Form 1095-B

ACA Form 1095‑B: Proof of Minimum Essential Health Coverage

Form 1095‑B is an annual tax statement that reports the months during which you, your spouse, and any dependents were enrolled in minimum essential coverage (MEC)—for example, coverage provided by a fully insured plan, a self‑insured employer plan, certain government programs (Medicaid, CHIP, TRICARE), or other qualifying insurers.

Who issues it? Every issuer of MEC—commercial insurers, government programs, and employers that operate self‑funded plans—must furnish a copy to each covered individual and file the data with the IRS.

Why does it matter? The information on Form 1095‑B helps the IRS confirm that you satisfied the Affordable Care Act individual coverage requirement for each month of the tax year. Although the federal “individual shared‑responsibility payment” has been reduced to $0 since tax year 2019, several states (e.g., California, Massachusetts, New Jersey) still impose their own penalties if residents lack MEC. Keeping the form in your records supports your state filing and can be useful if the federal mandate is reinstated.

Do I file it? You generally do not attach Form 1095‑B to your federal return, but you should retain it—along with any 1095‑A or 1095‑C you receive—for at least three years in case the IRS or a state tax agency requests proof of coverage.

Key deadlines

• Recipient copy: Must be furnished to individuals by Monday, March 3^rd, 2025.
• IRS filing (paper): Friday, February 28^th, 2025.
• IRS filing (electronic): Due Monday, March 31^st, 2025; electronic filing is mandatory if the filer submits 10 or more returns in aggregate for the year.

About Form 1095-B

Form 1095-B is part of the ACA reporting requirements in the United States. It provides information about an individual's health care coverage during the previous tax year.

The form is typically issued by health insurance providers, including insurance companies, self-insured employers, and other entities that provide minimum essential coverage. Form 1095-B contains details such as the type of coverage, the months covered, and the individuals covered under the policy. The information from the form helps the IRS ensure that people are maintaining the required health coverage and enables them to identify those who might be liable for a penalty for not meeting the coverage standards.

Who Must File Form 1095‑B?

IRC §6055 requires every entity that provides minimum essential coverage (MEC) for at least one month of the calendar year to report that coverage to the IRS and give a written statement to each covered individual. The obligation falls on the entity that actually “underwrites” or “sponsors” the coverage—not necessarily the employer or plan administrator. The primary filers are:

1. Insurance Issuers (Fully‑Insured Plans)  
   Commercial health insurers file for individual‑market policies, small‑ and large‑group policies, and expatriate health plans.
   Note: When an employer buys a fully insured plan, the insurer—not the employer—files Form 1095‑B.
2. Self‑Insured Employers (Non‑ALE)  
   Employers that are not Applicable Large Employers (i.e., generally fewer than 50 full‑time equivalents) but sponsor their own self‑funded plan must file a Form 1095‑B for each covered employee, retiree, and COBRA participant.
   If the employer is an ALE, the coverage is instead reported in Part III of Form 1095‑C, not on 1095‑B.
3. Government‑Sponsored Programs  
   Medicaid, CHIP, Medicare Part A, TRICARE, VA health care, the Federal Employees Health Benefits Program, and similar programs meet MEC. The agency that administers the program (or its designated TPA) files Form 1095‑B.
4. Other MEC Providers  
   Organizations such as student health insurance sponsors, church plans, and certain multi‑employer welfare arrangements (MEWAs) must file when they furnish MEC.

These filers must also furnish a copy to each responsible individual (often the primary insured) by Monday, March 3^rd, 2025.

What forms should be included when filing Form 1095-B with the IRS?

When filing Form 1095-B, the entity providing the coverage (such as an insurance company or self-insured employer) also needs to file Form 1094-B, which serves as the transmittal form for Form 1095-B. Together, Forms 1094-B and 1095-B provide comprehensive information to the IRS about individuals who have received minimum essential health coverage during the tax year, helping to ensure compliance with the Affordable Care Act (ACA) requirements.

What is Form 1094-B?

Form 1094-B is a cover sheet that includes summary information about the employer or insurer and the associated 1095-B forms. It includes details like the employer's name, Employer Identification Number (EIN), and contact information, as well as the total number of 1095-B forms being submitted.

What is the deadline to submit Form 1095-B?

For reicpients, Form 1095-B must typically be provided to the individuals covered under the policy by Monday, March 3^rd, 2025. If the deadline falls on a weekend or holiday, the deadline may be extended to the next business day.

When filing to the IRS, the ACA deadline will depend on the method of filing:

• If filing electronically, the deadline is Monday, March 31^st, 2025.
• If filing on paper, the deadline is Friday, February 28^th, 2025.

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Why should an employer choose to E-file over paper filing?

Employers and other entities may choose to e-file Form 1095-B over paper filing for several reasons:

1. Efficiency: E-filing can be faster and more efficient. Data can be entered and submitted quickly, and the process can often be automated, saving time and resources.
2. Accuracy: E-filing systems often include built-in validation checks that help reduce errors. Corrections can be made easily, minimizing the risk of mistakes that could result in penalties.
3. Convenience: E-filing can be done at any time and from anywhere with an internet connection. It doesn't require physical materials like paper or postage, simplifying the process.
4. Confirmation and Tracking: E-filing usually provides immediate confirmation that the forms have been received by the IRS. This can be useful for record-keeping and provides assurance that the documents have been submitted successfully.
5. Compliance for Large Filers: For entities that are required to file a large number of forms (such as 10 or more), e-filing may be mandatory, making it not just a choice but a compliance issue.
6. Cost Savings: Although there might be some initial setup costs, e-filing can save on printing, mailing, and handling expenses in the long run.
7. Extended Deadlines: Sometimes, the deadline for e-filing with the IRS is later than the deadline for paper filing, providing additional flexibility.

Overall, e-filing can provide substantial benefits in terms of efficiency, accuracy, and convenience, making it an attractive option for many employers and other entities responsible for filing Form 1095-B.

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