Important Note About Form 3895

Covered California consumers will not get an FTB Form 3895 for tax year 2022 and 2023 because they did not receive the California Premium Assistance Subsidy (state subsidy) for those years. This subsidy was discontinued.

State Subsidy Program

In 2021, Covered California discontinued its state subsidy program (also called the California premium subsidy or the Premium Assistance Subsidy) due to the increased federal financial help provided by the American Rescue Plan (and extended through 2025 by the Inflation Reduction Act). The increased federal financial help is more generous than the state subsidy program.  If you need to file an amended state tax return with the Franchise Tax Board for tax years 2020 or 2021, see the attached document with state subsidy information. for more information and if you need help repaying California subsidies.

Read more about the State Subsidy Program.

Other State Tax Information

Starting in 2020, state law requires California residents to have qualifying health insurance (sometimes called the “individual mandate”), pay a penalty (called the “individual shared responsibility penalty” on Form FTB 3853), or get an exemption.

When completing your state taxes, , on your California state tax return.

The Form FTB 3853 may require you to fill out the Marketplace Coverage Affordability Worksheet to find your lowest-cost Bronze plan and second-lowest-cost Silver plan premiums. To find these amounts, use our calculator and enter the gross monthly premium for the lowest-cost Bronze plan and second-lowest-cost Silver plan in the form.
Step-by-step instructions and more information can be found here.

Your situation may vary, and the information above is not intended as tax advice. Please consult the California Franchise Tax Board or a tax advisor if you have questions about how to use this form when preparing your taxes, your penalty amount, or your tax return.

If you need help, please contact the Covered California Service Center. Representatives can help you calculate the lowest-cost Bronze plan and second-lowest-cost Silver plan premium amounts but cannot provide tax advice. To view the forms referenced here and get more detailed instructions for how to complete these forms, .