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Printable Form 1095-A New Hampshire: What You Should Know

Form 1095-A, Health Insurance Marketplace Health Insurance Marketplaces use Form 1095-A to report income and premiums in the. Marketplace. About Form 1095-A, Health Insurance Marketplace In 2016, you must file an income and premium form on Form 1095-A. You can use this form to: • report information about income before you file your federal return if you're filing as an individual, and you have a wage or salary income • report information about family income that will apply to you when you file your federal return if you're filing as a head of household Your Marketplace page lists the information that must be provided on Form 1095-A. In 2015, you must file an income and premium claim form on Form 1095-PF. You can use this to: • report your refundable premium tax credit (up to 2,000) • report an overpayment of your premium tax credit (up to the IRS-assessed premium tax credit, 2,000 per person, per year) The 2017-18 Income & Premium Forms .pdf (6.1 MB) is the 2018-19 Income & Premium Forms .pdf is the 2019-20 Income & Premium Forms .pdf (6.0 MB). Form 1095-A, Health Insurance Marketplace You can use Form 1095-A to report health insurance details, information about: • the types of health insurance policies purchased for 2018. • the health insurance policies purchased from Marketplace insurance marketplaces. • the name and amount of the premium tax credit you claimed for 2014. The Form 1095-APDF, Premium Tax Credit Statement.pdf (8.3 MB) is the information return for 2017-18.

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