Maryland's Official Health Insurance Marketplace

What information is provided on Form 1095-A?

Form 1095-A has three parts:

  • Part I provides basic information about you and your family, and your health insurance start and end dates.
  • Part II provides information about each member of your “coverage household” – those members of your family also covered under the same policy.
  • Part III provides information for every month of the year for three items:
    1. the monthly premium amount of the health plan you selected,
    2. the premium amount of the second lowest cost Silver Plan available through Maryland Health Connection, also known as the benchmark premium, and
    3. the advance payments of the premium tax credit paid on your or a household member’s behalf to the issuer of the policy. The premium amount of the second lowest cost silver plan is provided because the law requires that we use this plan’s premium amount to calculate your premium tax credit.