Fill in a Valid IRS 1095-B Template

The IRS 1095-B form is a document provided by health insurance issuers to report coverage information for individuals. It details the months during which you had health coverage that meets the Affordable Care Act standards. Understanding this form is essential for ensuring compliance with health care requirements, so be sure to fill it out accurately by clicking the button below.

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The IRS 1095-B form plays a crucial role in the landscape of health insurance reporting. It’s designed to provide evidence of health coverage, which is essential for both the taxpayer and the IRS. Individuals receive this form from their insurance provider to confirm that they had qualifying health insurance for the entire year. It contains important information such as the name of the insured, the months of coverage, and details about the insurance provider. Taxpayers need to keep this document for their records and may need to reference it when filing their income tax returns. Understanding the 1095-B form is vital for ensuring compliance with the Affordable Care Act and avoiding potential penalties related to health coverage status. Additionally, being aware of its components helps individuals navigate their tax obligations more effectively.

IRS 1095-B Example

560118

Form 1095-B

Health Coverage

VOID

OMB No. 1545-2252

2020

Department of the Treasury

▶ Do not attach to your tax return. Keep for your records.

CORRECTED

Internal Revenue Service

▶ Go to www.irs.gov/Form1095B for instructions and the latest information.

Part I

Responsible

Individual

1 Name of responsible individual–First name, middle name, last name

Social security number (SSN) or other TIN

3 Date of birth (if SSN or other TIN is not available)

4 Street address (including apartment no.)

City or town

State or province

7 Country and ZIP or foreign postal code

Enter letter identifying Origin of the Health Coverage (see instructions for codes): . . .

▶

Reserved

Part II

Information About Certain Employer-Sponsored Coverage (see instructions)

Employer name

11 Employer identification number (EIN)

12 Street address (including room or suite no.)

City or town

State or province

15 Country and ZIP or foreign postal code

Part III

Issuer or Other Coverage Provider (see instructions)

Name

Employer identification number (EIN)

18 Contact telephone number

19 Street address (including room or suite no.)

City or town

State or province

22 Country and ZIP or foreign postal code

Part IV

Covered Individuals (Enter the information for each covered individual.)

(a) Name of covered individual(s)

(b) SSN or other TIN

(d) Covered

(e) Months of coverage

First name, middle initial, last name

TIN is not available)

all 12 months

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 60704B

Form

1095-

B (2020)

560220

Form 1095-B (2020)

Page 2

Instructions for Recipient

This Form 1095-B provides information about the individuals in your tax family (yourself, spouse, and dependents) who had certain health coverage (referred to as “minimum essential coverage”) for some or all months during the year. Minimum essential coverage includes government-sponsored programs, eligible employer-sponsored plans, individual market plans, and other coverage the Department of Health and Human Services designates as minimum essential coverage.

Before 2019, individuals who did not have minimum essential coverage and did not qualify for an exemption from this requirement could be liable for the individual shared responsibility payment. Beginning in 2019, individuals will not be responsible for the individual shared responsibility payment because the payment amount is reduced to $0. However, if individuals in your tax family are eligible for certain types of minimum essential coverage, you may not be eligible for the premium tax credit. For more information on the premium tax credit, see Pub. 974, Premium Tax Credit (PTC).

Providers of minimum essential coverage are required to furnish TIP only one Form 1095-B for all individuals whose coverage is

reported on that form. As the recipient of this Form 1095-B, you should provide a copy to other individuals covered under the policy if they request it for their records.

Additional information. For additional information about the tax provisions of the Affordable Care Act (ACA), including the individual shared responsibility provisions, and the premium tax credit, see www.irs.gov/ACA or call the IRS Healthcare Hotline for ACA questions (800-919-0452).

Part I. Responsible Individual, lines 1–9. Part I reports information about you and the coverage.

Lines 2 and 3. Line 2 reports your social security number (SSN) or other taxpayer identification number (TIN), if applicable. For your protection, this form may show only the last four digits. However, the coverage provider is required to report your complete SSN or other TIN, if applicable, to the IRS. Your date of birth will be entered on line 3 only if line 2 is blank.

Line 8. This is the code for the type of coverage in which you or other covered individuals were enrolled. Only one letter will be entered on this line.

A. Small Business Health Options Program (SHOP) B. Employer-sponsored coverage

C. Government-sponsored program D. Individual market insurance

E. Multiemployer plan

F. Other designated minimum essential coverage

G. Individual coverage health reimbursement arrangement (HRA)

If you or another family member received health insurance TIP coverage through a Health Insurance Marketplace (also known as

an Exchange), that coverage generally will be reported on a Form 1095-A rather than a Form 1095-B. If you or another family member received employer-sponsored coverage, that coverage may be reported on a Form 1095-C (Part III) rather than a Form 1095-B. For more information, see www.irs.gov/Affordable-Care-Act/Questions-and-Answers-About-Health- Care-Information-Forms-for-Individuals.

Line 9. Reserved.

Part II. Information About Certain Employer-Sponsored Coverage, lines 10–15. If you had employer-sponsored health coverage, this part may provide information about the employer sponsoring the coverage. This part may show only the last four digits of the employer’s EIN. This part may also be left blank, even if you had employer-sponsored health coverage. If this part is blank, you do not need to fill in the information or return it to your employer or other coverage provider.

Part III. Issuer or Other Coverage Provider, lines 16–22. This part reports information about the coverage provider (insurance company, employer providing self-insured coverage, government agency sponsoring coverage under a government program such as Medicaid or Medicare, or other coverage sponsor). Line 18 reports a telephone number for the coverage provider that you can call if you have questions about the information reported on the form.

Part IV. Covered Individuals, lines 23–28. This part reports the name, SSN or other TIN, and coverage information for each covered individual. A date of birth will be entered in column (c) only if the SSN or other TIN is not entered in column (b). Column (d) will be checked if the individual was covered for at least one day in every month of the year. For individuals who were covered for some but not all months, information will be entered in column (e) indicating the months for which these individuals were covered. If there are more than six covered individuals, see Part IV, Continuation Sheet(s), for information about the additional covered individuals.

560318

Form 1095-B (2020)

Page 3

Name of responsible individual–First name, middle name, last name

Social security number (SSN) or other TIN

Date of birth (if SSN or other TIN is not available)

Part IV

Covered Individuals — Continuation Sheet

(a) Name of covered individual(s)

(b) SSN or other TIN

(d) Covered

(e) Months of coverage

First name, middle initial, last name

TIN is not available)

all 12 months

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Form

1095-

B (2020)

Click for IRS 1095-B File

File Breakdown

Fact Name	Description
Purpose	The IRS 1095-B form provides information about health coverage, specifically whether an individual had minimum essential coverage during the tax year.
Who Issues It	This form is issued by health insurance providers, including insurers and government programs like Medicaid.
Information Included	The form contains information about the insured individual, the coverage period, and the type of coverage held.
Filing Requirement	While individuals do not need to file the 1095-B with their tax return, they are encouraged to retain it for their records.
State-Specific Forms	Some states, like California and Massachusetts, have their own health coverage requirements and may mandate additional forms consistent with their laws.

Guide to Using IRS 1095-B

After you have gathered all necessary information, you can proceed to fill out the IRS 1095-B form. This form is essential for reporting health coverage and is typically provided by health insurance providers or employers. Following the steps below will help ensure accurate completion.

Obtain the 1095-B form from the IRS website or request it from your health insurance provider.
Enter the appropriate year in the space provided at the top of the form.
Fill in your personal information: include your full name, social security number, and address.
Provide information for each individual covered by the health plan. This includes their names, social security numbers, and the months during which they were covered.
For each month, indicate whether the individual had minimum essential coverage. This may be done by marking checks or using an appropriate code.
Include the name, address, and employer identification number (if applicable) of the health insurance provider.
Sign and date the form once all information is correctly filled in.
Make copies of the completed form for your records before submitting it.

Once you have completed the 1095-B form, you are ready to submit it either to the IRS or include it with your tax return, depending on the instructions provided. Always keep a copy for your records.

Get Answers on IRS 1095-B

What is the IRS 1095-B form?

The IRS 1095-B form is a document that health insurance providers use to report information about health coverage offered to individuals. It shows if someone had minimum essential coverage during the year. This form is important for both taxpayers and the IRS to verify compliance with health care laws.

Who receives a 1095-B form?

Individuals who had health coverage through a provider, such as a private insurance company or Medicaid, will receive a 1095-B form. This includes:

Policyholders of the insurance.
Dependents covered by the policy.
Individuals enrolled in government-sponsored coverage like CHIP.

How do I use the 1095-B form when filing my taxes?

You should use the information on the 1095-B form to complete your tax return. While you do not need to attach it to your return, retain it for your records. When reporting health coverage on your tax filings, ensure the details match the information on the form to avoid discrepancies.

What should I do if I don't receive my 1095-B form?

If you do not receive your 1095-B form and believe you should have, first contact your health insurance provider. They may have sent it electronically or by mail. If issues persist, you can check your coverage on the IRS website or request a copy from their office if necessary.

Is there a penalty for not having a 1095-B form?

While there isn’t a penalty specifically for not receiving the 1095-B form, failing to have minimum essential coverage can lead to a penalty. The IRS requires proof of health coverage, which your 1095-B provides. If you didn’t have coverage, you could be responsible for the individual mandate penalty unless you qualify for an exemption.

Common mistakes

The IRS 1095-B form is crucial for anyone needing to confirm their health coverage, but mistakes can lead to delays or issues with your tax filing. One common error is failing to provide accurate personal information. The form requires your full name, Social Security number, and that of your dependents. Leaving out even a single digit can result in confusion or misprocessing, leading to delays in your tax return. Double-check that everything matches up with the details on your Social Security card and other official documents.

Another frequent mistake occurs during the selection of coverage dates. You must ensure that the start and end dates of your health coverage are clearly indicated. Omitting this information or incorrectly entering the dates can imply that you did not have coverage, potentially exposing you to penalties. Always take a moment to verify these dates against your insurance policy to ensure accuracy.

People often forget to check if the form is being completed by the right individual. If someone else, like a spouse or parent, is filling out the form on your behalf, it’s essential they include your correct information rather than their own. Make sure to clarify who is covered under each line item. Misrepresentation can lead to significant problems, particularly if there is an audit or if the information does not align with what the IRS has on file.

Lastly, remember to sign and date the form, if required. Many individuals neglect this final step, thinking the form will still be accepted without a signature. Incorrectly assuming that the absence of a signature will not cause issues can lead to your paperwork being considered incomplete. Take a moment to ensure that all necessary fields are filled out, signed, and dated before submitting the form.

Documents used along the form

The IRS 1095-B form is important for individuals and families, as it provides information about health coverage. Several other documents often accompany the 1095-B form, ensuring compliance with health insurance requirements and making tax filing smoother. Below is a list of commonly used forms and documents related to health coverage.

IRS Form 1040: This is the standard individual tax return form. Taxpayers use it to report their annual income, claim deductions and credits, and determine tax liability. The information from the 1095-B may play a role in confirming health coverage during the tax year.
IRS Form 1095-A: This form is provided by the Health Insurance Marketplace. It details the health insurance coverage obtained through the marketplace and any premium tax credits received. It is essential for individuals who enrolled in a marketplace plan.
IRS Form 1095-C: Employers use this form to report information about health insurance coverage offered to employees. It includes information about the coverage provided, employee data, and applicable months of coverage. This is particularly relevant for employees of larger companies.
Health Insurance Policy Documents: These are the actual insurance policy agreements between the insured and the insurance provider. They outline the coverage details, including benefits, exclusions, and terms. Policy documents might be needed for reference when filing taxes or addressing healthcare needs.
Proof of Coverage Letters: Insurers may send letters confirming that an individual had health coverage during the year. These letters act as additional verification and can be helpful if the 1095-B is unavailable or incomplete.

Having all these documents at hand can facilitate a smoother tax preparation process. Each document provides relevant information that can impact an individual's health coverage compliance and financial responsibilities. It's important to keep them organized and accessible during tax season.

Similar forms

Form 1095-A: This form is a Health Insurance Marketplace Statement. It provides information about health insurance obtained through the marketplace, including premium amounts and any subsidies received. Both forms document health coverage, but 1095-A applies specifically to marketplace plans.
Form 1095-C: Employers use this form to report health coverage offered to employees. While 1095-B focuses on individual coverage, 1095-C provides broader context about employer-provided health insurance options.
W-2 Form: This form summarizes an employee's annual earnings and tax withholdings. Similar to the 1095-B, the W-2 also serves to report information concerning taxes; however, it pertains specifically to wages rather than health coverage.
Form 1040: This is the individual income tax return form. Individuals include information from the 1095-B when filing their 1040, especially to prove health coverage compliance. Both forms play crucial roles in the tax process.
Schedule A: This form, part of the 1040 series, is used to itemize deductions. Some health expenses reported on this schedule may relate to the coverage documented in the 1095-B, connecting health information with tax deductions.

Dos and Don'ts

When filling out the IRS Form 1095-B, it's essential to ensure accuracy and completeness. This form provides information about your health coverage, which is crucial for tax purposes. Here are some dos and don'ts to consider:

Do verify that your coverage dates are correct. Ensure that the start and end dates accurately reflect your health insurance coverage period.
Do include all covered individuals. List everyone who was covered under your health plan during the year.
Do use the correct format for your Social Security Number (SSN). If the SSN is not available, provide an alternative identifier if applicable.
Do review the form for accuracy before submission. Double-check all the information to avoid delays or issues with your tax return.
Don't leave any fields blank unless instructed. Missing information can lead to complications when processing your tax return.
Don't submit the form without a copy of your proof of insurance. Keep a copy for your records and for your tax return.
Don't ignore deadline dates. Ensure that you submit your form in a timely manner to avoid penalties.
Don't panic if you make a mistake. If an error occurs after submission, contact the IRS to correct it as soon as possible.

By following these guidelines, individuals can help ensure the smooth processing of their tax documentation related to health coverage.

Misconceptions

The IRS 1095-B form plays an important role in health coverage reporting, but there are several common misconceptions surrounding its purpose and use. Let’s clarify some of these misunderstandings.

It is always required to file taxes. Many people mistakenly believe that they must submit the 1095-B with their tax return. However, this form is for information purposes only. You keep it for your records, but you don't need to attach it to your tax forms.
It only applies to those with employer-sponsored insurance. While the 1095-B does cover employer-sponsored health plans, it also includes coverage provided by government programs like Medicaid and the Children's Health Insurance Program (CHIP).
Receiving a 1095-B means you’re covered for the whole year. Some assume that if they receive a 1095-B, it means their health insurance was continuous throughout the year. In reality, the form only reflects coverage for the months stated on it, and gaps in coverage may have occurred.
Only individuals can receive a 1095-B. Another misconception is that only individuals receive this form. In fact, it can be issued to employers for their employees, as well as to family members who are covered under a health plan.
Filing a 1095-B is the same as filing a tax return. Some might think that submitting a 1095-B is equivalent to filing a tax return. In truth, the form serves merely to inform you of your health coverage status; it does not involve any tax dependency or liability calculations.
It is not necessary if you didn’t have health coverage. Individuals who did not have health coverage may think they don’t need the 1095-B at all. However, if you do receive one, it's still essential to keep it for your records, as it can provide insights into your health coverage history.
The information on the form is standard every year. People often assume the data on a 1095-B will be similar from year to year. However, changes in coverage, such as switching plans or changing providers, can lead to differences in the form's details.

Understanding these misconceptions can help individuals navigate their health insurance obligations more effectively. Holding onto the 1095-B can provide peace of mind and ensure a smoother tax filing experience.

Key takeaways

The IRS 1095-B form is crucial for taxpayers. Here are key takeaways to consider when filling it out and using it.

The form provides proof of minimum essential coverage for health insurance.
It is typically issued by health insurance providers.
Ensure that all fields are filled out correctly to avoid delays.
Keep it with your tax documents for reference when filing.
It is not necessary to submit it with your tax return, but must be available if requested.
Review the codes to understand your coverage situation accurately.
Be aware of deadlines for receiving and using this form to avoid penalties.