[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-301516-105":53,"doc-detail-301516-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","form-1095-a-health-insurance-marketplace-statement","Form 1095-A - Health Insurance Marketplace Statement","","Form 1095-A provides enrollment and coverage information from Health Insurance Marketplaces for individuals who enrolled in qualified health plans through the Marketplace. The form is used to complete Form 8962, Premium Tax Credit (PTC), when premium assistance was provided through advance credit payments or when claiming the premium tax credit. It includes recipient and covered individual details, policy identifiers, coverage period dates, and monthly enrollment and premium information, along with VOID and CORRECTED instructions for accurate reconciliation.",{"@graph":63,"@context":122},[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/form-1095-a-health-insurance-marketplace-statement/301516/",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/form-1095-a-health-insurance-marketplace-statement/301516.png","ImageObject",442,249,{"name":88,"@type":89},"Riley","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-22","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":79},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114,118],{"name":105,"@type":106,"acceptedAnswer":107},"What is Form 1095-A used for?","Question",{"text":108,"@type":109},"Health Insurance Marketplaces use Form 1095-A to report enrollment and coverage information for individuals enrolled in qualified health plans through the Marketplace. Individuals use it to complete Form 8962 when applicable.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"When must a recipient file Form 8962 with the tax return?",{"text":113,"@type":109},"File Form 8962 with your tax return if Part I, column C, of Form 1095-A shows any amount other than zero, or if you want to take the premium tax credit.",{"name":115,"@type":106,"acceptedAnswer":116},"What should recipients do if the VOID box is checked?",{"text":117,"@type":109},"If the VOID box is checked at the top of the form, the recipient previously received Form 1095-A in error for that policy. The recipient should not use this or the previously received form to figure the premium tax credit on Form 8962.",{"name":119,"@type":106,"acceptedAnswer":120},"What does the CORRECTED box indicate?",{"text":121,"@type":109},"If the CORRECTED box is checked, the recipient should use the information on this Form 1095-A to figure the premium tax credit and reconcile any advance credit payments on Form 8962, and not use the original form.","https://schema.org",{"og:url":78,"og:type":124,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":126,"canonical":78},"index,follow",{"doc_id":128,"site_id":56},301516,1790011748,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":88,"user_avatar":133,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":79,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":139,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":61,"update_tm":143,"read_time":9},1374391975076,"https://ap-avatar.wpscdn.com/avatar/14000253ca4ec9f6853?x-image-process=image/resize,m_fixed,w_180,h_180&k=1783305029341752051","CAUTION:NOT FOR FILING  \nForm 1095-A is provided here for informational purposes only.  \nHealth Insurance Marketplaces use Form 1095-A to report information on enrollments in aqualified health plan in the individual market through the Marketplace.As the form is to becompleted by the Marketplaces,individuals cannot complete and use Form 1095-Aavailable on IRS.gov.Individuals receiving a completed Form 1095-A from the HealthInsurance Marketplace will use the information received on the form and the guidance in theinstructions to assist them in filing an accurate tax return.  \n\n| 1095-A  \u003Cbr>Fom   | Health Insurance Marketplace Statement   VOID   |  | OMBNo.1545-2232   |\n| --- | --- | --- | --- |\n| Department of the Treasury  \u003Cbr>Internal Revenue Service   | □CORRECTED  \u003Cbr>Do not attach to your tax return.Keep for your records.  \u003Cbr>Go to www.irs.gov/Form1095A for instructions and the latest information.   |  | 2025   |\n\n# PartlRecipient Information\n\n\n| 1 Marketplace identifier   | 2 Marketplace-assigned policy number   | 3 Policy issuer's name   |  |\n| --- | --- | --- | --- |\n| 4 Recipient's name   |  | 5 Recipient's SSN   | 6 Recipient's date of birth   |\n| 7 Recipient's spouse's name   |  | 8 Recipient's spouse's SSN   | 9 Recipient's spouse's date of birth   |\n| 10 Policy start date   | 11 Policy termination date   | 12 Street address(including apartment no.)   |  |\n| 13 City or town   | 14 State or province   | 15 Country and ZIPor foreign postal code   |  |\n\n# PartⅡ Covered Individuals\n\n\n| A.Covered individual name   | B.Covered individual SSN   | C.Covered individual  \u003Cbr>date of birth   | D.Coverage start date   | E.Coverage termination date   |\n| --- | --- | --- | --- | --- |\n| 16___   |  |  |  |  |\n| 17  _   |  |  |  |  |\n| 18   |  |  |  |  |\n| 19  _   |  |  |  |  |\n| 20   |  |  |  |  |\n\n# PartⅢ Coverage Information\n\n\n| Month   | A.Monthly enrollment premiums   | B.Monthly second lowest cost silver  \u003Cbr>plan (SLCSP)premium   | C.Monthly advance payment of  \u003Cbr>premium tax credit   |\n| --- | --- | --- | --- |\n| 21 January   |  |  |  |\n| 22 February   |  |  |  |\n| 23 March   |  |  |  |\n| 24 April   |  |  |  |\n| 25 May   |  |  |  |\n| 26 June   |  |  |  |\n| 27 July   |  |  |  |\n| 28 August   |  |  |  |\n| 29 September   |  |  |  |\n| 30 October   |  |  |  |\n| 31 November   |  |  |  |\n| 32 December   |  |  |  |\n| 33 Annual Totals   |  |  |  |\n\nFor Privacy Act and Paperwork Reduction Act Notice,see separate instructions.  \nForm 1095-A(2025)Created 6/5/25  \nCat.No.60703Q  \n# Instructions for Recipient\n\nYou received this Form 1095-A because you or a family memberenrolled in health insurance coverage through the Health InsuranceMarketplace.This Form 1095-A provides information you need tocomplete Form 8962,Premium Tax Credit (PTC)You must completeForm 8962 and file it with your tax return(Form 1040,Form1040-SR,or Form 1040-NR)if any amount other than zero is shownin Part I,column C,of this Form 1095-A(meaning that youreceived premium assistance through advance payments of thepremium tax credit (also called advance credit payments))or if youwant to take the premium tax credit.The filing requirement applieswhether or not you're otherwise required to file a tax return.If you arefiling Form 8962,you cannot file Form 1040-NR-EZ,Form1040-SS,or Form 1040-PR.The Marketplace has also reported theinformation on this form to the IRS.If you or your family membersenrolled at the Marketplace in more than one qualified health planpolicy,you will receive a Form 1095-A foreach policy.Check theinformation on this form carefully.If you think the information isincorrect,or if you think you should not have received a Form 1095-Abecause neither you noranyone else in your family was enrolled inMarketplace health insurance,please contact your Marketplace CallCenter.If you purchased insurance through the federally facilitatedMarketplace,you can find your Call Center information at  \nwww.healthcare.gov/contact-us/.If you purchased insurance through aState","cbCaifkFhiToKXDB","https://ap.wps.com/l/cbCaifkFhiToKXDB","pdf",492196,"English","# PartlRecipient Information\n# PartⅡ Covered Individuals\n# PartⅢ Coverage Information\n# Instructions for Recipient","[{\"question\":\"What is Form 1095-A used for?\",\"answer\":\"Health Insurance Marketplaces use Form 1095-A to report enrollment and coverage information for individuals enrolled in qualified health plans through the Marketplace. Individuals use it to complete Form 8962 when applicable.\"},{\"question\":\"When must a recipient file Form 8962 with the tax return?\",\"answer\":\"File Form 8962 with your tax return if Part I, column C, of Form 1095-A shows any amount other than zero, or if you want to take the premium tax credit.\"},{\"question\":\"What should recipients do if the VOID box is checked?\",\"answer\":\"If the VOID box is checked at the top of the form, the recipient previously received Form 1095-A in error for that policy. The recipient should not use this or the previously received form to figure the premium tax credit on Form 8962.\"},{\"question\":\"What does the CORRECTED box indicate?\",\"answer\":\"If the CORRECTED box is checked, the recipient should use the information on this Form 1095-A to figure the premium tax credit and reconcile any advance credit payments on Form 8962, and not use the original form.\"}]","Form 1095-A - Health Insurance Marketplace Statement | PDF",1789783214]