US Medical Term · financial
Form 1095-A
Formulario 1095-A
In 9 languages
| Language | Term |
|---|---|
| English | Form 1095-A |
| Spanish (Español) | Formulario 1095-A |
| Chinese (中文) | 1095-A表格 |
| Korean (한국어) | 1095-A 양식 |
| Vietnamese (Tiếng Việt) | Mẫu 1095-A |
| Filipino (Tagalog) | Form 1095-A |
| Portuguese (Português) | Formulário 1095-A |
| Thai (ภาษาไทย) | แบบฟอร์ม 1095-A |
| Japanese (日本語) | フォーム1095-A |
What it means
Form 1095-A is the Health Insurance Marketplace Statement sent each January by your federal or state Marketplace if you were enrolled in a Marketplace plan during the previous year. The form shows the months you and your household members had coverage, the premium for the second-lowest-cost silver plan (SLCSP) in your area—used as the benchmark for calculating the premium tax credit—and the amount of any advance premium tax credit (APTC) paid on your behalf during the year. You must use Form 1095-A to complete Form 8962 and reconcile your actual premium tax credit on your federal tax return. Contact your Marketplace immediately if the form is not received by mid-January or contains errors.
How to say it
Sentences a patient might use with a doctor, nurse, pharmacist, or insurer:
You should receive Form 1095-A from your Marketplace by mid-January to use when filing your federal taxes.
Debe recibir el Formulario 1095-A de su Mercado a mediados de enero para usarlo al presentar sus impuestos federales.
Without Form 1095-A, you cannot complete Form 8962 to reconcile your premium tax credit.
Sin el Formulario 1095-A, no puede completar el Formulario 8962 para conciliar su crédito fiscal de prima.
Check Form 1095-A carefully—errors in the SLCSP column can cause an incorrect premium tax credit calculation.
Revise el Formulario 1095-A cuidadosamente: los errores en la columna SLCSP pueden causar un cálculo incorrecto del crédito fiscal de prima.
Where you'll see it
Related terms
Sources
Last reviewed: September 2026