Form 1095-B, "Health Coverage," is a tax document that provides information about an individual's health insurance coverage during a specific tax year. It is used in the context of the Affordable Care Act (ACA).
What Is Form 1095-B: Health Coverage?
Form 1095-B serves several key purposes:
- Who Files It: Insurance providers, including insurance companies and small employers that provide self-insured health coverage, are responsible for filing Form 1095-B.
- Information Included: The form includes details about the covered individuals, such as names, Social Security numbers or other taxpayer identification numbers, and the months they were covered by minimum essential coverage.
- Individual Mandate: Form 1095-B serves as evidence of compliance with the ACA's individual mandate, which requires most individuals to maintain health coverage that meets specific standards.
- Recipient: A copy of Form 1095-B must be furnished to the covered individual, by Tuesday, March 3rd, 2026. The individual may use this information when filing their tax return to report compliance with health coverage requirements.
Overall, Form 1095-B is an essential component of ACA reporting, enabling both the IRS and individuals to track compliance with health coverage requirements.
Which Organizations Must File Form 1095‑B?
Form 1095‑B, "Health Coverage," is the information‑return required under Internal Revenue Code §6055 whenever an entity provides minimum essential coverage (MEC) but is not required to file Form 1095‑C. The filing population is therefore limited and very specific:
- Commercial health‑insurance carriers. Any insurer that underwrites MEC for individuals, small groups, or COBRA continuants must file a 1095‑B for every covered "responsible individual" (usually the employee or subscriber) and their dependents.
- Small, self‑insured employers (< 50 full‑time‑equivalent employees). This bucket includes governmental units, church plans, and non‑profits that pay claims directly or through a level‑funded arrangement. Applicable Large Employers (ALEs) instead report on Form 1095‑C.
- Other MEC providers. Government‑sponsored programs such as Medicare, Medicaid, CHIP, TRICARE, and Veterans Health Administration plans also transmit 1095‑B data to the IRS.
Core Data Reported on Each 1095‑B
- Part I – Provider information: name, EIN, address, and contact phone.
- Part II – Employer information: completed only if the employer is not the coverage provider (e.g., a fully insured small group plan).
- Part III – Months of coverage for every individual who actually had MEC.
- Part IV – Other covered individuals, if more than six dependents are reported.
Furnishing Statements to Individuals
For the 2025 coverage year, you may use the IRS's "alternative manner" relief: instead of mailing a paper copy to every subscriber, post a conspicuous website notice by Tuesday, March 3rd, 2026 and keep it online through October 15 2026. You must still furnish an actual Form 1095‑B within 30 days if an individual requests it.
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How Can a Company Apply for an Extension for Filing ACA Form 1095-B?
To apply for an extension for filing ACA Form 1095-B, "Health Coverage," you must complete and submit IRS Form 8809, "Application for Extension of Time To File Information Returns." Here are the key steps to follow:
- Determine Eligibility: Verify that you are eligible for an extension and that you are filing the request before the original due date for Form 1095-B.
- Complete Form 8809: Fill out Form 8809 with the required information, including the filer's name, address, Employer Identification Number (EIN), and the type of returns for which the extension is requested.
- State the Reason: You may be asked to provide a reason for the extension request. Ensure that the reason is clear and aligns with acceptable grounds for an extension.
- Submit the Form: Form 8809 can be filed electronically through the FIRE (Filing Information Returns Electronically) system or sent by mail to the appropriate IRS address.
- Wait for Approval: An automatic 30-day extension is generally granted, but additional extensions may be requested under specific circumstances. Approval or denial will be communicated by the IRS.
It is important to file Form 8809 promptly. Keep in mind that an extension to file Form 1095-B does not extend the time to furnish the form to covered individuals.
What Is the Penalty for Not Filing ACA Form 1095-B?
Failure to file ACA Form 1095-B, or filing it late, can result in penalties from the IRS. The specific penalty amounts are subject to change and depend on various factors:
- General Penalty: For returns required to be filed for the 2025 tax year, the general penalty is $340 per return, with a maximum annual penalty of $4,098,500.
- Increased Penalty for Willful Neglect: If the failure to file is due to intentional disregard of the filing requirements, the penalty per return is greater, with no maximum annual penalty limit.
- Adjusted Penalty for Small Businesses: Lower maximum annual penalties may apply to organizations with gross receipts of $5 million or less.
- Reduction for Corrected Returns: Penalties may be reduced if the failure is corrected within a certain time frame.
- Waiver for Reasonable Cause: Penalties may be waived if the failure is due to reasonable cause and not willful neglect.
What Information Is Required to File Form 1095-B?
Filing Form 1095-B, "Health Coverage," requires gathering and reporting specific information related to the provision of minimum essential coverage (MEC). Here's what you'll need:
- Coverage Provider Information: The name, address, and Employer Identification Number (EIN) of the entity providing the coverage, such as an insurance company or employer with a self-insured plan.
- Responsible Individual's Information: The name, Social Security number (or other taxpayer identification number), and address of the person responsible for the coverage.
- Covered Individuals' Information: Names, Social Security numbers (or other taxpayer identification numbers), and birthdates of all individuals covered under the policy, including spouses and dependents.
- Coverage Details: Information about the coverage, including the months in which coverage was provided and whether it qualifies as MEC under the ACA.
- Offer of Coverage (if applicable): Details about the offer of employer-sponsored coverage, if provided by an employer that is not an Applicable Large Employer (ALE).
What Is the Role of Form 1095-B?
Form 1095-B, "Health Coverage," plays a vital role in the administration of the Affordable Care Act (ACA). Its main functions include:
- Reporting Minimum Essential Coverage (MEC): The form is used by insurance providers, small employers with self-insured plans, and other entities to report the provision of MEC to individuals. This information helps the IRS verify that individuals are complying with the ACA's individual mandate.
- Providing Information to Covered Individuals: A copy of Form 1095-B must be furnished to the covered individuals, informing them of the coverage provided. This information assists individuals in completing their tax returns and demonstrating compliance with the ACA's requirements.
- Facilitating IRS Oversight: By collecting detailed information about health coverage, Form 1095-B enables the IRS to monitor compliance with the ACA's provisions, enforce penalties for non-compliance, and gather data for policy analysis.
- Supporting Other ACA Provisions: In some cases, Form 1095-B may also be used to support other aspects of the ACA, such as providing information related to premium tax credits or other subsidies.
How Does Self-Insurance Work in Relation to Form 1095-B?
Self-insurance, also known as self-funded health coverage, refers to a situation where an employer directly funds the health care costs of its employees rather than purchasing coverage through an insurance company. In the context of Form 1095-B, "Health Coverage," self-insurance has particular implications:
- Responsibility for Reporting: Employers that provide self-insured health coverage are responsible for reporting this coverage by filing Form 1095-B with the IRS. They must report information about the coverage provided, including details about covered individuals and the periods of coverage.
- Minimum Essential Coverage (MEC): Self-insured employer-sponsored plans typically qualify as MEC under the ACA.
- Information for Covered Individuals: Employers must also furnish copies of Form 1095-B to individuals covered under the self-insured plan.
- Applicability: Self-insured employers that are not considered Applicable Large Employers (ALEs) under the ACA are required to use Form 1095-B for reporting. ALEs use Form 1095-C, even if they provide self-insured coverage.
What Is the Difference Between Sponsors & Providers?
In the context of healthcare and insurance, the terms "Sponsors" and "Providers" refer to different entities or individuals, each playing a unique role:
- Sponsors: Sponsors are typically organizations or individuals responsible for offering or funding a health plan. In the context of employer-sponsored health coverage, the employer is the sponsor, responsible for selecting and often contributing to the cost of the health plan.
- Providers: Providers refer to healthcare professionals or institutions that deliver medical services. This category includes doctors, nurses, therapists, hospitals, clinics, and other entities that provide medical care to patients.
Are There State Requirements for Reporting Form 1095-B?
While Form 1095-B is primarily a federal form used to report minimum essential coverage (MEC) to the IRS, some states have implemented their own healthcare mandates that require additional or similar reporting. These state requirements can vary and may include:
- Similar Forms and Reporting: Some states have established their own individual mandates that require reporting similar to the federal ACA requirements. This may involve submitting a form similar to 1095-B to a state agency.
- Additional Information: States may require additional information or details beyond what is required on the federal Form 1095-B.
- Different Deadlines: State reporting deadlines may differ from the federal deadlines for submitting Form 1095-B.
- Specific Exemptions or Penalties: State requirements may include unique exemptions, penalties, or other provisions that differ from federal rules.
