Part 1: Your General Information
The HCTC Eligible Recipient's name, SSN, date of birth, two phone numbers, mailing address and email address.
13441-A
Health Coverage Tax Credit (HCTC) Monthly Registration and Update
- Agency
- IRS
- Revision
- Rev. 4-2021
- Fillable fields
- 92
- Pages
- 5
- Official source
- IRS form page
- Checked
- October 21, 2026
Form 13441-A: Health Coverage Tax Credit (HCTC) Monthly Registration and Update
Form 13441-A is the registration and update form for the monthly Health Coverage Tax Credit (HCTC) program. Its instructions open with this notice: "The last eligible coverage month for HCTC is December 2021. The HCTC is not available for months starting with January 2022."
The form collects the eligible recipient's details, an eligibility certification, family members, health plan and premium information, an optional third-party designee and a signature. The instructions say that once the form is mailed, it can take up to 6 weeks (if all requirements are met) before registration confirmation arrives, and that people already enrolled report changes on an updated Form 13441-A.
The instructions also point to Form 8885, Health Coverage Tax Credit, filed with the annual federal tax return. You can fill it out free in your browser on this page and download the result without an account.
What's on Form 13441-A
Part 2: Confirm Your Eligibility
Boxes for PBGC payee or TAA, ATAA or RTAA status, and a certification of eight statements, such as not being enrolled in Medicare Part A, B, C, or D.
Part 3: Family Member Information
Up to five family members, each with name, SSN, date of birth, relationship and whether the person is on the same health plan.
Part 4: Health Plan Information
Plan provider, HCTC vendor name and number, ID numbers, policy holder, a seven-line premium calculation and a COBRA section.
Part 5: Account Accessibility
An optional Third-Party-Designee with name, two phone numbers and a five-digit Personal Identification Number (PIN).
Part 6: Form Completion
Signature under penalties of perjury, printed full name and date. Signing also authorizes the IRS to discuss eligibility and payments with the health insurer, administrator or former employer.
How to fill out Form 13441-A
- 1
Gather the health insurance bill
The instructions list a copy of the health insurance bill dated within the last 60 days, showing the name, plan name and phone, monthly premium, plan ID numbers, coverage dates and payment address.
- 2
Pick the type of registration
The instructions describe a new enrollment, a new enrollment as a Qualifying Family Member and an update. An update completes Parts 1, 2 and 6 plus any changing fields in Parts 3, 4 or 5.
- 3
Complete Parts 1 to 3
Enter the recipient's details, check the eligibility boxes and list each family member. The instructions ask for the SSN at the top of each document sent.
- 4
Work through Part 4
Enter the plan details and premiums. The form says line 5 is line 1 minus line 4, multiplied by 27.5% (.275), and line 7 is line 5 plus line 6.
- 5
Choose a designee or not
Check Yes in Part 5 and choose a five-digit PIN to name a Third-Party-Designee, or check No and go to Part 6.
- 6
Sign Part 6
Sign, print the full name and date. The form says it has to be signed and dated for the registration to be processed.
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Where it went, timing and the program end
Program end
The instructions say the last eligible coverage month for HCTC is December 2021 and the HCTC is not available for months starting with January 2022.
Fax or email
The instructions list fax 855-250-1731 with a cover sheet, or password-protected email to [email protected]. A faxed form is not sent again by mail.
Internal Revenue Service, Stop 6098 AUSC, Austin, Texas 78741. The instructions say no acknowledgment is sent and duplicate requests delay processing.
Processing time
Up to 6 weeks (if all requirements are met) before registration confirmation. The instructions say to keep paying 100% of the health insurance bills to the plan in the meantime.
Form 8885
The instructions say Form 8885 is filed with the annual federal tax return by the due date (including any extensions) to confirm the months elected for the monthly HCTC.
Health plan payment setup
The instructions say to confirm that the Health Plan Provider or Third Party Administrator meets the IRS payment requirements, including filing Form 3881, ACH Vendor/Miscellaneous Payment Enrollment - HCTC.
Related forms
Who fills out Form 13441-A?
The person registering for the monthly HCTC completes and signs it and sends it to the HCTC Program at the IRS.
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Questions about Form 13441-A
Does Form 13441-A cover current coverage months?
The instructions say the last eligible coverage month for HCTC is December 2021 and the HCTC is not available for months starting with January 2022.
How long did registration take?
The instructions say it can take up to 6 weeks (if all requirements are met) before registration confirmation arrives.
What document goes with the form?
A copy of the health insurance bill dated within the last 60 days with the items the instructions list. A Qualifying Family Member registering after Medicare enrollment, death or divorce adds proof of that event.
What is a Third-Party-Designee?
A person named in Part 5, such as a spouse, family member or other trusted advisor, who can ask about or change the HCTC account. They give the chosen PIN when they call.
How does Form 8885 relate to it?
The instructions say Form 8885 is filed with the annual return to confirm the months elected. Without a timely election, the instructions say all Advance Monthly Payment amounts and HCTC reimbursements are repaid as additional tax.
What about coverage through a spouse's employer?
Part 4 says that coverage through a spouse's employer that is not a COBRA plan cannot receive the Monthly HCTC, but the Yearly HCTC can be claimed by filing Form 8885 with the federal income tax return.