| Part |
Description |
| Part I |
This section contains details about your Marketplace insurance. Leave this section blank if you did not have Marketplace coverage. Information to fill in includes:
- Marketplace identifier
Enter the identifier for your coverage area. This is often a state abbreviation.
- Policy number
This number should be found on the 1095-A form you receive from the marketplace.
- Recipient's identifying number
This is the taxpayer's social security number.
|
| Part II |
In this part, you'll provide details about the individual(s) covered under the policy. It includes:
- Covered individual names
List the names of every person covered under the Marketplace policy.
- Policy start & end date
Fill, as shown on your Form 1095-A.
- DOB and SSN
Here, fill in the birth date and Social Security Numbers for everyone listed.
|
| Part III |
This part comprises the details of the coverage months and payment amounts. You may need this information to determine your Premium Tax Credit on Form 8962. Information required includes:
- Monthly enrollment premiums
Fill in the monthly premium amounts for every person covered under the policy. This information is found on your 1095-A form.
- Monthly Second lowest cost Silver plan (SLCSP)
The SLCSP is the second-lowest monthly premium available to you through the state Marketplace for a policy that covers all persons in Part II.
- Monthly advance payment of premium tax credit
If you have opted for advanced payments, mention the amount here.
|
| Part IV |
This section is for shared policies and only needs to be completed if someone shared a policy with you, and they’re not on your tax return. For shared policies, information to be filled includes:
- Allocation start month
Provide the first month when the policy was shared.
- Allocation Stop month
Provide the last month when the policy was shared.
You will also need to provide details on how the premium, SLCSP, and Advance Credit Payment is being allocated between the shared policyholders; your form might allocate these amounts differently for different months. |
Remember, this is an important tax document that contains information about health insurance coverages purchased through the Marketplace. Completing the form appropriately ensures accurate tax filings and prevents unnecessary delays or errors in processing your return.
