Form 1095-B

Consumers enrolled in Medicaid, Child Health Plus and Essential Plan (EP) may request a copy of Form 1095-B from the NYS Department of Health.  For Medicaid, this includes individuals whose coverage is through Local Departments of Social Services (LDSS), Human Resources Administration (HRA), or NY State of Health.  Health plans send the Form 1095-B to consumers who were enrolled in Catastrophic plans, purchased their plan directly from the insurer, or had coverage through the Small Business Marketplace.

  • Phone: 1-800-541-2831
  • E-mail: 1095B@health.ny.gov
  • Mail: P.O. Box 11774, Albany, NY 12211

 

 

Frequently Asked Questions about Form 1095-B

Frequently asked questions about Form 1095-B are available below. They are also available here.

 

From the NYS Department of Health 

Consumers enrolled in Medicaid, Child Health Plus and Essential Plan (EP) may request a copy of Form 1095-B from the NYS Department of Health. For Medicaid, this includes individuals whose coverage is through Local Departments of Social Services (LDSS), Human Resources Administration (HRA), or NY State of Health. Health plans send the Form 1095-B to consumers who were enrolled in Catastrophic plans, purchased their plan directly from the insurer, or had coverage through the Small Business Marketplace.

These FAQs are about the Form 1095-B for consumers enrolled in Medicaid, Child Health Plus and EP. 

 

  1. What is a Form 1095-B from the NYS Department of Health? 

Form 1095-B is available by request for consumers who, were enrolled in Medicaid, Child Health Plus or EP during the past year. A separate form will be available for each Medicaid, Child Health Plus and EP consumer, even if multiple children are on the same Child Health Plus policy. These forms are only provided upon request. Please contact NY State of Health to request a Form 1095-B.

  • Phone: 1-800-541-2831
  • E-mail: 1095B@health.ny.gov

  • Mail: NY State of Health P.O. Box 11774, Albany, NY 12211

     

  1. What do I need to do with Form 1095-B from the NYS Department of Health? 

If you would like a copy of your Form 1095-B for your records, you can contact NY State of Health at 1-800-541-2831 or at the email or mailing address listed above. This document provides information to verify coverage provided by Medicaid, Child Health Plus or EP. You do not need to attach Form 1095-B to your federal income tax return. To determine whether you are required to file a federal income tax return, be sure to check with the IRS at their website, www.irs.gov.

 

  1. When will I receive my Form 1095-B from the NYS Department of Health? 

The NYS Department of Health will only mail Form 1095-B to consumers upon request. Please contact NY State of Health at 1-800-541-2831 or at the email or mailing address listed above.

 

  1. I disagree with the information on my Form 1095-B from the NYS Department of Health. Can I file an appeal?

Under federal rules, you may not file an appeal regarding the Form 1095-B. If you think the information on your Form 1095-B is not correct, please call NY State of Health at 1-855-766-7860 for assistance. If the information is found to be incorrect, the NYS Department of Health will correct the form. 

 

  1. Where can I get help filing my taxes? 

You can get assistance from your own tax advisor or preparer. You can also get help from the IRS at www.irs.gov. The IRS website offers “Help and Resources” for those who need it. Help includes “Local Taxpayer Advocates” and “Low Income Taxpayer Clinics.”

Free tax assistance is also available through local Volunteer Income Tax Assistance Sites (VITA) for taxpayers who generally make less than $60,000, or have disabilities, or are limited English speakers, or are elderly. For more information call (800)-906-9887 or visit https://irs.treasury.gov/freetaxprep/

 

 

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