eligible taxpayers. For information about enrollment periods, visit HealthCare.gov or contact your state-based Marketplace.

If you enrolled in insurance coverage through the Marketplace, you should report any changes in your circumstances — like changes to your household income or family size — to the Marketplace when they happen. Changes in circumstances may affect your advance payments of the premium tax credit. When you report a change in circumstances, you may become eligible for a special enrollment period, which allows you to purchase health care insurance through the Marketplace outside of the open enrollment period. Visit the Marketplace at HealthCare.gov for more information about reporting changes in circumstances and special enrollment.

To estimate the effect that changes in circumstances may have upon the amount of premium tax credit that you can claim - see the Premium Tax Credit Change Estimator on our Affordable Care Act Estimator Tools page.

Find out more about the Premium Tax Credit and other tax provisions of the Affordable Care Act at IRS.gov

Small Business Health Options Program Marketplace

The Small Business Health Options Program Marketplace - also known simply as SHOP - helps small businesses provide health coverage to their employees. While the SHOP Marketplace was previously only open to employers with 50 or fewer full-time equivalent employees, starting in 2016, some states may make the SHOP Marketplace available to businesses with up to 100 employees. If you have more than 50 employees and don't know if you can use the SHOP Marketplace, contact your state Department of Insurance or the SHOP Call Center.

The SHOP Marketplace - which is also open to non-profit organizations - allows you to offer health and dental coverage that meets the needs of your business and your employees. SHOP offers flexibility, choice, and online application and account management. You can enroll in SHOP any time of year. There’s no restricted enrollment period when you can start offering a SHOP plan.

Businesses that offer health coverage through the SHOP Marketplace may be eligible for the small business health care tax credit.