Form 109b 2025

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Your Form 1095-B shows your Medi-Cal coverage and can be used to verify that you had MEC during the previous calendar year. You can use this information to complete your state and/or federal income tax returns. If you are required to file state or federal taxes, you may self-attest your coverage as well.
You will use the information from the Form 1095-A to calculate the amount of your premium tax credit. You will also use this form to reconcile advance payments of the premium tax credit made on your behalf with the premium tax credit you are claiming on your tax return.
About Form 8822, Change of Address.
Health Insurance Marketplaces use Form 1095-A to report information on enrollments in a qualified health plan in the individual market through the Marketplace.
Form 1095-B is used to report certain information to the IRS and to taxpayers about individuals who are covered by minimum essential coverage. Eligibility for certain types of minimum essential coverage can affect a taxpayers eligibility for the premium tax credit.
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You will not attach Form 1095-B or Form 1095-C to your tax return, but you should keep both forms with your tax records.
Health insurance issuers or carriers will file Form 1095-B for all insured employer coverage. Plan sponsors are responsible for reporting self-insured employer coverage.
You can use Form 109-B to notify the Comptroller of Maryland that you have changed your business mailing address. If you have changed both your home and business mailing addresses, submit Form 109-B along with Form 109-I. Note: this form will only change/update your physical address and mailing address in our system.

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