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Official form guide
Form 13441A: Health Coverage Tax Credit (HCTC) Monthly Registration and Update
IRS Form 13441-A is the Health Coverage Tax Credit (HCTC) Monthly Registration and Update used by eligible individuals to enroll or update their monthly HCTC benefits. The program’s last eligible coverage month is December 2021.
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IRS Form 13441A - Health Coverage Tax Credit (HCTC) Monthly Registration and Update
IRS Form 13441-A is the Health Coverage Tax Credit (HCTC) Monthly Registration and Update used by eligible individuals to enroll or update their monthly HCTC benefits. The program’s last eligible coverage month is December 2021.
Risk Radar
Scan points- 1Sending a duplicate request can delay processing of your HCTC registration.
- 2Omitting the HCTC PIN or last 4 SSN on each faxed page.
- 3Failing to include a cover sheet with date, name, and PIN/SSN on the fax.
- 4Sending email attachments without password protection.
- 5Providing a health‑insurance bill older than 60 days or missing required fields.
Plain English
This form lets you start or change your monthly Health Coverage Tax Credit. You provide your personal details, family member info, and health‑plan data, then send it to the IRS. The IRS uses it to give you advance monthly tax credits.
Submission Date
- Filing date: 2021-04-12 22:10:17
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
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What this form is for
- Use this form when you need to enroll in the monthly HCTC program or update your registration, family members, or health insurance cost.
- Do not use it when you are enrolled in an Affordable Care Act Marketplace insurance.
- Check Form 8885 instead when you need guidance on qualifying family member eligibility.
Form selector
Use this form or another form?
Need to determine eligibility of a qualifying family member
Eligibility rules affect whether the family member can receive HCTC benefits
✓ Confirm the family member meets the criteria in Form 8885 instructions
Enrolling in Direct Deposit for HCTC payments
Direct Deposit requires IRS approval via Form 3881
✓ Verify the health plan provider has completed Form 3881
Submitting a change due to Medicare enrollment, death, or divorce of the eligible participant
Changes affect the duration of HCTC eligibility for qualifying family members
✓ Ensure supporting documents (Medicare letter, death certificate, divorce decree) are attached
Deadline or filing window
Not stated in the official source.
Checklist
What you need before filling it out
Policy holder’s name (Part 4)
Policy holder’s full name · Health plan enrollment documents
Effective date of coverage change (Part 4)
Effective date of the change · Health plan letter or amendment
Health insurance bill (required supporting document)
Bill dated within last 60 days showing name, premium, dates, plan name, phone, ID numbers, mailing address · Health insurance provider statement
Medicare eligibility evidence (for qualifying family member)
Medicare enrollment letter, Medicare card, or other proof · Medicare correspondence
Death certificate (for qualifying family member)
Death certificate with date of death · Vital records
Before you submit
- 1Verify the HCTC PIN or last 4 of SSN appears on every faxed page
- 2Include a cover sheet with date, name, and HCTC PIN or last 4 of SSN when faxing
- 3Password protect all email attachments
- 4Send the password for email attachments in a separate email
- 5Attach a health insurance bill dated within the last 60 days containing all required details
- 6Provide supporting documents for any changes in Part 3 or Part 4 (e.g., Medicare letter, death certificate, divorce decree)
- 7Complete Parts 1, 2, and 6 with current information
- 8Check the box indicating you are updating your current monthly registration if applicable
- 9Keep a copy of the completed form and all attached documents for your records
How to file this form
- 1Gather the health insurance bill dated within the last 60 days and any required supporting documents (e.g., Medicare enrollment letter, death certificate, divorce decree) to attach to the form.
- 2Complete Parts 1, 2, and 6 with current information, and fill any changed fields in Parts 3, 4, or 5.
- 3Create a fax cover sheet that lists the date, your name, and your HCTC PIN or last 4 of SSN.
- 4Fax the completed Form 13441‑A and all attachments to 855‑250‑1731, ensuring the PIN appears on each page, and retain the fax transmission receipt as proof.
- 5If emailing, password‑protect the attachments, send them to [email protected], and keep the sent‑email confirmation as proof.
- 6Make a copy of the completed form and all submitted documents for your records.
- 7Allow up to 6 weeks for registration confirmation before taking further action.
Known limitations
- 1The HCTC is not available for months starting with January 2022.
- 2The last eligible coverage month for HCTC is December 2021.
- 3If you have coverage through your spouse’s employer that is not a COBRA plan, you cannot receive the Monthly HCTC for this type of coverage.
- 4Qualifying Family members of HCTC eligible individuals may receive the HCTC for up to 24 months following the eligible individual’s Medicare enrollment, death or divorce.
Field map
Compact field-by-field guide
General Info
2 items
Full legal name and taxpayer identification number (SSN or EIN).
Current mailing address.
Details
2 items
Complete all applicable sections of this form according to the official IRS instructions.
Enter the relevant dollar amount if this form involves tax calculation.
Certification
1 items
Read and acknowledge any certifications required by this form.
Signatures
1 items
Sign and date. Unsigned forms cannot be processed.
Almost done reviewing the fields?
Fillable formOpen in Editor->The form revision date is 04/21 (Rev. 4‑2021). The source directs users to the IRS website for the latest HCTC information.
What changed or needs a fresh check
- Edition date — confirm the form revision reads 04/21
- Cover sheet — include date, name, and HCTC PIN or last 4 of SSN on fax cover sheet
- Fax number — confirm you fax to 855-250-1731
- Email address — confirm you email to [email protected] with password‑protected attachments
- Signature — Not stated in the official source
Quick Facts
Downloads
After you file
- 1Make a copy of the completed HCTC Monthly Registration and Update form and all required documents for your records.
- 2It can take up to 6 weeks (if all requirements are met) before you receive registration confirmation.
- 3During this time, you must continue to pay 100% of your health insurance bills directly to your health plan.
- 4Keep records of your health insurance payments while awaiting confirmation.
Sources
- SRCForm p.1 — last eligible coverage month is December 2021.
- SRCForm p.1 — HCTC is not available for months starting with January 2022.
- SRCForm p.4 — You cannot receive the Monthly HCTC for this type of coverage.
- SRCForm p.2 — it can take up to 6 weeks (if all requirements are met) before you receive registration confirmation.
- SRCForm p.2 — continue to pay 100% of your health insurance bills directly to your health plan.
- SRCForm p.1 — Make a copy of the completed HCTC Monthly Registration and Update form and all required documents for your records.
- SRCForm p.1 — Include a cover sheet with the following: Date, Name, Your HCTC PIN or Name and Last 4 of your SSN.
- SRCForm p.1 — Fax to: 855-250-1731 and Don’t send another copy by mail.
- SRCForm p.2 — Qualifying Family members of HCTC eligible individuals may receive the HCTC for up to 24 months following the eligible individual’s Medicare enrollment, death or divorce.
- SRCForm p.3 — Part 2: Confirm Your Eligibilitycheck box if you are registering as the HCTC Eligible Recipient or Qualifying Family Member.
Common confusion points
Can I receive the Monthly HCTC if my spouse’s employer provides non‑COBRA coverage?
The form says You cannot receive the Monthly HCTC for this type of coverage.
→ Check that the health plan is not a non‑COBRA spouse employer plan.
What is the last month I can claim the HCTC?
The source states the last eligible coverage month is December 2021.
→ Confirm the coverage month does not go beyond December 2021.
Do I need to send the form by both fax and mail?
The instructions say Don’t send another copy by mail.
→ Verify you only fax the form and do not mail another copy.
How long will it take to get registration confirmation?
It can take up to 6 weeks (if all requirements are met) before you receive registration confirmation.
→ Expect confirmation within 6 weeks of submission.
Do I need to include a cover sheet when faxing?
Include a cover sheet with the following: Date, Name, Your HCTC PIN or Name and Last 4 of your SSN.
→ Add a cover sheet with the required information.
Can a qualifying family member receive HCTC for more than 24 months?
Qualifying Family members of HCTC eligible individuals may receive the HCTC for up to 24 months following the eligible individual’s Medicare enrollment, death or divorce.
→ Ensure the family member’s claim does not exceed 24 months.
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- Form 8885 – consult its instructions for qualifying family member eligibility.
Questions about IRS Form 13441A
What is IRS Form 13441A used for?
This form lets you start or change your monthly Health Coverage Tax Credit. You provide your personal details, family member info, and health‑plan data, then send it to the IRS. The IRS uses it to give you advance monthly tax credits.
What information does IRS Form 13441A require?
The form collects the eligible recipient’s name in Part 1, family member details in Part 3, health‑plan information and effective coverage date in Part 4, and current information in Part 6, plus a signature.
Where do I file IRS Form 13441A?
Send the completed form and supporting documents by fax to 855‑250‑1731 (include your HCTC PIN or last 4 SSN on each page), by password‑protected email to [email protected], or by mail to Internal Revenue Service Stop 6098 AUSC, Austin, Texas 78741.
How do I complete IRS Form 13441A?
First, gather a health‑insurance bill dated within the last 60 days that shows all required details. Then fill out the form, entering your information in Parts 1, 3, 4, and 6 and signing and dating the bottom of page 5. Include the effective date of coverage in Part 4. Finally, send the form and bill by fax, email (password‑protected), or mail as directed.
What happens if IRS Form 13441A is filed incorrectly?
Submitting duplicate requests or an incomplete form can delay processing of your HCTC registration.
Can I receive the Monthly HCTC if my spouse’s employer provides non‑COBRA coverage?
The form says You cannot receive the Monthly HCTC for this type of coverage. Check that the health plan is not a non‑COBRA spouse employer plan.
What is the last month I can claim the HCTC?
The source states the last eligible coverage month is December 2021. Confirm the coverage month does not go beyond December 2021.
Do I need to send the form by both fax and mail?
The instructions say Don’t send another copy by mail. Verify you only fax the form and do not mail another copy.
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