1095 A, B & C  & FTB 3895 Covered CA Statement of Coverage & Subsidies


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Covered CA will send you Form 1095 A – 

InstructionsHTML & Cover LetterCovered CA Video  so that you can fill out Form 8962 to reconcile  Premium Tax Credit – Subsidy.  In addition this form will give you proof of coverage so that you don’t have to pay the California mandate penalty of 2.5% of income.

If you don’t get the form in the mail, just log into your Covered CA Account and get it.

For personal year around service from Covered CA, just appoint us as your agent, by completing this form.

1095 a form & instructions

3895 CA proof of insurance

Form FTB 3895

CA Franchise Tax Board FTB form # 3895 is proof of coverage so that you can claim the 600%  Premium Assistance Subsidy (state subsidy) beyond the 400% Federal Subsidy  and reconcile any advanced state subsidy received, form 8962  and to file an accurate tax return to avoid paying the state individual mandate penalty of 2.5% of income.. The amount displayed on the Form FTB 3895 reflect how much was paid to your Health Insurance Company Insurance as a subsidy, besides what you paid as Net Premium

Email us [email protected] for the “Toolkit” or questions on this new form.

See our webpage on the California Mandate Penalty


2016 Revised 1095? Insure Me Kevin.Com

If you got the WRONG 1095 A form, you don’t have to refile taxes per

About 50% of people who got subsidies will have to return a portion of the $$$  CA Healthline 3.25.2015

Where to find 1095 A in your Covered CA portal
1095 location Covered CA

IRS – 1095 B
#Confirmation of Employer,
Medi-Cal  & Non Covered CA Minimum Essential Coverage Coverage 

The 1095 B  shows proof that you had coverage from your employer’s health plan.  While there is no longer a Federal Mandate Penalty there is a penalty  for California.   The California FTB Franchise Tax Board is in charge of working out all the rules and procedures.   We’ll have to wait and see.


1095 B IRS Website




  • Form 1095-B, Health Coverage
    • Individuals who had health coverage for themselves or their family members that is not reported on Form 1095-A from Covered CA or Form 1095-C from Large Employers and Self Insured Plans
      • Insurance companies outside Covered CA
      • Government agencies such as Medicare or Medi Cal 
      • Employers who provide certain kinds of health coverage, which is sometimes referred to as “self-insured coverage,” but are not required to send Form 1095-C.
      • Health Coverage Providers –
    • Use Form 1095-B for information on whether you and your family members had health coverage that satisfies the individual shared responsibility provision (Mandate Penalty).
      • If there are months when you or your family members did not have coverage, determine if you qualify for an exemption or must make an individual shared responsibility payment mandate penalty prior to 2019.


      You don’t need to wait for your Form 1095- B to file your tax return. Do not attach Form 1095-B to your tax return – keep it with your tax records. Contact the issuer if you have questions about your Form 1095-B.  Source   HCTT-2016-81   IRS bulletin dated 12.21.2016


Visit our Employer Website & Get Quotes

Medi Cal 1095 B

CA Department of Health Care Services

The Form 1095-B is an Internal Revenue Service (IRS) document that many, but not all, people who have Medi-Cal will receive. The Department of Health Care Services (DHCS) only sends Form 1095-B to people who had Medi-Cal benefits that met certain requirements, known as “minimum essential coverage,” at least one month during the tax year.  READ MORE and the Rest of the FAQ’s 



May request Social Security #‘s


Talking Points Minimum Essential Reporting

Minimum Essential Coverage

Health Net Explanation

Deadline Extended for employers to send B & C,  IRS says you can file your 1040 without it  – Insure Me Kevin.com

Other Pages in this section

Forms that Employers must provide to employees

Questions and Answers on Information Reporting by Health Coverage Providers (Section 6055) IRS Website

Our Webpage on 6055 & 6056 Reporting Requirements


Health Net’s Rules & Interpretations




What is form 1095 C Proof of Coverage from a #Large Employer?

Form 1095-C   is provided by a large employer to employees so they can prove they had coverage for the year and not get fined in CA for not having coverage, or so they can get coverage from Covered CA – no extra charge to use a broker, click on button below to get quotes and subsidy calculation,  if no coverage is provide.

Form 1095-C provides information about the health coverage offered by your employer and, in some cases, about whether you enrolled in this coverage.   Use Form 1095-C to help determine your eligibility for the premium tax credit.

  • If you enrolled in a health plan in Covered CA,  you may need the information in Part II of Form 1095-C to help determine your eligibility for the premium tax credit.
  •  If you did not enroll in a health plan in the Marketplace, the information in Part II of your Form 1095-C is not relevant to you.

Use Form 1095-C for information on whether you or any family members enrolled in certain kinds of coverage offered by your employer – sometimes referred to as “self-insured coverage”.

  • If Form 1095-C shows coverage for you and everyone in your family for the entire year, check the full-year coverage box on your tax return.
  • If there are months when you or your family members did not have coverage, determine if you qualify for an exemption or must make an individual shared responsibility payment – tax penalty. 

You don’t need to wait for your Form 1095- C to file your tax return. Do not attach Form 1095-C to your tax return – keep it with your tax records. Contact the issuer if you have questions about your Form 1095-B.

Understanding Form 1095-C,

Employer-Provided Health Insurance Offer and Coverage

Employers with 50 or more full-time employees, including full-time equivalent employees, in the previous year use Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, to report the information required about offers of health coverage and enrollment in health coverage for their employees.  Form 1095-C is used to report information about each employee. Employers that offer employer-sponsored self-insured coverage also use Form 1095-C to report information to the IRS and to employees about individuals who have minimum essential coverage under the employer plan and therefore are not liable for the individual shared responsibility payment for the months that they are covered under the plan. An employer must furnish a Form 1095-C to each of its full-time employees by January 31 of the year following the year to which the Form 1095-C relates. Employers will meet the requirement to furnish Form 1095-C to an employee if the form is properly addressed and mailed on or before the due date. If the regular due date falls on a Saturday, Sunday, or legal holiday, employers may file by the next business day. The Form 1095-C that employers send may include only the last four digits of the employee’s social security number, replacing the first five digits with asterisks or Xs. Forms 1095-C must be sent on paper by mail or hand delivered, unless the employee consents to receive the statement in an electronic format. The consent ensures that the employee can access the electronic statement. If mailed, the statement must be sent to the employee’s last known permanent address, or if no permanent address is known, to the employee’s temporary address. Individuals who worked for multiple employers that are required to file Form 1095-C may receive a Form 1095-C from each employer. 

Related and Child Pages

12 comments on “1095 A, B & C & FTB 3895 Covered CA Statement of Subsidy & Proof of Coverage

  1. 8 comments on “#1095 B Confirmation of Employer, Medi-Cal & Non Covered CA Coverage”

    1. Anonymous says:

      I was direct off exchange with Kaiser, not Covered CA. I called Kaiser and they say they don’t have my 1095 B form. What do I do?

    2. Anonymous says:

      Does Medi-Cal issue a 1095 B Form?

    3. Ana G says:

      The number Blue Cross Help Line 1-844-301-5617 you provided for help is a SCAM and they will take your personal data and SSN. Please remove it from your article immediately so people are not affected by this scam.

      People should only call the number in the customer service numbers back their BCBS cards.

      • Thank you very much for pointing this out. We have removed the number. According to agent-link.net the phone # was set up on a temporary basis to handle the influx of calls the first year that 1095 B’s came out.

        I’ve received several bulletins about this year’s 2016 1095 B where the deadline has been extended. I’ll see if I can forward them to you. This page does not get much traffic, so I haven’t put this at the top of my priorities.

    4. M. Morrow says:

      1. What is the minimum income to qualify for a subsidy? Does withdrawal from ira count as income toward the qualifying amount?

      2. If I receive $12000 from disability and take$5000 from my Ira, do I qualify for a subsidy.(Assuming the qualifying amount is $17000.)

      3. Also, can I revise my previous year income tax and qualify for the previous subsidy as I mis -calculated originally and made $17000 .

  2. I need my 1095-A form but can’t recall my Password, and can’t answer ALL QUESTIONS SENT.



    • See above about appointing us as your broker. If nothing else, call Covered CA and ask that we get appointed as your broker. We can then easily get your 1095 for you.

      If your parent were claiming you as a dependent, that might cause problems with the subsidy amount that you were getting.

      Definition of household & all.

  3. For the last one month I have been calling covered Ca to resolve the problem of getting form 1095 to submlt my tax return. Almost every time I had to waste almost half an hour but no luck. Yesterday I spent between two to three hours continuously in talking to one or the other person from covered ca.

    They helped me in getting fresh password. Later the computer gets jammed. The the message comes site is down etc.

    On Feb 20 I talked to one of their rep and I was promised that form will come in my mail in two weeks. I called on March 5 and was told to wait for one more day i.e till March 6. Still no luck

    Today my son made a few attempts to log in to my account without any success. Then he tried to log in to his account. He too had the same kind of frustation.

    Will you please get me form 1095 ASAP.

    Also please submit this complaint to the highest authorities of covered Ca.

    Needless to say covered ca is giving me this frustration. I would like to take up this complaint with head of covered Ca.

  4. I don’t believe I received my 1095-A form from Covered CA for the 2017 year.

    I tried to track it down online but it appears the only way I can get it is by filling out a dispute form.

    How can I get it?

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