ACA Forms Guide to Form 1095-B for the 2023 Tax Year

Image of Form 1095-B Header Section

If you're a small employer or healthcare provider, completing your Form 1095-B filing showing all enrolled individuals is very important. Form 1095-B must be accurately filled out and submitted annually to the IRS. The form must also be provided to the Responsible Individual. To avoid errors, familiarize yourself with the 1095-B instructions for the 2023 tax year. When submitting this form to the IRS, it should be accompanied by the 1094-B transmittal form.

What is Form 1095-B?

Form 1095-B is an information return filed by health insurance providers or employers offering self-funded coverage with fewer than 50 full-time + full-time equivalent employees.

Insurance Providers
Self-Funded Small Employers

less than 50 full-time + full-time equivalent employees

For more info on Tax Year 2023 Form 1095-B, click here.

Instructions for Form 1095-B - A Line-by-Line Guide

Part I - Responsible Individual

Image of Form 1095-B Part I

This section needs to be completed with the personal details of the beneficiary or employee. It consists of nine lines, as detailed below:

  • Line 1 - Responsible Individual Name

  • Line 2 - Social Security Number (SSN) or alternative TIN

    Enter the individual's full 9-digit Social Security Number or an alternative TIN if an SSN is unavailable.

  • Line 3 - Date of birth (if SSN or alternative TIN is not available)

    This line should only be completed if line 2 is left blank.

  • Line 4 - Full street address

  • Line 5 - City or town

  • Line 6 - State or province

  • Line 7 - Country and ZIP (or foreign postal code)

  • Line 8 - Input the Origin of Health Coverage code

    On this line, use the code that applies to the coverage provided to the individual and their dependents.

    What are Form 1095-B Line 8 Codes?

    Code Definition


    Small Business Health Options Program (SHOP)


    Employer-sponsored coverage, except for an ICHRA


    Government-sponsored program


    Individual market insurance


    Multiemployer plan


    Other designated minimum essential coverage


    Employer-sponsored ICHRA

    For broken-down examples of ACA Codes Line 8 on Form 1095-B, download our PDF Line 8 Code Guidance.

  • Line 9 - Reserved for future use

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Part II - Information About Certain Employer-Sponsored Coverage

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This section must be completed by issuers or carriers of insured group health coverage plans, including SHOP-purchased coverage.

Note: Insurance companies that enter codes A or B on line 8 need to fill out Part II. Employers reporting self-insured group health plan coverage on Form 1095-B, with code B on line 8, should leave Part II blank. If you have entered code B for self-insured coverage, skip Part II and proceed to Part III. Part II should not be filled if the coverage comes from a multiemployer plan.

  • Line 10 - Employer's name

  • Line 11 - Employer Identification Number (EIN)

  • Line 12 - Full street address (including room or suite number)

  • Line 13 - City or town

  • Line 14 - State or province

  • Line 15 - Country and ZIP or foreign postal code

Part III - Issuer or Other Coverage Provider

Image of Form 1095-B Part III

This section should be filled out by the entity providing the coverage. This could be the issuer or carrier of insured coverage, a government agency supplying government-backed coverage, a sponsor of a self-insured employer plan, or other coverage sponsors.

  • Line 16 - Name of Issuer or Other Coverage Provider

  • Line 17 - Employer Identification Number (EIN)

  • Line 18 - Contact telephone number

  • Line 19 - Full street address (including room or suite number)

  • Line 20 - City or town

  • Line 21 - State or province

  • Line 22 - Country and ZIP or foreign postal code

Part IV - Covered Individuals

Image of Form 1095-B Part IV

In Part IV, information about the individual and dependents enrolled under the coverage should be given. Continuation Sheets can be used if more than six covered individuals need to be added.

Note: The Responsible Individual should be listed in the Covered Individuals section if they had coverage for any month of the year.

  • (a) Covered individual(s) name - First name, middle initial, last name
  • (b) SSN or other TIN
  • (​c) DOB (if SSN or other TIN is not available)
  • (d) Covered for all 12 months
  • (e) Months of coverage

Once each 1095-B has been filled out, complete the 1094-B form and send both forms to the IRS. Also, send a copy of 1095-B to the recipient.

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