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It describes how Covered California reviews corrections and issues a corrected Form 1095-A, including required supporting documents. The instructions also clarify why accuracy matters for IRS Form 8962, when corrected forms are expected, and cases where Medi-Cal, SHOP, or Minimum Coverage Plans do not result in Form 1095-A for tax year 2014.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/dispute-form-1095-a-consumer-how-to-request-a-corrected-form-1095-a/302198/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/dispute-form-1095-a-consumer-how-to-request-a-corrected-form-1095-a/302198.png","ImageObject",442,249,{"name":88,"@type":89},"Connor ","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-27","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is this Dispute Form 1095-A used for?","Question",{"text":108,"@type":109},"Use this form to dispute information on your Form 1095-A or request a Form 1095-A if you did not receive one. Covered California reviews and checks the new information you report.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Do I have to use this form to make every change to my Form 1095-A?",{"text":113,"@type":109},"No. You can correct certain items by calling Covered California’s Service Center or contacting your local County Social Services office, such as your name, date of birth, Social Security number, or address.",{"name":115,"@type":106,"acceptedAnswer":116},"How does this relate to IRS Form 8962 and premium tax credit reconciliation?",{"text":117,"@type":109},"Form 1095-A provides information needed to complete IRS Form 8962 for the premium tax credit (including APTC). If you disagree with information on Form 1095-A, you must report it to Covered California and send a corrected Form 8962 to the IRS if you already filed taxes.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},302198,1790351343,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":47,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":73},687207022233,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Dispute Form 1095-A for Covered California  \nConsumer  \n􀂾 If you need help in Spanish, or would like this form in Spanish, you can call 1-800-300-0213. If you need help in a language other than English or Spanish, please see the final page of this document for language-specific telephone numbers.  \n􀂾 If you would like more information about Form 1095-A, please visit: [www.coveredca.com](www.coveredca.com).  \n􀂾 If you would like more information about filing your taxes, please visit: [www.irs.gov/aca](www.irs.gov/aca).  \n􀂾 Free tax advice is also available through Volunteer Income Tax Assistance at 1-800-906-9887 or if you are over 60 years old there is free Tax Counseling for the Elderly at 1-800-906-9887.  \nInstructions:  \nYou may use this form to dispute the information on the Form 1095-A or request a Form 1095-A if you did not receive one. Based on any corrections you show on this form, Covered California will review and check the new information you report. If, after review, Covered California determines that the updated information you provided is correct, we will send you a new, corrected Form 1095-A. To help with our review, please include any supporting documents with this form. Supporting documents could include invoices from your health plan that show the amount of premium assistance (tax credits or APTC) you received and monthly premium you paid, or Covered California notices that show how much premium assistance you were eligible for.  \nDo I have to use this form to make all changes to information on my Form 1095-A?  \nNo. If you would like to correct any of the following information on your Form 1095-A, you may do so by calling Covered California’s Service Center or contacting your local County Social Services office. You do not need to complete this form for the following types of changes.  \nThe information a Service Center Representative or local County Social Services official can change is:  \n􀂾 Your name  \n􀂾 Your date of birth  \n􀂾 Your social security number  \n􀂾 Your address  \nWhy do I need to ensure the information is correct on my Form 1095-A?  \nForm 1095-A is used to report important information to the Internal Revenue Service (IRS) about your health insurance bought through Covered California. The Form 1095-A also tells you how much premium assistance (tax credits or APTC) your health plan got on your behalf during 2014. If you enrolled in a health plan through Covered California but did not receive premium assistance, you will still receive a Form 1095-A from Covered California to show you what months you had health insurance (this rule does not apply to individuals who purchased Minimum Coverage Plans or health plans through Covered California’s Small Business Health Options Program (SHOP)) . All Covered California health plan consumers must use the information on the Form 1095-A to complete IRS Form 8962: Premium Tax Credit. If you disagree with any of the information shown on the Form 1095-A, you must report it to Covered California and you must send a corrected Form 8962 to the IRS if you already filed your taxes.  \nWhat is IRS Form 8962?  \nForm 8962 is a new IRS form that you will use to “reconcile” the premium assistance (tax credit or APTC) amount your health insurance plan got (or how much you may get, if you did not get premium assistance in advance) based on your estimated income for 2014 along with the amount that is determined based on your actual income for 2014, as reported on your federal tax return. People who received premium assistance will have to “reconcile” the premium amount they got based on their estimated income (this will be listed in their Form 1095-A) with the amount that is determined based on their actual income as reported on their federal tax return. For more information on IRS Form 8962, [please visit:](please visit: www.irs.gov/aca)[ ](please visit: www.irs.gov/aca)[www.irs.gov/aca](please visit: www.irs.gov/aca).  \nWhen will I receive a corrected Form 1095-A?  \nIf you use","cbCaicdAeJcaoKgk","https://ap.wps.com/l/cbCaicdAeJcaoKgk","pdf",171543,"English","# Dispute Form 1095-A for Covered California Consumer\n## When to use this form and what Covered California reviews\n## Changes that do not require this form\n## Why accuracy on Form 1095-A matters for IRS Form 8962\n## What is IRS Form 8962 and how reconciliation works\n## When you receive a corrected Form 1095-A\n## Recipient information fields","[{\"question\":\"What is this Dispute Form 1095-A used for?\",\"answer\":\"Use this form to dispute information on your Form 1095-A or request a Form 1095-A if you did not receive one. Covered California reviews and checks the new information you report.\"},{\"question\":\"Do I have to use this form to make every change to my Form 1095-A?\",\"answer\":\"No. You can correct certain items by calling Covered California’s Service Center or contacting your local County Social Services office, such as your name, date of birth, Social Security number, or address.\"},{\"question\":\"How does this relate to IRS Form 8962 and premium tax credit reconciliation?\",\"answer\":\"Form 1095-A provides information needed to complete IRS Form 8962 for the premium tax credit (including APTC). If you disagree with information on Form 1095-A, you must report it to Covered California and send a corrected Form 8962 to the IRS if you already filed taxes.\"}]","Dispute Form 1095-A - Consumer - How to Request a Corrected Form 1095-A | PDF",1789790205]