Marketplace health insurance and Form 1095-A

What Form 1095-A is

The Marketplace sends you Form 1095-A early in the year, by mail or in your online account. It shows, month by month, what your plan cost, the cost of the benchmark plan (the second-lowest-cost silver plan) and the help the government paid directly to your insurer.

This form is not for insurance through work, Medicaid or Medicare. If you had Marketplace coverage, you need the 1095-A to prepare your return: do not file without it.

The Premium Tax Credit and Form 8962

The Premium Tax Credit helps pay for Marketplace insurance. Most people get it in advance: the Marketplace figures the help from the income you estimated when you enrolled and pays it to your insurer each month.

The real credit depends on your income for the year, compared with the federal poverty line. For 2025, people with low income may pay nothing for the benchmark plan, and no one who qualifies pays more than 8.5% of household income for that plan, even with income above 400% of the poverty line. Form 8962 does that math and compares it with what was paid in advance.

Reconciling: you may get more or have to pay some back

If your income was lower than you estimated, or your family grew, you may be due more help: the difference comes to you as a refundable credit on your return. If your income was higher, you may have to pay back part of what was paid in advance.

For 2025, if your household income is under 400% of the poverty line, what you have to pay back is capped. At or above 400%, there is no cap and you repay the whole excess.

• Under 200% of the poverty line: up to $375 if you file as single, or $750 for any other filing status.
• 200% to under 300%: up to $975 single, or $1,950 for any other filing status.
• 300% to under 400%: up to $1,625 single, or $3,250 for any other filing status.

Why you must file, and what to do if the 1095-A is wrong

If advance payments were made for you, you must file a return with Form 8962, even if your income is so low that you would not otherwise have to file. If you do not, you can lose advance help with your insurance in later years.

If you file as married filing separately, you generally cannot get the credit and must pay back the advance payments, subject to the same caps. There is an exception for victims of domestic abuse or spousal abandonment.

If your 1095-A has a mistake, for example in the people covered, the months or the amounts, ask the Marketplace for a corrected form before you file. If you already filed and a corrected one arrives later, you may need to amend your return.

How Vordana Tax handles it

With Vordana Tax you copy the figures from your 1095-A, for the year or month by month, and answer simple questions. The program figures your household income against the poverty line, the credit you are due, any extra you get back or what you must repay with its cap, and prepares Form 8962 with your Form 1040, which is e-filed to the IRS.

Questions