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Reporting Under Section 6055 and 6056

When the Affordable Care Act was made law, the IRS updated the Internal Revenue Code (IRC) to include Sections 6055 and
6056 regarding ACA reporting.

IRC 6055

Section 6055 Requirements

Section 6055 was added to the IRC to state that anyone who provides at least minimum essential coverage (MEC) to individuals will report that coverage information on IRS Form 1095-B &
Form 1094-B each year to the IRS. This reporting shows compliance with the new ACA laws that all taxpayers receive
health insurance each year.

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IRC 6056

Section 6056 Requirements

Section 6056 was added to the IRC, also to require reporting of coverage information, but this is for Applicable Large Employers, or ALEs. Any employer with 50 or more full time employees (including full-time equivalent employees) must also provide at least the MEC of health insurance to their full-time employees. ALEs report that they provided this coverage on IRS Form 1095-C & Form 1094-C.

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What are ACA Reporting Form?

IRS Form 1095-B

Health Coverage

IRS Form 1095-B is filed by providers of health care coverage who aren't considered ALEs. That means this is filed by health insurance issuers or carriers, plan sponsors of self-insured group plans, and executive departments or agencies of governmental units.
Form 1095-B reports the coverage offered by month to each recipient by the filer, and a copy must be sent to the IRS as well as the recipient of the coverage.

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IRS Form 1094-B

Transmittal of Health Coverage Information Returns

IRS Form 1094-B is the transmittal form for Form 1095-B. It's also filed by insurance providers who aren't ALEs, but only with the IRS by paper filers. Form 1094-B acts as a cover letter, summarizing the information in the accompanying 1095-B Forms, so there's no need to send it to recipients.

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IRS Form 1095-C

Employer-Provided Health Insurance Offer and Coverage

IRS Form 1095-C is filed by ALEs to report the health insurance coverage provided to their employees throughout the year. Like Form 1095-B, a copy of Form 1095-C is filed with the IRS and a copy is sent to the full-time employees who were offered the coverage provided by the ALE

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IRS Form 1094-C

Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns

IRS Form 1094-C is the transmittal form for Form 1095-C. There's no need to send Form 1094-C to any of your recipients. However, when you paper file 1095-C forms with the IRS, you'll need to include Form 1094-C. This form supplies a summary of the information contained on your 1095-C forms.

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What is the Minimum Essential Coverage?

The minimum essential coverage (MEC) refers to the least amount of coverage a person can have and still be compliant with ACA laws.

Anyone covered under the following plans is considered to have MEC:

  • Eligible employer-sponsored coverage
  • Coverage purchased through the individual market
  • Medicare Part A & Medicare Advantage plus
  • Most Medicaid
  • Children’s Health Insurance Program (CHIP)
  • Certain coverage administered by the Veteran’s Administration
  • Most types of TRICARE
  • Peace Corps volunteer coverage
  • Refugee Medical Assistance (Administration for Children and Families)

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E-File 1095 C

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E-File 1095-C with us and get your ACA 1095-C filed to the IRS

Form 1095 FAQs

The employer shared responsibility provisions state that ALEs must offer at least the MEC of health insurance to their full-time employees or pay an employer shared responsibility payment to the IRS. Another part of these provisions requires ALEs to report their coverage information to the IRS and their employees or pay a penalty for each missing form.

The minimum value (MV) is a standard health plans are required to meet. It's met if the health plan pays at least 60% of the total cost of medical services for a standard population. Its benefits must include substantial coverage of inpatient hospital and physician services.

If you have missed the IRS Form 1095 filing deadline you may be penalized by the IRS. Penalty amounts are based on the size of the organization and the date form is actually filed.

If you’re unable to file IRS Form 1095 on time, you can apply for an automatic 30-day extension by completing Form 8809 by your original due date.

For the calendar year 2024, the IRS made some changes to the ACA forms for the IRS 1095-B form 8th Line code has been updated as individual coverage, health reimbursement arrangement is added, and for IRS 1095-C form in line 14 new codes are updated.

The federal mandate penalty was eliminated by Congress under the Affordable Care Act, so the states like California, Massachusetts, New Jersey, Rhode Island, Vermont, and District of Columbia have made individual mandates at state level and now states like Connecticut ,Hawaii, Maryland, Minnesota, Washington are considering to have individual mandate.

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