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Blank 1095 a-2026
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- Click ‘Get Form’ to open the blank 1095-A in the editor.
- Begin with Part I, where you will enter your personal information. Fill in the marketplace identifier, policy number, and your name along with your Social Security Number (SSN) and date of birth.
- Next, provide details about your spouse if applicable, including their name, SSN, and date of birth. Then, complete the policy start and termination dates along with your address.
- Move to Part II to list covered individuals under your policy. For each person, input their name, SSN, date of birth, and coverage start/termination dates.
- Finally, in Part III, record the monthly premium amounts for each month of coverage as well as any advance payment amounts made on your behalf. Ensure all totals are accurate for tax credit reconciliation.
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