1095-B Tax Form

Upon request, the Department of Human Services will mail 1095-B tax forms to households who have a member receiving Medical Assistance (MA) coverage.

Why are you receiving this form?

The Internal Revenue Service (IRS) requires all health insurance providers send this form upon request to all enrollees who have health insurance and meet the "minimum essential coverage" requirements of the Affordable Care Act (ACA) and requested the form. The ACA requires nearly all Americans who meet health care reform standards to have health insurance. The 1095-B form informs the IRS who had coverage and for how long.

What information is on the 1095-B tax form?

For each person covered on your policy, the 1095-B lists:

  • Name
  • Address
  • Date of birth
  • Taxpayer identification number
  • Months of coverage

If you need a copy of your 1095-B tax form, you can:

You can also request the form by:

Additional Information