VOID and CORRECTED boxes
Boxes at the top of the form. VOID marks a statement sent in error for the policy. CORRECTED marks a statement that replaces an earlier one for the same policy.
1095-A
Health Insurance Marketplace Statement
- Agency
- IRS
- Revision
- 2025
- Fillable fields
- 81
- Pages
- 3
- Official source
- IRS form page
- Checked
- October 21, 2026
Form 1095-A: Health Insurance Marketplace Statement
Form 1095-A, Health Insurance Marketplace Statement, is the form Health Insurance Marketplaces use to report enrollments in a qualified health plan in the individual market through the Marketplace. The IRS says Marketplaces furnish it to the IRS and to individuals, so that individuals can take the premium tax credit, reconcile the credit with advance payments of the premium tax credit (advance credit payments), and file an accurate tax return.
This is the 2025 form. The copy posted on IRS.gov is marked "CAUTION: NOT FOR FILING" and says that, as the form is to be completed by the Marketplaces, individuals cannot complete and use the IRS.gov copy. A person who receives a completed Form 1095-A from the Marketplace uses its figures to complete Form 8962, Premium Tax Credit (PTC).
The form says "Do not attach to your tax return. Keep for your records." You can open the PDF free in your browser on this page to see its layout, and download it without an account.
What's on Form 1095-A
Part I: Recipient Information, lines 1 to 15
The Marketplace identifier, the policy number, the policy issuer's name, the recipient's and spouse's names, SSNs and dates of birth, the policy start and termination dates, and the recipient's address.
Part II: Covered Individuals, lines 16 to 20
One line for each covered person, with columns A to E for name, SSN, date of birth, coverage start date and coverage termination date.
Part III: Coverage Information, lines 21 to 33
Lines 21 to 32 run from January to December, one line per month, and line 33 holds the annual totals.
Part III columns A, B and C
Column A is monthly enrollment premiums, column B is the monthly second lowest cost silver plan (SLCSP) premium, and column C is the monthly advance payment of premium tax credit.
How to read Form 1095-A
- 1
Check the top boxes
If VOID is checked, the form says not to use this or the earlier Form 1095-A to figure the premium tax credit. If CORRECTED is checked, it says to use this form and not the original.
- 2
Review Part I
Line 1 is the state where coverage was enrolled through the Marketplace, line 2 the Marketplace policy number and line 3 the insurance company. Line 5 may show only the last four digits of the SSN.
- 3
Review Part II
Each covered individual is listed on lines 16 to 20. A date of birth appears in column C only when column B has no SSN. With more than five covered people, more Forms 1095-A continue Part II.
- 4
Read the monthly amounts
The Marketplace reports columns A, B and C on lines 21 to 32 for each month and the totals on line 33. The form says to use this information to complete Form 8962, line 11 or lines 12 to 23.
- 5
Report errors to the Marketplace
If the information looks wrong, or no one in the family was enrolled, the form says to contact the Marketplace Call Center. For the federally facilitated Marketplace it points to www.healthcare.gov/contact-us/.
The Marketplace fills in every box. These steps follow the Instructions for Recipient printed on page 2 of the form.
Why fill Form 1095-A on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the IRS, not a copy someone retyped
- Works on a phone, tablet or computer
Who sends it, deadlines and what to do with it
Filing with the IRS
The instructions say Marketplaces submit the information to the IRS electronically, through the Department of Health and Human Services Data Services Hub.
Deadline
The instructions say to file the annual report with the IRS and furnish statements to individuals on or before January 31, 2026, for coverage in calendar year 2025.
How recipients get it
The instructions say statements are furnished on paper by mail, unless the recipient affirmatively consents to an electronic statement, for example in a Marketplace account.
Do not attach it
The form says "Do not attach to your tax return. Keep for your records." Its figures go onto Form 8962, which is filed with Form 1040, 1040-SR or 1040-NR.
When Form 8962 comes in
The form says Form 8962 is completed and filed with the return if Part III, column C shows any amount other than zero, or to take the premium tax credit, whether or not a return is otherwise required.
Questions
For questions on the Affordable Care Act tax provisions, the form lists the IRS Healthcare Hotline for ACA questions at 800-919-0452.
Related forms
Who fills out Form 1095-A?
The instructions say Health Insurance Marketplaces file Form 1095-A. Individuals receive a completed copy; they do not fill it out themselves.
Official sources and the blank
Do it all with indox
No tool matches that search.
Questions about Form 1095-A
Can I fill out Form 1095-A myself?
No. The copy on IRS.gov says the form is to be completed by the Marketplaces and that individuals cannot complete and use it. Individuals use the completed form their Marketplace sends.
Do I send Form 1095-A to the IRS?
No. The form says not to attach it to your tax return and to keep it for your records. The Marketplace has already reported the information to the IRS.
What is Form 1095-A used for?
The form says it provides the information needed to complete Form 8962, Premium Tax Credit (PTC), to take the credit or to reconcile advance credit payments.
What if my Form 1095-A is wrong?
The form says to contact your Marketplace Call Center. For the federally facilitated Marketplace, Call Center details are at www.healthcare.gov/contact-us/. State-based Marketplaces list theirs on their own websites.
Why did I get more than one Form 1095-A?
The form says a separate Form 1095-A comes for each policy. Additional forms also continue Part II when more than five individuals are covered.
When is Form 1095-A sent out?
The instructions set January 31, 2026, as the date for furnishing statements for coverage in calendar year 2025.