1095 A  & FTB 3895 Covered CA Statement of Coverage & Subsidies


Try turning sideways to better view PDF's & Screen Shots

Covered CA will send you Form 1095 A – InstructionsHTML & Cover Letter  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

Check out the analysis of #1095 Form from our Friendly Competitor insure me kevin.com    ♦  Tax Guidance on Friendly Competitors Blog

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 on Health Insurance Marketplace.

IRS FAQ’s Questions and Answers about 1095 a, b & c

#Form8962 Premium Tax Credit
Reconciliation Form attaches to 1040
Subsidy is IMHO hocus pocus - smoke & mirrors
it all comes out when you file taxes!

8962 Subsidy Reconciliation

IRS #Pub974 

Premium Tax Credit
IRS Publication 974

VIDEO What is APTC Advance Premium Tax Credit


aptc interactive assistant

Interactive Tax Assistant (ITA)

Am I eligible to claim the Premium Tax Credit? 

IRS FAQ on Premium Tax Credit


Tax #Estimators



ACA What You Need To Know  #5187 ACA What you need to know # 5187

Health Net VIDEO
How to get subsidies – pay less for coverage 

Kaiser Foundation reports that 27% of uninsured individuals are eligible to purchase a bronze plan with $0 premiums after subsidies in 2019.  Silver plans with cost-sharing reductions (CSR) for single individuals with incomes below 200% of the poverty level can be purchased for roughly $20 to $130 per month after subsidies, depending on an enrollees’ income. KFF *

22 comments on “1095 A & FTB 3895 Covered CA Statement of Subsidy & Proof of Coverage

  1. Hi Steve

    I watched your video, thank you for making it.

    The issue here is Attiano had coverage of his own from his College, and a major defense contractor.

    I haven’t gotten from him when those coverages started,

    He also had Medical, [Medi-Cal] you may remember that for some reason the exchange placed him and Liam on soft pause, we had since tried to get him out, currently even though Medical [Medi Cal] recognizes that he is not on our account, and doesn’t have an account at all we still receive bills from his coverage.

    So I agree with you the exchange is a mess.

    The question remains though since he was covered by other plans, including medical, [Medi-Cal] and thus should have not been on my plan, am I responsible for the subsidy he received?

    I mean I didn’t receive that money, the insurance did, on error from the exchanges seems to me.

    Attiano never used the service nor my insurance neither Medical.

    So it really was a virtual service.

    So should we zoom?


  2. What was the date Attiano was actually removed from coverage?

    Here’s where he was removed as a member of the household, right?


    So, he wasn’t covered, but subsidies were based on taking him as a tax deduction, right?
    people in houshold

  3. 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.

  4. 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.

  5. 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?

Leave a Reply

Your email address will not be published.