ACA Questionnaire

The Affordable Care Act aka ACA aka Obamacare has unique tax consequences that we must address.  The ACA Questionnaire is only required if you received your health insurance through a marketplace.  If your health insurance is provided thru your employer or you have private health insurance, you no longer need to fill out an ACA questionnaire.

Form 1095

This form is being used to report your health insurance coverage, and it has three sources-

Form Health Insurance Source
1095-A Marketplace
1095-B Private Insurance
1095-C Employer Sponsored

Only the 1095-A form must be provided for 2019 and later. 1095-B and 1095-C forms don’t have to be provided starting in 2019.

So, if you purchased health insurance from the marketplace YOU MUST provide us the Form 1095-A.

ACA Questions

Please describe the health insurance coverage that you AND your family had, and the periods of time that you had it. For example, you had a job from Jan thru Apr with company sponsored insurance, used COBRA for May, and then purchased private insurance for Jun thru Dec.

Is anyone in your family qualify for an exemption from the health care coverage mandate? If so, please describe below-

Were there any periods of time in 2020 where you were NOT covered by health insurance? If so, please describe below-


Please select the tax year that this information is associated with. In addition, please enter your name so we can group your submissions together plus your email address. Click the Submit button below to securely and safely send this information to us. You can submit as many forms as needed. If you later discover an error- simply re-submit your information and check the box below letting us know.

Yes     No