CEEB TOOM: Koj daim foos 1095-B yog pov thawj ntawm kev pov hwm kev noj qab haus huv rau IRS thiab tsis tas yuav ua kom tiav lossis xa mus rau DHCS. Thov khaws daim foos no rau koj cov ntaub ntawv.​​ 

Rov qab mus rau Daim Ntawv 1095-B Rov Qab​​ 

Daim Ntawv 1095-B yog Internal Revenue Service (IRS) cov ntaub ntawv uas ntau, tab sis tsis yog tag nrho, cov neeg uas muaj Medi-Cal yuav tau txais. Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tsuas yog xa Daim Ntawv 1095-B rau cov neeg uas tau txais Medi-Cal cov kev pab cuam uas ua tau raws li qee yam kev cai, hu ua "kev pab them nqi tsawg kawg nkaus (MEC)," tsawg kawg ib hlis hauv lub xyoo se.​​ 

MEC yog hais txog qib ntawm cov txiaj ntsig kev noj qab haus huv uas IRS xav kom txhua tus neeg muaj. Tus neeg lossis lawv tus neeg npaj se yuav siv cov ntaub ntawv los ntawm Daim Ntawv 1095-B ua pov thawj ntawm kev pab them nqi kho mob rau xyoo se ntawd.​​ 

If you only had health coverage for part of the year or no health coverage at all, the tax penalty no longer applies. However, the ACA still requires most people to report to the IRS that they had MEC health coverage for the tax year. Although, you are not required to have Form 1095-B to file your taxes, please save this form for your record.​​ 

DHCS will mail Form 1095-B to people who had Medi-Cal that met the health coverage requirement by January 31. A cover letter explaining the purpose of the form will be included with Form 1095-B. DHCS will also send an electronic copy of Form 1095-B to the IRS by March 30.​​  

IRS Resources​​ 

Mus rau ntawm no kom pom cov npe ntawm cov lus nug nquag nug los ntawm cov ncauj lus los ntawm Internal Revenue Service.​​  

Affordable Care Act thiab California Health Mandate​​ 

Dab tsi yog Txoj Cai Tswjfwm Tus Kheej lossis California Txoj Cai Saib Xyuas Kev Noj Qab Haus Huv?​​ 

The Affordable Care Act (ACA) requires most people to have health coverage that meets certain minimum standards, also called minimum essential coverage (MEC). California Senate Bill 78, chaptered into law in 2019, also requires most California residents to have MEC or pay a penalty to the state beginning in 2020, if they do not qualify for an exemption from the requirement to have coverage. These laws requiring health care coverage are also referred to as the “Individual Mandate” or the “Health Care Mandate”.​​  

Dab tsi yog qhov kev zam los ntawm cov cai kom muaj kev pab them nqi?​​ 

Cov tib neeg yuav tsim nyog tau txais kev zam thiab tsis tas yuav them tus nqi nplua rau qhov tsis muaj kev pov hwm kev noj qab haus huv tsim nyog raws li California's Health Mandate. Koj tuaj yeem thov qee qhov kev zam los ntawm Covered California thiab lwm yam kev zam kuj tuaj yeem thov tau thaum koj xa koj daim ntawv them se hauv xeev. 

Yog xav paub ntxiv txog cov kev zam tshwj xeeb thiab yuav thov li cas, mus saib lub vev xaib Franchise Tax Board (FTB).​​ 

Tsoom fwv teb chaws cov se raug nplua raug tshem tawm ntawm ACA, qhov ntawd cuam tshuam rau kuv li cas?​​ 

Hauv xyoo 2019, tsoomfwv cov nqi se cuam tshuam nrog ACA raug txo qis rau xoom. Txawm li cas los xij, raws li California Txoj Cai Tswjfwm Saib Xyuas Kev Noj Qab Haus Huv, pib xyoo 2020, yog tias koj tsis muaj Medi-Cal lossis lwm yam kev pabcuam kev noj qab haus huv uas tsim nyog rau tag nrho kaum ob lub hlis ntawm xyoo dhau los, thiab koj tsis tsim nyog tau txais kev zam los ntawm cov kev pabcuam uas xav tau, koj tej zaum yuav raug nplua los ntawm FTB thaum koj ua koj cov se hauv lub xeev. Txawm hais tias tsis muaj kev nplua los ntawm tsoomfwv, ACA tseem xav kom cov neeg feem coob qhia rau IRS yog tias lawv muaj MEC rau xyoo ua se ua ntej.​​ 

Where can I get additional information about the Individual Mandates and the potential penalty under California’s Health Mandate?​​ 

Additional information about the ACA, California’s Health Mandate, and state or federal tax filings can be found on the following webpages:​​  

• Covered California information regarding California’s Health Mandate and exemptions​​ 
• FTB information regarding California’s Health Mandate​​ 
• Department Health Care Services Form 1095-B:​​ 
• Federal Mandate thiab ACA cov ntaub ntawv​​ 
• Internal Revenue Service (IRS) cov ntaub ntawv hais txog tsoomfwv txoj cai tswjfwm thiab ACA​​ 

Daim Ntawv 1095-B Basics​​ 

Daim Ntawv 109-5-B yog dab tsi?​​ 

Daim Ntawv Foos 1095-B yog Internal Revenue Service (IRS) cov ntaub ntawv uas yuav siv tau los ua pov thawj tias ib tus neeg tau txais kev pab them nqi kho mob tsim nyog uas suav tias yog Qhov Kev Pab Cuam Tshuam Yam Tsawg (MEC) thaum lub xyoo se. Ua raws li Txoj Cai Saib Xyuas Nqis Nqis thiab Txoj Cai Kho Mob California, feem ntau cov neeg yuav tsum tau tuav pov hwm kev noj qab haus huv uas ua tau raws li MEC cov cai txhua xyoo. Feem ntau Medi Cal kev pab them nqi yog suav tias yog MEC.​​  

Koj Daim Ntawv Foos 1095-B qhia koj qhov kev pab cuam Medi-Cal thiab tuaj yeem siv los txheeb xyuas tias koj muaj MEC hauv xyoo dhau los. Koj tuaj yeem siv cov ntaub ntawv no los ua kom tiav koj lub xeev thiab / lossis cov nyiaj tau los ntawm tsoomfwv. Yog tias koj yuav tsum tau ua ntaub ntawv se ntawm lub xeev lossis tseem fwv, koj tuaj yeem ua pov thawj koj tus kheej ntawm koj qhov kev pab cuam thiab. Koj tsis tas yuav xa daim ntawv theej ntawm Daim Ntawv 1095-B nrog koj daim ntawv them se, tab sis koj tseem yuav tsum khaws cia rau koj cov ntaub ntawv.​​ 

Cov ntaub ntawv dab tsi yuav suav nrog hauv Daim Ntawv 1095-B?​​ 

 The Form 1095-B will include the insured person’s:​​ 

• Lub npe​​ 
• Chaw nyob​​ 
• Tus lej Xaus Saus (tus lej plaub kawg nkaus xwb)​​ 
• Hnub yug (tsuas yog tus lej Xaus Saus tsis muaj)​​ 
• Lub hlis ntawm Medi-Cal kev pab them nqi uas ua tau raws li qhov yuav tsum tau muaj kev pab them nqi tsawg kawg nkaus lossis qhov qhia tau tias qhov kev pab them nqi tsawg kawg nkaus tau ntsib rau tag nrho xyoo se​​ 

Vim li cas kuv thiaj tau txais lwm daim ntawv uas zoo li Daim Ntawv 1095-B?​​ 

IRS muaj 1095 daim ntawv se sib txawv, zoo ib yam li Daim Ntawv 1095-B, siv rau kev tshaj tawm txog kev noj qab haus huv:​​ 

• Form 1095-A –Individuals who enroll in health insurance through Covered California or the Federal Marketplace will get this form.​​ 
• Form 1095-B –Individuals who enroll in health insurance through Medi-Cal, Medicare, and other insurance companies or coverage providers will receive this form.​​ 
• Form 1095-C –Individuals who enroll in health insurance through their employers will receive this form.​​ 

Yog tias koj tau txais ib daim ntawv teev npe saum toj no, tsis txhob muab pov tseg. Daim ntawv 1095 ua pov thawj ntawm kev tsim nyog tau txais kev pab them nqi kho mob thaum lub xyoo se tau tshaj tawm.​​  

Leej twg tau txais daim ntawv 1095-B​​ 

Leej twg yuav tau txais nws tus kheej daim ntawv 1095-B?​​ 

Pib txij li xyoo them se 2015, Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) yuav xa ntawv rau txhua tus neeg, cov neeg laus lossis menyuam yaus, uas tau lossis tau sau npe rau hauv qhov kev pab cuam Medi-Cal uas ua tau raws li qhov yuav tsum tau ua rau qhov kev pab cuam tsawg kawg nkaus (MEC), nws tus kheej daim ntawv 1095-B.
Pib nrog xyoo them se 2020, Daim Ntawv 1095-B kuj tseem yuav ua pov thawj ntawm MEC rau California's Health Mandate.​​ 

Puas muaj cov neeg uas muaj Medi-Cal tab sis yuav tsis tau Daim Ntawv 1095-B?​​ 

Yes. People who are enrolled in a Medi-Cal program that does not meet the requirement for MEC will not get a Form 1095-B.
Please see the next question below for examples of Medi-Cal programs that do not meet the requirement for MEC.​​ 

Kuv yuav ua li cas thiaj paub yog tias qhov kev pab cuam Medi-Cal kuv yog los yog tau tso npe rau hauv c o unts li MEC??​​ 

Most Medi-Cal coverage meets the MEC requirements. Nearly all people enrolled in the Medi-Cal program have full coverage, including those in pregnancy programs, which qualifies as MEC. The list below provides a few examples of Medi-Cal or state-funded programs that do not meet the MEC requirement:​​ 

• Medi-Cal nrog rau qhov sib faib tsis tau them tus nqi​​ 
• Restricted Medi-Cal, (sometimes called “emergency” Medi-Cal)​​ 
• Family Planning, Access, Care, and Treatment (FPACT)​​ 
• Cov kev kho mob tshwj xeeb xws li kev kho tuberculosis, dialysis, thiab parenteral hyper-alimentation​​ 

For more information on your Medi-Cal coverage, contact your county eligibility worker. To find an office near you please go to the county human services agencies listing.​​ 

Yog tias kuv tsis yog neeg xam xaj lossis neeg tsiv teb tsaws chaw, tab sis raug cai tam sim no hauv Tebchaws Meskas thiab tau rau npe hauv Medi-Cal, kuv puas yuav tau txais Daim Ntawv Foos 1095-B?​​ 

Txhua tus neeg uas tau txais Medi-Cal kev pab them nqi kho mob raws li qhov yuav tsum tau muaj rau MEC yuav tau txais Daim Ntawv Foos 1095-B.​​ 

Kuv yuav tau txais Daim Ntawv Foos 1095-B li cas?​​ 

Daim Ntawv 1095-B yuav raug xa tuaj rau koj los ntawm DHCS thaum lub caij them se tom qab xyoo them se uas tau tshaj tawm. Yuav muaj ib tsab ntawv piav qhia txog daim ntawv no txhais li cas rau koj thiab muab cov ntaub ntawv ntxiv rau koj.
Yog tias koj xav kom koj cov ntawv xa mus rau qhov chaw nyob tshiab lossis yog tias koj xav tau hloov kho koj qhov chaw nyob vim koj tau tsiv mus lawm, thov hu rau koj lub koom haum pabcuam tib neeg hauv nroog kom hloov kho koj cov ntaub ntawv tiv tauj.​​ 

SSI/SSP recipients​​ 

If your Medi-Cal is provided through Supplemental Security Income (SSI) or State Supplementary Payment (SSP), you or the member of your household who gets SSI/SSP must contact the Social Security Administration (SSA) to verify or update your eligibility status or personal information used by Medi-Cal.
To find contact information for your local SSA office, please visit SSA’s Office Locator webpage. You can also contact SSA by phone: 1-800-772-1213.​​ 

Yuav ua li cas yog tias kuv tsuas muaj Medi-Cal rau ib feem ntawm lub xyoo, kuv puas tseem yuav tau txais Daim Ntawv Foos 1095-B?​​ 

Yog lawm, DHCS yog lub luag haujlwm tshaj tawm txhua lub hlis ntawm Medi-Cal kev pab them nqi uas ua tau raws li qhov yuav tsum tau muaj rau MEC rau IRS thiab Franchise Tax Board (FTB). DHCS tseem yuav tsum muab Daim Ntawv Foos 1095-B rau txhua tus neeg uas nws tau tshaj tawm txog kev pab them nqi kho mob rau IRS thiab FTB. Daim ntawv koj yuav tau txais yuav qhia tias lub hlis twg koj muaj MEC.​​ 

Yuav ua li cas yog tias kuv muaj Medi-Cal rau ib feem ntawm lub xyoo thiab tom qab ntawd kuv tau yuav Covered California txoj kev pab them nqi kho mob?​​ 

Koj yuav tau txais Daim Ntawv Foos 1095-B rau koj qhov kev pab cuam Medi-Cal los ntawm DHCS thiab koj tseem yuav tau txais Daim Ntawv Foos 1095-A los ntawm Covered California. Txhua daim ntawv yuav qhia txog lub hlis ntawm kev pab them nqi kho mob raws li qhov yuav tsum tau muaj rau MEC rau txhua lub hlis ntawm kev pab them nqi uas koj tau txais los ntawm Medi-Cal lossis Covered California.​​ 

Qee cov neeg hauv kuv tsev muaj Covered California thiab lwm tus muaj Medi-Cal. Daim Ntawv 1095-B puas yuav qhia cov tswv cuab ntawm kuv tsev neeg uas tsis tau tso npe rau hauv ib qho kev pab cuam Medi-Cal?​​ 

No. DHCS will only report a person’s coverage to the IRS and FTB if that person receives coverage from Medi-Cal. Every person in the home enrolled in Medi-Cal will get their own Form 1095-B. If you have family members enrolled in Covered California, they should receive Form 1095-A.​​ 

Yog tias kuv muaj ib tus neeg sawv cev tso cai sau tseg hauv kuv cov ntaub ntawv Medi-Cal, lawv puas tuaj yeem tau txais lossis thov Daim Ntawv Foos 1095-B rau kuv?​​ 

Currently, authorized representatives are not allowed to request your Form 1095-B. If you would like someone else to receive your tax information, you can either provide them with your Form 1095-B information directly or you may request to have a reprint of your Form 1095-B mailed to a different address. Please contact your county human services agency and speak to an eligibility worker to make this request.​​ 

Kuv puas tuaj yeem xa kuv Daim Ntawv Foos 1095-B mus rau kuv tus neeg ua haujlwm them se?​​ 

Yes! Simply contact your county human service agency and they will be able to help you. SSI/SSP recipients can also request their Form 1095-B be sent to their named tax preparer through their local county human service agency. Please contact your county human services agency and speak to an eligibility worker to make this request.​​ 

Ua kom koj 1095-B yog qhov tseeb​​ 

Kuv yuav hloov kho kuv cov ntaub ntawv li cas kom ntseeg tau tias kuv tau txais kuv Daim Ntawv Foos 1-095-B?​​ 

Contact your county human services agency county eligibility worker (CEW) to verify or update your contact information for Medi-Cal. The CEW may discuss your personal information and they can make necessary changes. In some cases, your CEW may need you to give them additional information to verify your identity.​​ 

SSI/SSP recipients​​ 

If your Medi-Cal is provided through Supplemental Security Income (SSI) or State Supplementary Payment (SSP), you or the member of your household who gets SSI/SSP must contact the Social Security Administration (SSA) to verify or update your eligibility status or personal information used by Medi-Cal.
To find contact information for your local SSA office, please visit SSA’s Office Locator webpage. You can also contact SSA by phone: 1-800-772-1213.​​ 

Cov kev hloov pauv dab tsi uas kuv yuav tsum tau tshaj tawm kom paub tseeb tias kuv cov ntaub ntawv yog nyob rau hnub?​​ 

You must report changes to your home or mailing address, income, household size, employment, or other health insurance coverage. These changes must be reported to the county human services agency within 10 calendar days from the date the change occurred.​​ 

SSI/SSP recipients​​ 

If your Medi-Cal is provided through SSI or SSP, you or the member of your household who gets SSI/SSP must contact the SSA to verify or update your eligibility status or personal information used by Medi-Cal.
To find contact information for your local SSA office, please visit SSA’s Office Locator webpage. You can also contact SSA by phone: 1-800-772-1213.​​  

Kuv yuav nrhiav tau kuv lub county lub koom haum pab tib neeg li cas?​​ 

You can locate your county human services agency from the Department of Health Care Services County listing. Agencies are listed by county and may include street addresses, telephone numbers, and web pages.​​ 

Yuav Ua Li Cas Nrog Koj Daim Ntawv 1095-B​​ 

Kuv yuav ua li cas rau kuv Daim Ntawv Foos 109-5-B?​​ 

Keep your Form 1095-B for your records. Form 1095-B is used as proof of Minimum Essential Coverage (MEC) when filing your state and/or federal taxes. It should be kept with your other tax information in the event the Internal Revenue Service (IRS) or Franchise Tax Board (FTB) requires you to provide it as proof of your health care coverage.
Please remember, that Form 1095-B is not required to file your state or federal taxes and you may self‑attest your health coverage without it.​​ 

Vim li cas Medi-Cal/Department Health Care Services thiaj xa Daim Ntawv Foos 1095-B cov ntaub ntawv mus rau IRS thiab FTB?​​ 

 Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) yuav tsum tau los ntawm lub xeev thiab tsoomfwv txoj cai lij choj kom xa Daim Ntawv 1095-B cov ntaub ntawv mus rau IRS thiab FTB rau lub hom phiaj ntawm kev lees paub lub hlis ntawm kev pov hwm kev noj qab haus huv tau tshaj tawm los ntawm tus neeg thov lawv lub xeev thiab / lossis tsoomfwv cov se.​​ 

Vim li cas kuv thiaj tau txais ntau dua ib Daim Ntawv Foos 1095-B los ntawm Medi-Cal thiab kuv yuav ua li cas rau lawv?​​ 

DHCS will mail a Form 1095-B to every person enrolled in a Medi-Cal program that meets the requirement for MEC.
If you received another copy of your Form 1095-B, it could be a corrected Form 1095-B. A corrected Form 1095-B will have a box checked “Corrected” at the top of the form. If it is a corrected form, then this new form is the most current version of your Form 1095-B. The Form 1095-B will include a print date to assist with distinguishing which form is the most current. Please keep all Form 1095-Bs for your records.​​ 

Yuav ua li cas yog tias koj muaj teeb meem nrog daim ntawv 1095-B​​ 

Kuv tuaj yeem tiv tauj leej twg yog kuv xav tau kev pab ntxiv nrog Daim Ntawv 1-095-B?​​ 

Yog tias koj xav tau kev txhawb nqa ua lwm hom lus, thov hu rau Medi-Cal 1095-B Helpdesk ntawm 1-844-253-0883 (rau TTY hu rau 1-844-357-5709) rau kev txhawb nqa nyob. Peb lub chaw pabcuam pabcuam tuaj yeem muab kev pabcuam ua lus Askiv thiab lwm yam lus.  Nov yog qhov kev pabcuam pub dawb uas muaj hnub Monday txog Friday txij 8 teev sawv ntxov txog 5 teev tsaus ntuj PTS, tshwj tsis yog cov hnub so loj.​​ 

Kuv yuav ua li cas yog tias kuv cov ntaub ntawv ntiag tug tsis raug lossis qee lub hlis uas kuv muaj Medi-Cal tsis nyob hauv daim ntawv?​​ 

Contact your county human services agency county eligibility worker (CEW) to verify your months of coverage or to update your contact information for Medi-Cal. The CEW may discuss your personal information and they can make necessary changes. In some cases, your CEW may need you to give them additional information to verify your identity.​​ 

SSI/SSP recipients​​ 

If your Medi-Cal is provided through Supplemental Security Income (SSI) or State Supplementary Payment (SSP), you or the member of your household who gets SSI/SSP must contact the Social Security Administration (SSA) to verify or update your eligibility status or personal information used by Medi-Cal. 
To find contact information for your local SSA office, please visit SSA’s Office Locator webpage. You can also contact SSA by phone: 1-800-772-1213.​​ 

Kuv yuav hu rau leej twg kom tau txais lwm daim qauv ntawm kuv Daim Ntawv Foos 1095-B?​​ 

Thov hu rau koj lub chaw saib xyuas kev pab tib neeg hauv Nroog hauv zos kom thov kom rov luam dua ib daim foos 1095-B yav dhau los. Cov neeg ua haujlwm tsim nyog hauv lub nroog tuaj yeem thov kom Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv tau luam tawm thiab xa koj daim foos 1095-B. Kev thov rov luam dua yog ua tiav thaum kawg ntawm txhua lub hlis. Thaum thov, nws yuav siv sijhawm li 45 hnub kom tau txais daim ntawv xa tuaj.​​ 

SSI/SSP recipients​​ 

Yog tias koj qhov Medi-Cal tau muab los ntawm Supplemental Security Income (SSI) lossis State Supplementary Payment (SSP), koj lossis tus tswvcuab ntawm koj tsev neeg uas tau txais SSI/SSP yuav tsum hu rau Social Security Administration (SSA) txhawm rau txheeb xyuas lossis hloov kho koj qhov kev tsim nyog. los yog cov ntaub ntawv tus kheej.​​ 

To find contact information for your local SSA office, please visit SSA’s Office Locator webpage. You can also contact SSA by phone: 1-800-772-1213.​​ 

Vim li cas kuv thiaj tsis tau txais daim Form 1095-B?​​ 

There may be one of two reasons why you did not get a Form 1095-B. The mailing address we have on record may be incorrect or you were enrolled in a Medi-Cal program that does not meet the requirement for Minimum Essential Coverage (MEC). Please contact your county human services agency to find out why you did not receive a Form 1095-B. You may have to update some of your information with the county. Also, you can request a new copy of any Form 1095-B previously mailed.​​ 

SSI/SSP recipients​​ 

If your Medi-Cal is provided through Supplemental Security Income (SSI) or State Supplementary Payment (SSP), you or the member of your household who gets SSI/SSP must contact the Social Security Administration (SSA) to verify or update your eligibility status or personal information used by Medi-Cal.  
To find contact information for your local SSA office, please visit SSA’s Office Locator webpage. You can also contact SSA by phone: 1-800-772-1213.​​ 

I normally get my mail through my P.O. Box. I received my Form 1095-B but I did not get my child’s Form 1095-B. How can I get my child’s Form 1095-B?​​ 

Department Health Care Services will send all Form 1095-B letters to the mailing address on record. If you use a P.O. Box and your child is not listed on your P.O. Box through the post office, your child’s Form 1095-B will not be delivered. Please add your child or children to your P.O. Box at your local post office or update your mailing address with Medi-Cal by contacting your county human services agency. 
If you would like a reprint of your Form 1095-B for any previous tax year, just ask your county eligibility worker and they will assist.​​ 

Kuv thov tus neeg laus nyob ntawm kuv cov se. Kuv tuaj yeem tau txais lawv Daim Ntawv Foos 1095-B li cas rau kev sau se?​​ 

Yog koj thov kom ib tug neeg laus ua tus neeg uas koj saib xyuas ntawm koj cov se thiab koj muaj lub luag haujlwm los qhia txog lawv txoj kev pov hwm kho mob, tej zaum koj yuav tsum tau nkag mus rau lawv daim ntawv 1095-B. Yog koj ua li ntawd, tus neeg laus uas tseem nyob hauv kev them se yuav tsum muab lawv daim ntawv 1095-B rau koj. Tus neeg laus uas tseem nyob ntawm seb them se puas yuav xa daim ntawv 1095-B mus rau lwm tus neeg uas lawv xaiv. Lawv yuav tsum tiv tauj lawv lub koom haum pabcuam tib neeg hauv nroog thiab nrog tus neeg ua haujlwm tsim nyog tham kom ua qhov kev thov no.​​ 

Yuav ua li cas yog tias kuv tau txais kev pab them nqi kho mob Medicaid rau ib feem ntawm lub xyoo thaum nyob hauv lwm lub xeev?​​ 

California’s Medicaid program is known as Medi-Cal. If you got Medicaid coverage in another state, the human services agency from that state will send a Form 1095-B to your most recent address they have on record.​​ 

If you moved to a different county in California, it is important that you report your current address to the California county human services agency you lived in so that they can send Form 1095-B for your months of eligible Medi-Cal coverage to your current address.
To find contact information for each Medicaid agency by state please go visit the Medicaid webpage.​​ 

What if I received Qualified Health Plan coverage while living in another state for part of the year through that state’s marketplace or through the Federally Facilitated Marketplace?​​ 

If you lived in another state and received Qualified Health Plan coverage through that state’s marketplace or through the Federally Facilitated Marketplace (also known as healthcare.gov), you will receive a Form 1095-A from that marketplace. It is important that you report your current address to that marketplace and the health plan that covered you so they can send the Form 1095-A to your current address.​​ 

• Update your contact information with the federal marketplace.​​ 
• How to update your contact information with a state marketplace that does not take enrollments through healthcare.gov.​​ 

Kev Pab Them Se​​ 

Puas muaj leej twg tuaj yeem pab kuv ua kuv lub xeev thiab / lossis tsoomfwv cov se?​​ 

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv tsis muab lus qhia txog se.  Nov yog qee qhov kev pab cuam los pab koj ua koj cov se:​​ 

• You can get help from your local Taxpayer Assistance Center Office or call 1-800-829-1040.​​ 
• You can get free tax assistance from your local Volunteer Income Tax Assistance office or Tax Counseling for the Elderly Program. This service is for people who generally make $56,000 or less per year, persons with disabilities, the elderly, and limited English speaking taxpayers. To find the nearest center, visit their locator website.​​ 

Daim Ntawv Foos 1095-BI tau txais muaj cov ntaub ntawv tsis raug, tab sis kuv twb tau xa kuv lub xeev thiab / lossis tsoomfwv cov se. Kuv puas yuav tsum tau hloov kuv lub xeev thiab/lossis tsoom fwv teb chaws se rov qab thaum kuv tau txais daim ntawv kho 1095-B?​​ 

Nyob ntawm seb cov ntaub ntawv hloov pauv li cas, koj yuav tau hloov koj cov se. Koj kuj tuaj yeem xav sab laj nrog koj tus neeg npaj se los txiav txim seb koj puas yuav tau txais txiaj ntsig los ntawm kev hloov kho.​​ 

If you notice any incorrect information on your Form 1095-B, Department Health Care Services (DHCS) highly recommends that you contact your county human services agency and work with your county eligibility worker to fix the wrong information and have a corrected Form 1095-B.​​ 

SSI/SSP recipients​​ 

If your Medi-Cal is provided through Supplemental Security Income (SSI) or State Supplementary Payment (SSP), you or the member of your household who gets SSI/SSP must contact the Social Security Administration (SSA) to verify or update your eligibility status or personal information used by Medi-Cal.  
To find contact information for your local SSA office, please visit SSA’s Office Locator webpage. You can also contact SSA by phone: 1-800-772-1213.​​ 

Kuv puas tuaj yeem sau kuv lub xeev thiab / lossis tsoomfwv cov se thiab tshaj tawm tias kuv tau txais kev pabcuam kev noj qab haus huv ua ntej kuv tau txais kuv Daim Ntawv Foos 1095-B los ntawm DHCS?​​ 

Yog lawm, koj tuaj yeem ua pov thawj rau koj tus kheej thaum koj ua koj lub xeev thiab / lossis tsoomfwv cov se ua ntej tau txais koj Daim Ntawv Foos 1095-B. Thov nco ntsoov tias Internal Revenue Service (IRS) lossis Franchise Tax Board (FTB) yuav xav tau cov ntaub ntawv pov thawj ntawm koj qhov kev pab cuam los ntawm kev thov ib daim qauv ntawm koj Daim Ntawv Foos 1095-B. DHCS xav kom koj khaws koj Daim Ntawv Foos 1095-B rau koj cov ntaub ntawv. Tsis txhob xa koj Daim Ntawv Foos 1095-B rau DHCS.​​ 

Yuav ua li cas yog tias kuv tsis tau txais Daim Ntawv Foos 1095-B tab sis kuv tau ua kuv lub xeev thiab / lossis tsoomfwv cov nyiaj tau los tsis muaj ntaub ntawv los ntawm daim ntawv?​​ 

Form 1095-B is not required to file your state or federal taxes and you may self‑attest to your health coverage without it. You should get a Form 1095-B in the mail by January 31 following the reported tax year.  
If the information reported on the Form 1095-B was different than what was reported on your state and/or federal taxes, you may need to amend your taxes. You also may want to consult with your tax preparer to determine if you would benefit from amending. 
If you do not receive a Form 1095-B and you would like a Form 1095-B for your records, you should contact your eligibility worker at your county human services agency to determine why and request a reprint.​​ 

Yog tias kuv tsis sau se tas li, puas muaj txiaj ntsig los ua se rau xyoo no?​​ 

Even if you are not required to file taxes, you may be able to claim federal or state tax credits available for low to moderate income level households. One of these incentives is called the Earned Income Tax Credit (EITC) and it is now available for both federal and California state taxes. You should consult with your tax preparer to determine if you qualify for available tax credits.
Also, if you or someone in your household receives a premium tax credit through Covered California (or through healthcare.gov or another state marketplace if you lived outside of California for any part of the tax year) you are required to file taxes. When someone receives a premium tax credit and does not file taxes, Covered California will not continue to provide financial assistance in paying for their coverage.​​ 

Kuv yuav ua li cas txog Daim Ntawv 1095-B yog tias ib tug tswv cuab ntawm kuv tsev neeg tau tas sim neej?​​ 

DHCS does not mail a Form 1095-B for individuals who are deceased. However, a Form 1095-B can be obtained by a family member with the appropriate documentation. The family member can contact the responsible county for the deceased’s Medi-Cal coverage information and request a reprint of their Form 1095-B. A forwarding address should be given if the Form 1095-B needs to be sent to a different address.
To find an office near you please go to the county human services agency .​​ 

Puas muaj ib qho kev txiav txim siab tshwj xeeb rau kuv tus me nyuam tu los yog cov me nyuam saws hais txog Daim Ntawv 1095-B?​​ 

Yog. Yog tias koj yog niam txiv tu menyuam, niam txiv saws, lossis tus saib xyuas raws li txoj cai uas thov tus menyuam ua tus neeg nyob ntawm koj hauv koj daim ntawv them se rau xyoo se uas tau muab, koj muaj lub luag haujlwm kom tau txais kev pov hwm kev noj qab haus huv uas tsim nyog, uas suav tias yog kev pov hwm tsawg kawg nkaus (MEC) thaum lub xyoo se, rau tus menyuam tu menyuam ntawd. Yog tias kev saws me nyuam lossis kev tso tus me nyuam tshwm sim thaum lub xyoo them se, koj tsuas yog lub luag haujlwm rau lub hlis tom qab kev saws me nyuam lossis kev tso tus me nyuam mus txog thaum kawg ntawm lub xyoo them se. Cov niam txiv uas tsis tuaj yeem thov tus menyuam ua tus neeg nyob ntawm lawv tsis muaj lub luag haujlwm kom tau txais MEC rau tus menyuam rau lub hlis uas lawv tau lav ris rau tus menyuam.
Kev saib xyuas menyuam lossis cov niam txiv saws thiab cov menyuam raug tswj hwm tib txoj cai hais txog MEC. Yog tias ib tug niam txiv tu menyuam, niam txiv saws, lossis tus saib xyuas raws li txoj cai tsis tau txais Daim Ntawv 1095-B rau lawv tus menyuam, lawv tuaj yeem thov kom luam tawm dua los ntawm tus neeg ua haujlwm tsim nyog ntawm lawv lub koom haum pabcuam tib neeg hauv nroog.
Thov nco ntsoov tias txhua tus tub ntxhais hluas uas tau txais kev pab tu yav dhau los, txog hnub nyoog 26 xyoo, tsim nyog tau txais kev pab them nqi Medi-Cal uas tsim nyog ua MEC.​​ 

Puas muaj kev txiav txim siab tshwj xeeb txog Daim Ntawv 1095-B yog tias kuv yog niam txiv ntawm cov menyuam yaus uas tau nkag mus rau kev tu menyuam?​​ 

Cov niam txiv uas muaj lawv tus menyuam nkag mus rau kev tu menyuam yuav tsis tau txais Daim Ntawv Foos 1095-B rau lawv tus menyuam lossis menyuam yaus. Txog thaum tau txais kev taw qhia ntxiv los ntawm Lub Chaw rau Medicare & Medicaid Services, DHCS yuav tsis muab lossis muab luam tawm ntawm Daim Ntawv 1095-B rau cov niam txiv no.​​