Blank IRS 1095-B Template

The IRS 1095-B form is a document that provides essential information about minimum essential health coverage. This form is typically issued by health insurers and is important for individuals to prove that they had health insurance during the previous year. For those needing to complete this form, filling it out accurately is crucial, so make sure to get started by clicking the button below.

Article Guide

The IRS 1095-B form plays a crucial role in the landscape of health insurance coverage in the United States. It serves as proof of insurance that individuals and families must receive from their healthcare providers or insurers. Designed to help confirm compliance with the Affordable Care Act’s (ACA) individual mandate, this form provides essential details like the type of coverage you had, the months you were covered, and the names of those covered under your policy. Whether you obtained coverage through your employer, the marketplace, or government programs like Medicaid, the 1095-B helps ensure you meet tax requirements when filing your returns. Missing this document or failing to understand its implications can lead to unwanted complications. Keeping a close eye on the 1095-B will help you avoid issues with the IRS and stay informed about your health insurance status.

Form Sample

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)

⇩ PDF

Document Specifications

Fact Name	Description
Purpose	The IRS 1095-B form is used to report information about individuals who had health coverage during the year.
Who Files	Insurance providers or government programs typically file the 1095-B form.
Recipient	Individual taxpayers receive a copy of the form, which details their health insurance coverage.
Required Information	The form includes names, addresses, and dates of coverage for individuals covered under the policy.
Due Date	The form must be filed with the IRS by February 28, or March 31 if filed electronically.
State Variations	Some states have their own requirements, such as California Health and Safety Code Section 135.300-135.336.
Importance	Receiving the 1095-B form is important for taxpayers to confirm their health coverage for tax purposes.

Steps to Filling Out IRS 1095-B

After you have gathered all necessary information, filling out the IRS 1095-B form will be straightforward. Take your time to ensure accuracy. Once completed, you will provide this form to the IRS as proof of health coverage for the tax year.

Obtain a blank IRS 1095-B form, either online or from your health insurance provider.
Fill in your name and address in the designated fields at the top of the form.
List your Social Security Number (SSN) or, if applicable, Individual Taxpayer Identification Number (ITIN).
Provide the name and address of your health insurance provider in the relevant section.
Enter the provider’s Employer Identification Number (EIN), if available.
Fill in the coverage details for each month of the year. Indicate the months you were covered by checking the appropriate boxes.
If applicable, list any other individuals covered under your health insurance plan, such as family members.
Check for accuracy before submitting. Verify all names, dates, and numbers are correct.
Sign and date the form where indicated.

After you complete these steps, file the form with your tax return or send it directly to the IRS, following the specific instructions given for the tax year.

More About IRS 1095-B

What is the IRS 1095-B form?

The IRS 1095-B form is a tax document used to report information about individuals who are covered by minimum essential health coverage. It is issued by health insurance providers and offers details on the coverage type and the months during which coverage was available to the individual.

Who receives the 1095-B form?

Individuals who have health coverage through providers such as insurance companies, self-insured employers, or government programs like Medicaid will receive the 1095-B form. If you were covered for any month during the year, you should expect to receive this form.

Why is the 1095-B form important?

The 1095-B form provides proof of health coverage, which is necessary for complying with the Affordable Care Act. While the individual mandate penalty was reduced to $0 at the federal level, some states have their own health insurance requirements that mandate proof of coverage.

How do I use the information on the 1095-B form?

The information on the 1095-B form serves as documentation for your tax return. You do not need to submit it with your tax return, but you should keep it for your records. It can help confirm your health coverage status for the tax year in question.

What happens if I do not receive my 1095-B form?

If you do not receive your 1095-B form and believe you should have, you should contact your health insurance provider. They can provide you with a copy or confirm your coverage status. It is important to ensure that you have this information available for your taxes.

Can I access the 1095-B form online?

Many insurance providers offer online access to tax documents, including the 1095-B form. Check your provider’s website or contact customer service to inquire about how to obtain your form electronically.

Is the information on the 1095-B form the same as the 1095-A form?

No, the information on the 1095-B form is not the same as the 1095-A form. The 1095-A form is issued to individuals who purchase health insurance through the Health Insurance Marketplace, while the 1095-B form pertains to other forms of health coverage.

What if I find an error on my 1095-B form?

If you notice any errors on your 1095-B form, contact your health insurance provider immediately. They can issue a corrected form if necessary. It is crucial to rectify any inaccuracies before filing your taxes.

Do I need to file the 1095-B form with my tax return?

You do not need to file the 1095-B form with your tax return. However, you should keep it for your records as it serves as proof of health coverage for the tax year.

Common mistakes

When individuals fill out the IRS 1095-B form, several common mistakes can hinder the accuracy of the information submitted. Understanding these pitfalls can significantly improve the filing experience. Below is a detailed list of some frequent errors:

Wrong Personal Information: Sometimes individuals may provide incorrect names, Social Security numbers, or addresses. Accurate personal details are crucial for proper identification.
Incomplete Coverage Information: Failing to report all months of health coverage can lead to issues. Each month of coverage needs to be listed to maintain compliance.
Missing Signature: Omitting a signature may result in the form being rejected. Ensure that all required signatures are included prior to submission.
Incorrect Policy Number: Providing an inaccurate health insurance policy number can cause significant delays. Double-check this number to ensure it matches what was issued by the insurer.
Neglecting to Report Dependents: If a person has dependents, their coverage should also be reported. Omitting dependents’ information means the form might not provide a complete picture.
Submitting the Wrong Form: Sometimes people accidentally fill out another version of the form, such as the 1095-C, instead of the 1095-B. Make sure to use the correct form relevant to your circumstances.
Ignoring Submission Deadlines: Missing the deadlines for submission can lead to penalties. Be aware of the timelines imposed by the IRS for timely filing.
Filing Without a Copy: It’s important to keep a copy of the completed form for personal records. Failing to do so can complicate matters if questions arise in the future.
Overlooking Additional Documentation: Sometimes supporting documents may be necessary for clarity. Ignoring these requirements can lead to processing delays or rejections.

Being aware of these common mistakes on the IRS 1095-B form can help individuals ensure that they are submitting accurate and complete information, ultimately facilitating a smoother filing process.

Documents used along the form

The IRS 1095-B form is essential for reporting minimum essential coverage to the Internal Revenue Service. It provides proof that you had health insurance coverage during the previous year, which is important for compliance with the Affordable Care Act. A variety of other forms and documents accompany the 1095-B, helping to provide a comprehensive view of an individual's health coverage and tax obligations. Below is a list of these pertinent forms and documents.

IRS 1040 Form: This is the standard individual income tax return form used by residents of the United States. It summarizes income, deductions, and credits, and is required for calculating tax liability.
IRS 1095-C Form: Similar to the 1095-B, the 1095-C form is used by applicable large employers to report information about the health insurance offered to their employees. It helps employees understand their coverage options.
Form 8962: This form is used to calculate the Premium Tax Credit, which helps eligible individuals and families afford health insurance purchased through the Health Insurance Marketplace.
Form 8885: This form allows taxpayers to calculate the Health Coverage Tax Credit, which is available to certain individuals who receive specific payments and meet other qualifying criteria.
IRS 1099-H Form: This form reports the Health Coverage Tax Credit (HCTC) received by eligible individuals. It provides assistance for those who are eligible for health coverage through the program.
W-2 Form: Employers provide this form to employees, which details their annual wages and the amount of taxes withheld from their paychecks. It can sometimes reflect health insurance premiums paid through payroll deductions.
Marketplace Coverage Affordability Tool: While not an IRS form, this tool helps individuals determine if their employer's health insurance is affordable, thereby guiding them on whether to seek coverage through the Marketplace.
Form 8862: This form is utilized by taxpayers who have previously been denied the Earned Income Tax Credit (EITC) and are now seeking to claim it again. While not directly related to health coverage, it can affect overall tax filing.

These forms and documents work together to ensure that taxpayers accurately report their health coverage and comply with federal regulations. Understanding their purpose is vital for fulfilling tax responsibilities and receiving any benefits for which an individual may be eligible.

Similar forms

The IRS 1095-A form is similar to the 1095-B form in that both are used to report health insurance coverage. However, the 1095-A specifically pertains to individuals who enroll in health plans through the Health Insurance Marketplace. It details the type of coverage, the months covered, and any premium tax credits received. Like the 1095-B, this form provides essential information for tax filing, ensuring that taxpayers report their health insurance status accurately.

The IRS 1095-C form is another document related to health insurance coverage. This form is issued by applicable large employers (ALEs) to report the health insurance they offer to their employees. While the 1095-B form focuses on Medicaid or individual market coverage, the 1095-C is centered around employer-sponsored health plans. Both documents share the goal of verifying coverage to comply with the Affordable Care Act requirements.

The W-2 form, though primarily for reporting wages and taxes withheld, often includes information about health insurance benefits provided by employers. This document allows employees to understand not only their income but also the value of their health benefits. While the W-2 and 1095-B serve different primary purposes, they both play a role in demonstrating health coverage when filing federal taxes.

The IRS Form 8962 stands apart from the 1095-B form but is still connected to health insurance. This form is used to claim the Premium Tax Credit (PTC). Taxpayers must complete this form to reconcile the premium amount they paid against the credit they may receive. Similar to the 1095-B, it relies on accurate information regarding coverage to ensure correct eligibility for tax benefits.

The IRS 1094-B form serves as a transmittal document that summarizes the 1095-B forms sent to the IRS. It provides an overview of the number of recipients and the total forms submitted. Like the 1095-B, it confirms health coverage, but its function is to streamline reporting for those who qualify under the health care law. It acts as a companion to the 1095-B, ensuring all necessary information about coverage is properly reported.

The 1094-C form operates similarly to the 1094-B but is designed for applicable large employers. This transmittal document reports the total of all the 1095-C forms filed by the employer. It provides the IRS with essential information regarding employer-provided health coverage. Both the 1094-B and 1094-C serve to ensure compliance with health care regulations, emphasizing the importance of accurate reporting in health care coverage.

Dos and Don'ts

When filling out the IRS 1095-B form, it is important to pay attention to certain actions to ensure accuracy and compliance. Here are some things to do and avoid:

Do fill out the form completely with accurate information.
Do check all entries for typos or errors before submission.
Do keep a copy of the completed form for your records.
Do ensure that you report all members covered under your health plan.

Don't leave any sections blank unless specifically instructed to do so.
Don't forget to use the correct tax year for the information provided.
Don't submit the form without checking the IRS guidelines for submission.
Don't ignore deadlines for filing or sending the form to the relevant parties.

Misconceptions

The IRS 1095-B form plays a crucial role in health coverage reporting. However, many people harbor misconceptions about this form. Let's clear up some of the most common misunderstandings.

Misconception 1: The 1095-B form is only for individuals with health insurance through the Marketplace.

This is not true. While the form does report coverage obtained through the Marketplace, it also covers health insurance obtained through employers and other sources.

Misconception 2: You must file the 1095-B with your taxes.

In reality, you do not need to submit the 1095-B form with your tax return. However, you should keep it for your records as proof of your health coverage.

Misconception 3: Receiving a 1095-B means you are guaranteed to avoid a penalty.

While the 1095-B indicates that you had minimum essential coverage, it does not automatically confirm that you qualify for avoiding penalties. Other factors come into play, and you should review your situation carefully.

Misconception 4: I won’t receive a 1095-B if I have Medicaid or Medicare.

This is incorrect. Individuals enrolled in Medicaid or Medicare will indeed receive a 1095-B form. It confirms that they had the required health coverage during the year.

Misconception 5: The 1095-B form is only used for tax purposes.

Although primarily associated with tax filings, the 1095-B form serves additional uses. It can help individuals verify their health coverage when enrolling in new insurance plans or applying for financial assistance.

Misconception 6: You don’t need to worry about the 1095-B if you had insurance for only part of the year.

This is misleading. If you had health coverage for part of the year, you would still receive the form. The 1095-B documents the months you had coverage, which is important for tax reporting.

Key takeaways

The IRS 1095-B form is used to report minimum essential health coverage provided to individuals.
This form is typically issued by insurance companies or employers who provide health coverage, not by individuals.
The 1095-B form includes important details such as the covered individuals, the coverage provider, and the months when coverage was active.
Receiving a 1095-B form is not a requirement for filing your tax return, but it can help verify your health coverage.
Individuals should keep the form with their tax records as it may be needed for future reference or audits.
The deadline to issue this form to recipients is usually around January 31 of the year following the coverage.
Both the IRS and the covered individuals receive copies of the form, ensuring consistent record-keeping.
If coverage was provided for only part of the year, the form will show the specific months when coverage was active.
Failing to have minimum essential coverage may result in a penalty, although these penalties have been reduced or eliminated in recent years.