Form 1095-A + AI Agent Skill: Marketplace Health Insurance Guide 2026

Hi, I'm Slava, CEO and co-founder of Jupid. Every spring I see the same conversation play out: a freelancer or solo founder gets a Form 1095-A in the mail from healthcare.gov, glances at it, and files it next to the W-2s without realizing it actually changes their tax bill. Sometimes the change is in their favor — they qualified for more Premium Tax Credit than the Marketplace advanced them, and they're owed money. Sometimes the change goes the other way — they earned more than estimated, and they owe back excess advance credits. Either way, ignoring 1095-A is not an option: the IRS already has a copy.

Official IRS resources: Form 1095-A (PDF) · Instructions (PDF) · About Form 1095-A

If you bought health insurance through the federal Marketplace at healthcare.gov or through a state-run exchange like Covered California or NY State of Health, you'll receive Form 1095-A by January 31. The form itself is informational — you don't attach it to your return. But the numbers on it drive Form 8962, which is what actually reconciles the Premium Tax Credit and either lowers your tax or raises it.

This guide walks through 1095-A box by box, shows how it feeds Form 8962, covers the 2026 Premium Tax Credit rules, and includes a full worked example with both a refund scenario and a repayment scenario.

What Is Form 1095-A?

Form 1095-A (officially "Health Insurance Marketplace Statement") is the information return the Marketplace sends to anyone who enrolled in a qualified health plan through healthcare.gov or a state-based exchange during the year. It reports three monthly numbers — the premium you paid, the benchmark premium for the second-lowest cost silver plan (SLCSP) in your area, and the advance Premium Tax Credit (APTC) the Marketplace paid directly to your insurer on your behalf.

You use those three columns to fill out Form 8962, which calculates the actual Premium Tax Credit you qualified for based on your final household income and family size. The difference between the actual credit and the advance credit either becomes a refund (if you under-took the advance) or a tax due (if you over-took it).

Legal Basis: IRC §36B governs the Premium Tax Credit; IRC §6055 requires Marketplaces to report coverage on Form 1095-A by January 31. IRS Publication 974 provides the comprehensive Premium Tax Credit guidance.

Who Receives Form 1095-A?

You receive Form 1095-A if any of these are true for any month of the year:

• You enrolled in a qualified health plan through healthcare.gov
• You enrolled through a state Marketplace (Covered California, NY State of Health, MNsure, Pennie, etc.)
• A family member you can claim as a dependent enrolled through the Marketplace and you're listed as the recipient
• You received an advance Premium Tax Credit (APTC) — even $1 of APTC requires Form 8962 reconciliation

You do not receive 1095-A if your only health coverage was:

• Employer-sponsored insurance (you'd get 1095-C from the employer instead — informational only, not used on the return)
• Medicaid, CHIP, or Medicare (you'd get 1095-B — informational only, not used on the return)
• Coverage purchased outside the Marketplace, directly from an insurer (no 1095-A; no Premium Tax Credit possible)
• TRICARE or VA health coverage (no 1095-A)

If you had Marketplace coverage for even one month of the year, you'll get 1095-A and you must file Form 8962 with your return — failure to reconcile blocks future APTC eligibility.

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Executive Summary: 2026 Premium Tax Credit Key Numbers

The Premium Tax Credit framework was temporarily expanded by the American Rescue Plan Act (ARPA) in 2021, then extended through 2025 by the Inflation Reduction Act (IRA). As of April 2026, the post-2025 status of the expanded subsidies depends on legislation that may have been enacted, extended, or allowed to lapse. Verify the current rules in IRS Publication 974 and Form 8962 instructions before filing.

Legal Basis: IRC §36B (Premium Tax Credit); IRC §6055 (Marketplace reporting); Rev. Proc. 2024-36 (FPL applicable figures for tax year 2025); IRS Publication 974; Form 8962 instructions.

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Form 1095-A Layout

Form 1095-A has three parts. Part I and Part II are identifying information; Part III is the monthly premium and credit data that drives Form 8962.

Part I — Recipient Information (Lines 1–15)

The Marketplace identifies the person who's responsible for reconciling the Premium Tax Credit on the tax return.

• Lines 1–7 — Marketplace identifier and policy number
• Lines 8–15 — Recipient's name, SSN, date of birth, address, and the policy issuer (the insurance company providing the plan)

If anything in Part I is wrong (especially the SSN, name spelling, or policy issuer), call the Marketplace immediately to request a corrected 1095-A. Filing Form 8962 with mismatched identifying info triggers a delay or rejection.

Part II — Covered Individuals (Lines 16–20+)

Each person enrolled under the policy gets a row showing their name, SSN, date of birth, coverage start date, and coverage end date.

This part matters for two reasons:

1. Family size for Form 8962 must include everyone covered who's also on the tax return. Anyone listed in Part II who isn't a dependent on your return shouldn't count toward your family size for the PTC calculation.
2. Shared policy allocation — if you and an ex-spouse, or two unmarried parents, share a single 1095-A policy but file separate returns, you must allocate the Part III amounts between the two returns. See Form 8962 instructions Section "Allocation of Policy Amounts."

Part III — Monthly Premium, SLCSP, and APTC (the heart of the form)

This is the table that drives Form 8962. Three columns, twelve rows (one per month):

If Column B shows $0 in any month when you had coverage, the Marketplace failed to calculate the SLCSP. You must look it up using the healthcare.gov Tax Tool or the equivalent state Marketplace tool. Don't leave Column B at zero — it produces an incorrect PTC.

If you had no coverage in a given month, all three columns should be blank or zero for that month.

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How Form 1095-A Feeds Form 8962

Form 8962 is where the actual reconciliation happens. The 1095-A numbers populate Form 8962, which then computes whether you owe back excess APTC or are owed additional PTC.

Step-by-Step from 1095-A to 8962

1. Compute household income (Form 8962 Lines 1–5)

• Line 1: Tax family size (you + spouse + dependents, including unborn for 2025+)
• Line 2a: Modified AGI from Form 1040 (AGI + tax-exempt interest + Social Security excluded + foreign earned income excluded)
• Line 3: Household income (sum of you and your dependents' modified AGI if dependents had filing requirement)
• Line 4: Federal Poverty Line (FPL) for your tax family size — use the FPL table in Form 8962 instructions (2024 FPL for tax year 2025; 2025 FPL for tax year 2026)
• Line 5: Household income as percent of FPL = Line 3 ÷ Line 4 × 100, rounded down to nearest whole percent

2. Determine annual or monthly calculation (Line 10)

• Annual — if you had Marketplace coverage and same APTC every month, you can use Line 11 (annual). Faster.
• Monthly — if coverage, premium, SLCSP, or APTC changed during the year (e.g., baby born, marriage, job change), you must use Lines 12–23 (monthly).

3. Fill in 1095-A amounts

• Line 11(a) or Lines 12–23(a): Column A from 1095-A (annual sum or each month)
• Line 11(b) or Lines 12–23(b): Column B from 1095-A
• Line 11(f) or Lines 12–23(f): Column C from 1095-A

4. Compute the PTC

• Line 8a: Applicable Figure (from Table 2 in Form 8962 instructions, based on your Line 5 FPL percentage)
• Line 8b: Annual contribution amount = Line 3 × Line 8a
• Line 11(c) or 12–23(c): Annual or monthly contribution amount
• Line 11(d) or 12–23(d): Maximum premium assistance = Line 11(b) − Line 11(c), but not less than zero
• Line 11(e) or 12–23(e): PTC allowed = lesser of Line 11(a) or Line 11(d)

5. Reconcile

• Line 24: Total PTC you qualified for (sum of column e)
• Line 25: Total APTC paid (sum of column f, matches Form 1095-A Column C totals)
• Line 26: If Line 24 > Line 25 → Net Premium Tax Credit (refundable, flows to Schedule 3 Line 9)
• Line 27–29: If Line 25 > Line 24 → Excess APTC (subject to repayment limits per Pub 974 Table 5; flows to Schedule 2 Line 1a)

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2026 Premium Tax Credit Eligibility

To claim PTC or have APTC reconciled, all of these must be true for the months you had Marketplace coverage:

1. Household income within the qualifying range — historically 100% to 400% of FPL, expanded under ARPA/IRA through 2025 to remove the upper limit for those whose benchmark plan exceeds 8.5% of income; 2026 status depends on legislation
2. Not eligible for affordable employer coverage — if you or a family member could enroll in employer-sponsored insurance that costs less than the IRS affordability threshold (9.12% of household income for 2024, adjusted annually) and provides minimum value, you're not eligible for PTC for those months
3. Not eligible for Medicare, Medicaid, CHIP, or other government coverage that disqualifies you
4. U.S. citizen or lawfully present immigrant for the months claimed
5. Filing status — generally cannot file Married Filing Separately and claim PTC, with limited exceptions for victims of domestic abuse or spousal abandonment (see Form 8962 instructions)
6. Cannot be claimed as a dependent by another taxpayer

If your final household income at year-end is below 100% FPL but you received APTC based on a higher estimate, the IRS will not require repayment as long as you weren't ineligible for other reasons (Pub 974, "Below 100% FPL" rules). This is a narrow safe harbor — don't rely on it.

Legal Citation: IRC §36B(c)(1) defines the applicable taxpayer; §36B(c)(2)(C) defines minimum essential coverage for affordability tests; Pub 974 Chapter 1 covers eligibility comprehensively.

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Common 1095-A Issues and What to Do

Issue 1: 1095-A Never Arrived

The Marketplace must mail 1095-A by January 31. If you don't have it by mid-February:

• Log in to your healthcare.gov account (or state Marketplace portal) and download it from the "Tax Forms" section
• Call the Marketplace Call Center (1-800-318-2596 for healthcare.gov)
• Do not file your return without it — you'll have to amend later

Issue 2: 1095-A Has Wrong Numbers

Common errors: incorrect SLCSP in Column B, wrong APTC amounts, wrong covered individuals, wrong start/end dates. To correct:

• Call the Marketplace and request a corrected 1095-A (called "void" + "corrected" copy)
• Wait for the corrected form before filing
• If the IRS already received the original incorrect 1095-A and you file using the corrected numbers, the IRS may flag your return for review — keep the corrected 1095-A as documentation

Issue 3: Column B is $0

This usually means the Marketplace didn't apply for a benchmark plan calculation (often happens if you applied late or had eligibility issues). Use the healthcare.gov Tax Tool for federal Marketplace, or your state's equivalent, to look up the SLCSP for your zip code, family size, and ages. Manually enter the correct number on Form 8962.

Issue 4: Got 1095-A But Never Had Marketplace Coverage

This is rare but indicates either identity theft (someone enrolled using your SSN) or a Marketplace data error. Contact the Marketplace immediately and IRS identity theft hotline (1-800-908-4490).

Issue 5: Shared Policy with an Ex-Spouse or Unmarried Parents

If two tax households share a single 1095-A policy, the amounts must be allocated. Form 8962 Part IV (Lines 30–34) handles this. Without an agreement, the default allocation is 50/50. If you and the other party can agree on a different split, document it (file with both returns) — but the total across both returns must equal the 1095-A amounts.

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Worked Example: Lisa, Freelance Writer, Marketplace Coverage All Year

To make this concrete, here's how Lisa's 2025 tax year reconciliation works.

Background:

• Lisa, age 34, single, no dependents
• Enrolled in a healthcare.gov silver plan all 12 months of 2025
• Family size = 1
• 2024 FPL for household of 1 = $15,060 (used for 2025 PTC)
• Estimated 2025 income at enrollment: $30,000 (about 200% FPL)
• Actual 2025 AGI: $42,000 (about 279% FPL)

Lisa's 1095-A Numbers (Part III)

The Marketplace sends Lisa a 1095-A showing the same amounts every month (no mid-year changes):

Scenario 1 — AGI of $42,000 (PTC owed back to Lisa)

Lisa's actual income places her at 279% FPL ($42,000 ÷ $15,060 = 279%). At 279% FPL under the ARPA/IRA-extended applicable figures (2025), her contribution percentage is roughly 4% (interpolated from Table 2 of Form 8962 instructions — verify exact 2025 figure).

Form 8962 Annual Calculation (Line 11):

Wait — in this scenario, APTC ($4,560) exceeded the allowed PTC ($3,360), so Lisa actually owes back the difference, not the other way around. With Lisa at 279% FPL, the excess APTC repayment limit (single, 200–300% FPL) caps her repayment at $975 (2025 figure — verify Pub 974 Table 5 for the actual year).

Result: Lisa repays $975 (capped). The remaining $225 of excess APTC is forgiven under the repayment limit. The $975 flows to Schedule 2 Line 1a and increases her tax due.

Scenario 2 — AGI Came in at $30,000 (PTC owed to Lisa)

If Lisa's actual income matched her estimate at 200% FPL, her applicable figure under ARPA/IRA was 0%. Her annual contribution would be $0, allowed PTC would be $5,040 (full SLCSP), but capped at the actual premium of $5,760 — so PTC = $5,040.

Comparing PTC ($5,040) to APTC ($4,560), Lisa is owed an additional $480 net Premium Tax Credit (Form 8962 Line 26) — this flows to Schedule 3 Line 9 as a refundable credit.

Key takeaway: the difference between estimating $30,000 vs. earning $42,000 cost Lisa $1,455 in tax outcome ($480 refund she didn't get + $975 she had to repay). Updating income estimates with the Marketplace mid-year — every time you get a new client, raise your rates, or take a side gig — minimizes year-end surprises.

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Common Mistakes to Avoid

Mistake #1: Filing Without Form 8962

Problem: Filer receives 1095-A, didn't get APTC (Column C is all zeros), and figures they don't need to reconcile.

Impact: If you had any Marketplace coverage and want to claim the Premium Tax Credit, you must file Form 8962 even if APTC was zero. Filing without it forfeits the credit. If you did receive APTC and skip 8962, the IRS rejects the return and blocks future APTC eligibility until you reconcile.

Solution: Always attach Form 8962 if you have a 1095-A. Even with zero APTC, Form 8962 establishes whether you qualify for net PTC.

Mistake #2: Using the Wrong FPL Table

Problem: Filer uses the current-year FPL table to compute Line 4 instead of the prior year's FPL table.

Impact: Wrong income percentage, wrong applicable figure, wrong PTC. Underclaim or overclaim the credit.

Solution: Form 8962 instructions specify which year's FPL applies to each tax year. For tax year 2025, use the 2024 FPL (released January 2024). For tax year 2026, use the 2025 FPL. The IRS publishes both in the Form 8962 instructions appendix.

Mistake #3: Mismatching 1095-A Numbers Between Spouses Who File Separately

Problem: Married couple files MFS and each tries to claim the full 1095-A on their separate return.

Impact: Combined total exceeds the 1095-A amounts, IRS rejects both returns or assesses penalties.

Solution: Generally, MFS filers can't claim PTC at all (limited exceptions for domestic abuse or spousal abandonment per Form 8962 instructions). If the exception applies, file Form 8962 and check the box. Otherwise, switch to MFJ if both want to access the credit.

Mistake #4: Ignoring a Corrected 1095-A

Problem: Filer files the return using the original 1095-A, then gets a "corrected" 1095-A in March or April.

Impact: Original return has wrong PTC. IRS will eventually receive the corrected 1095-A and issue a CP2000 notice with proposed adjustment plus interest and penalties.

Solution: File Form 1040-X (Amended Return) with the corrected Form 8962. Note "1095-A corrected" in the explanation. Doing it proactively avoids notice penalties.

Mistake #5: Forgetting Shared Policy Allocation

Problem: Divorced parents share a single 1095-A policy that covers their child. Each parent files separately and each claims the full Column A and Column B amounts.

Impact: Combined total reported on Forms 8962 is double the actual 1095-A. IRS rejects or audits both returns.

Solution: Allocate per Form 8962 Part IV. If parents agree, document the percentage split. If not, the default is 50/50. Each parent's 8962 Line 11 amounts get multiplied by their allocation percentage.

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How Jupid AI Helps with Form 1095-A and Premium Tax Credit Reconciliation

Premium Tax Credit reconciliation is one of the trickiest parts of a self-employed person's tax return. Income volatility makes the year-end true-up unpredictable, and the moving pieces — 1095-A from the Marketplace, FPL tables, applicable figures, repayment limits — change every year.

What Jupid does:

• Real-time income tracking — Jupid connects to your bank and tracks self-employment income as it arrives. When your year-to-date earnings drift away from what you reported to the Marketplace at enrollment, Jupid flags it so you can update your income estimate before year-end and avoid a surprise APTC repayment.
• Automatic transaction categorization — At 95.9% accuracy, Jupid categorizes business expenses that affect your AGI (and therefore your PTC calculation). Lower AGI means a lower applicable figure and a higher PTC.
• Bank connection and auto-categorization — One connection covers your business and personal accounts, so Jupid sees the full picture of what your AGI will look like at year-end.
• Chat with your AI accountant — Ask "If my income comes in at $45,000 instead of $30,000, how much APTC will I owe back?" or "Should I make a SEP-IRA contribution to lower my AGI for PTC purposes?" and get an answer in WhatsApp or iMessage with the IRS citation.

Example conversation:

• You: "My 1095-A Column B is $0 for July. What do I do?"
• Jupid: "Column B should not be zero if you had coverage in July. Use the healthcare.gov Tax Tool to look up the second-lowest cost silver plan for your zip code, family size, and age in July 2025. Enter that number on Form 8962 manually. I've also drafted an inquiry to the Marketplace requesting a corrected 1095-A — want me to send it?"

For freelancers whose income swings $20–30K year over year, getting PTC reconciliation right is worth thousands. Jupid makes the recordkeeping automatic and the math defensible.

Try Jupid →

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Action Checklist: Form 1095-A and Form 8962 Filing

Throughout the Year

• Update Marketplace income estimate every time income changes materially (new client, rate increase, lost income)
• Track self-employment income against the estimate you gave the Marketplace
• Save every Marketplace correspondence (eligibility notices, plan change notices)
• If you change family size mid-year (marriage, divorce, baby), report it to the Marketplace within 30 days

Before Filing

• Receive Form 1095-A by January 31 (download from healthcare.gov if mailed copy delays)
• Verify Part I is correct (name, SSN, policy number)
• Verify Part II covered individuals match your tax family
• Check Part III Column B for any $0 months — look up SLCSP from Tax Tool if missing
• If you received corrected 1095-A, use the corrected amounts
• Confirm filing status — MFS generally cannot claim PTC

When Filing

• Complete Form 8962 with 1095-A Part III amounts
• Use prior-year FPL (2024 FPL for tax year 2025; 2025 FPL for tax year 2026)
• Use Table 2 in Form 8962 instructions for Applicable Figure
• Decide annual (Line 11) vs. monthly (Lines 12–23) calculation
• Verify Line 26 net PTC flows to Schedule 3 Line 9 OR Line 29 excess APTC flows to Schedule 2 Line 1a
• Apply repayment limit (Pub 974 Table 5) if income is under 400% FPL
• Attach Form 8962 to Form 1040

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Resources and Citations

IRS Forms and Instructions

• Form 1095-A — Health Insurance Marketplace Statement
• Form 1095-A Instructions — Issued to Marketplaces; recipient guidance is on the back of Form 1095-A
• About Form 1095-A — IRS landing page with annual revisions
• Form 8962 — Premium Tax Credit reconciliation form (the form 1095-A feeds)
• Form 8962 Instructions — Line-by-line reconciliation guidance with FPL and applicable figure tables
• Schedule 3 — where Net PTC (Line 9) lands
• Schedule 2 — where Excess APTC repayment (Line 1a) lands

IRS Publications

• Publication 974 — Premium Tax Credit (the comprehensive guide; covers eligibility, calculation, repayment limits, and shared policy allocation)

Tax Code References

• IRC §36B — Premium Tax Credit (eligibility, calculation, applicable taxpayer)
• IRC §6055 — Information reporting for minimum essential coverage (requires Marketplaces to issue 1095-A)
• Rev. Proc. 2024-36 — 2025 inflation-adjusted applicable figure percentages and household income brackets
• ARPA / Inflation Reduction Act — 2021–2025 expansion of PTC (no upper income cap, lower applicable figures)

Marketplace Tools

• healthcare.gov Tax Tool — Look up SLCSP for any zip code, family size, age combination
• State Marketplace Tax Tools — Covered California, NY State of Health, MNsure, Pennie, etc. all publish equivalent tools

Related Jupid Guides

• Schedule C Instructions: Complete Line-by-Line Guide 2026 — for self-employed filers whose AGI determines PTC
• Form 8889 + AI Agent Skill: HSA Contributions Guide 2026 — HSA contributions reduce AGI, increasing PTC

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Final Thoughts

Form 1095-A is informational, but the reconciliation it triggers on Form 8962 is consequential. For self-employed filers especially — where final AGI is hard to predict at the start of the year — the gap between estimated and actual income is the difference between getting a refund and owing money back.

The strategies that actually move the needle:

1. Update Marketplace income whenever it changes by 10% or more — the Marketplace will adjust APTC monthly, smoothing year-end surprises
2. Lower AGI before December 31 through above-the-line deductions: SEP-IRA or solo 401(k), HSA, self-employed health insurance — every $1,000 of AGI reduction is worth real PTC dollars
3. File Form 8962 even when APTC was zero — that's how you claim net PTC if you under-estimated your premium subsidy
4. Save every 1095-A correction — corrected forms are common, and the IRS treats them as authoritative

The Marketplace handles the paperwork. Form 8962 handles the math. Your job is to keep the income estimate honest throughout the year so the year-end true-up is small.

Use This with Your AI Agent

If you're using Claude, ChatGPT, or another AI agent to help fill out Form 8962 from your 1095-A, we've published an open-source skill that gives the agent exact line-by-line instructions, validation checks, ask-don't-guess prompts, and worked examples — the same logic Jupid uses internally.

→ jupid-tax/jupid-skills on GitHub — forms/form-1095-a/SKILL.md

For Claude Code: cp -r jupid-skills/forms/form-1095-a ~/.claude/skills/. For the Anthropic SDK, load SKILL.md into the system prompt and the references/ files on demand. For browser-automation runtimes, filing.md covers the e-file or paper-file workflow.

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Disclaimer

This article provides general information about Form 1095-A and the Premium Tax Credit and should not be considered tax or financial advice. Premium Tax Credit rules are complex and depend heavily on household income, family size, coverage details, and applicable legislation. The post-2025 status of the ARPA/IRA-expanded subsidies depends on legislation that may have been enacted, extended, or allowed to lapse — verify the current Form 8962 instructions and IRS Publication 974 before filing. For advice specific to your situation, consult with a qualified tax professional.

Tax Year: 2026 (figures shown reflect 2025 rules where 2026 has not been announced) Last Updated: May 2, 2026