A Guide to 1095-B vs. 1095-C: Which One Applies to You?
Understanding your health insurance coverage can be confusing, especially when tax season rolls around and you encounter forms like the 1095-B and 1095-C. These forms provide proof of health insurance coverage and are used to determine if you comply with the Affordable Care Act’s (ACA) individual mandate, although the penalty for not having coverage has been eliminated in most states. While both forms serve a similar purpose, they come from different sources and contain slightly different information. This guide will break down the key differences between the 1095-B and 1095-C to help you understand which one applies to you.
1095-B: Health Coverage Form
The 1095-B form is the more general of the two. It’s provided by health insurance providers, including:
- Small self-insured employers: Companies that pay their employees’ health claims directly.
- Government-sponsored health insurance providers: Organizations providing coverage through programs like Medicare, Medicaid, CHIP, and certain other government plans.
- Insurance companies: Companies offering individual health insurance plans purchased directly or through the Health Insurance Marketplace.
Information included on Form 1095-B:
- Covered individuals: Names and social security numbers of individuals covered under the plan.
- Coverage period: The months of the year during which each individual had coverage.
- Type of coverage: Indicates the kind of health insurance plan.
- Name of the provider: Identifies the entity providing the insurance coverage.
Who receives a 1095-B?
Anyone who had minimum essential coverage (MEC) during the year, regardless of how they obtained it, should receive a 1095-B.
1095-C: Employer-Provided Health Insurance Offer and Coverage
The 1095-C form is specifically for employees of Applicable Large Employers (ALEs). An ALE is generally an employer with 50 or more full-time equivalent employees. This form reports information about the health insurance coverage offered to employees and their dependents.
Information included on Form 1095-C:
- Employee and employer information: Names, addresses, and Employer Identification Numbers (EINs).
- Offer of coverage: Details about the health insurance offered to the employee, including the cost of employee-only coverage and whether the offer met ACA requirements.
- Months of coverage: Indicates which months the employee and their dependents were enrolled in employer-sponsored coverage.
- Line 14: Second lowest cost silver plan (SLCSP) premium: This information helps determine premium tax credit eligibility if the employee purchased coverage through the Marketplace.
- Line 15: Employee required contribution: The amount the employee would have to contribute for self-only coverage.
- Line 16: Affordability safe harbor: Codes indicating whether the offer of coverage was considered affordable under ACA rules.
Who receives a 1095-C?
Full-time employees of ALEs, regardless of whether they accepted the offered coverage, should receive a 1095-C. Part-time employees may also receive one in certain circumstances.
Do you need both forms?
It’s possible to receive both a 1095-B and a 1095-C. For example, if you’re a full-time employee of an ALE and also enrolled in your spouse’s employer-sponsored health plan, you would likely receive a 1095-C from your employer and a 1095-B from your spouse’s insurance provider.
What to do with your forms:
While the individual mandate penalty is largely gone, you should keep these forms with your tax records. They can be helpful if questions arise about your health coverage. You do not need to submit them with your tax return.
Key Differences Summarized:
| Feature | 1095-B | 1095-C |
|—————-|——————————————-|—————————————————|
| Issuer | Insurance provider, government program | Applicable Large Employer (ALE) |
| Recipient | Anyone with minimum essential coverage | Full-time employees of ALEs |
| Purpose | Proof of health coverage | Proof of health coverage offer and enrollment |
| Key Information | Coverage dates, type of coverage | Offer details, affordability, months of coverage |
By understanding the differences between Form 1095-B and Form 1095-C, you can better navigate your health insurance information and ensure you have the necessary documentation for your records. If you have further questions, consult with a tax professional or refer to IRS resources.