Request Your 1095-A Form | Covered America

What is Form 1095-A? If you enrolled in a health plan through the Marketplace (HealthCare.gov or your state exchange), you will receive a 1095-A. It shows your coverage dates, the plans enrolled in, and the amount of any Advance Premium Tax Credit (APTC) you received. You need this form to complete IRS Form 8962 when filing your federal income taxes.

1095-A Request Form

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Coverage Year *

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About Form 1095-A

You can also access your 1095-A directly at HealthCare.gov → log in → "Tax forms".