Form 14095 2025

See details

4.9 out of 5

24 votes

The document is the IRS Form 14095, used to request reimbursement for health insurance premiums paid directly to a qualified health plan while eligible for the Health Coverage Tax Credit (HCTC) but not enrolled in the HCTC Advanced Monthly Payment program. It outlines eligibility criteria, instructions for completing the form, required supporting documents, and submission details. The form must be submitted by September 30 of the current calendar year, and it can take up to 12 weeks to process.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out form 14095 with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open it in the editor.
Begin with Part 1, providing your personal information. Fill in your name, social security number (last four digits), mailing address, and contact details accurately.
Move to Part 2 to determine eligibility. Carefully check each statement regarding your health coverage and ensure you meet all criteria before requesting reimbursement.
In Part 3, indicate the months for which you are requesting reimbursement by checking the appropriate boxes. Enter the total amounts paid for qualified premiums in the designated fields.
Part 4 requires you to gather supporting documents. Attach proof of payment and health insurance bills that include necessary details like your name and premium amounts.
Finally, complete Part 5 by signing and dating the form. Ensure all information is accurate to avoid delays in processing your request.

Start using our platform today for free to streamline your form completion process!

See more form 14095 versions

We've got more versions of the form 14095 form. Select the right form 14095 version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2020	4.9 Satisfied (24 Votes)
2017	4.3 Satisfied (57 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to fill out form 3949 A?

Use Form D-3949A to report alleged tax law violations. Complete if you are reporting an individual. Include their name, street address, city, state, ZIP Code, Social Security Number or Taxpayer Identification Number, date of birth, occupation, marital status, name of spouse (if married), and email address.

How do you get your 1095 form for taxes?

How to find your 1095-A online Log into your Marketplace account and select your 2024 application not your 2025 application. Select Tax Forms from the menu. Under Your Form 1095-A, select Download PDF. If a form has a Corrected status, download this corrected form instead of a previous version.

Does a 1095-C form mean I owe taxes?

Much like the Form W-2 is used to determine whether or not you owe taxes, the IRS will use the information reported from your Form 1095-C to determine whether you (or your employer) may have to pay a fine for failing to comply with the Affordable Care Act.

Do I need to report Form 1095-A on my tax return?

Why did I get a letter from the IRS asking for more information and a copy of my 1095-A? You do not have to send your Form 1095-A to the IRS with your tax return when you file and claim the premium tax credit.