Form 1095-A - Information About Form 1095-A and its Separate Instructions - VOID CORRECTED

Sep 19, 2026

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Draft notice for IRS Form 1095-A with health insurance marketplace statement content and recipient instructions. The text explains that the form relates to coverage obtained through the Health Insurance Marketplace and is used to complete Form 8962, Premium Tax Credit (PTC). It includes guidance on completing and filing requirements, mentions that only specific individuals will appear when advance credit payments are made, and notes the handling of drafts on IRS.gov versus final releases. It also provides a structured outline for recipient, covered individuals, and monthly/annual coverage information fields.

LanguageEnglish

CategoryForms

FormatPDF

Pages3

Reading Time1 min

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Draft Notice and Filing Restrictions

Recipient Instructions

Part I: Recipient Information

Part II: Covered Individuals

Part III: Coverage Information

Caution: DRAFT—NOT FOR FILING This is an early release draft of an IRS tax form, instructions, or publication, which the IRS is providing for your information as a courtesy. Do not file draft forms. Also, do not rely on draft instructions and publications for filing. We generally do not release drafts of forms until we believe we have incorporated all changes. However, unexpected issues sometimes arise, or legislation is passed, necessitating a change to a draft form. In addition, forms generally are subject to OMB approval before they can be officially released. Drafts of instructions and publications usually have at least some changes before being officially released. Early releases of draft forms and instructions are at [IRS.gov/draftforms](IRS.gov/draftforms). Please note [that drafts may remain on IRS.gov](that drafts may remain on IRS.gov) even after the final release is posted at [IRS.gov/downloadforms](IRS.gov/downloadforms), and thus may not be removed until thereis a new draft for the subsequent revision. All information about all revisions of all forms, instructions, and publications is at [IRS.gov/formspubs](IRS.gov/formspubs). Almost every form and publication also has its own easily accessible [information page on IRS.gov. For](information page on IRS.gov. For) example, the Form 1040 page is at [IRS.gov/form1040](IRS.gov/form1040) ; the Form W-2 page is at [IRS.gov/w2](IRS.gov/w2) ; the Publication 17 page is at [IRS.gov/pub17](IRS.gov/pub17) ; the Form W-4 page is at [IRS.gov/w4](IRS.gov/w4) ; the Form 8863 page is at [IRS.gov/form8863](IRS.gov/form8863) ; and the Schedule A (Form 1040) page is at [IRS.gov/schedulea](IRS.gov/schedulea. If )[. If ](IRS.gov/schedulea. If )typing in the links above instead of clicking on them: type the link into the address bar of your browser, not in a Search box; the text after the slash must be lowercase; and your browser may require the link to begin with “www.”. Note that these are shortcut links that will automatically go to the actual link for the page. If you wish, you can submit comments about draft or final forms, instructions, or publications on the Comment on Tax Forms and Publications [page on IRS.gov. We](page on IRS.gov. We) cannot respond to all comments due to the high volume we receive, but we will carefully consider each one. Please note that we may not be able to consider many suggestions until the subsequent revision of the product. | Form 1095-A
Department of the Treasury Internal Revenue Service | Health Insurance Marketplace Statement
▶ Information about Form 1095-A and its separate instructions
[is at](is at www.irs.gov/form1095a)[ www.irs.gov/form1095a](is at www.irs.gov/form1095a). | | VOID
CORRECTED | OMB No. 1545-2232 | | --- | --- | --- | --- | --- | | | | | | 2015 | | | | | | | | | | | | | Part I Recipient Information | 1 Marketplace identifier | | 2 Marketplace-assigned policy number | | | | 3 Policy issuer's name | | | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | 4 Recipient's name | | | | | | 5 Recipient's SSN | | | 6 Recipient's date of birth | | | 7 Recipient's spouse's name | | | | | | 8 Recipient's spouse's SSN | | | 9 Recipient's spouse's date of birth | | | 10 Policy start date | | 11 Policy termination date | | | | 12 Street address (including apartment no.) | | | | | | 13 City or town | | 14 State or province | | | | 15 Country and ZIP or foreign postal code | | | | | | Part II Covered Individuals | | , 2015 | | | | | | | | | | A. Covered individual name | | | B. Covered individual SSN | | C. Covered individual
date of birth | | D. Coverage start date | | | E. Coverage termination date | | 16 | | | | | | | | | | | | 17 | | | | | | | | | | | | 18 | | | | | | | | | | | | 19 | | | | | | | | | | | | 20 | | | | | | | | | | | | Part III Coverage Information | | |

FAQs

Why did you receive Form 1095-A?

You received Form 1095-A because you or a family member enrolled in health insurance coverage through the Health Insurance Marketplace.

What must you do with Form 1095-A to file taxes?

You must complete Form 8962 and file it with your tax return.

Who will be listed on Form 1095-A when advance credit payments are made?

Only the individuals for whom you attested an intention to claim a personal exemption deduction at enrollment (you, spouse, and dependents) will be listed on Form 1095-A.

Sep 19, 2026

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