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Form 13441A: Health Coverage Tax Credit (HCTC) Monthly Registration and Update
IRS Form 13441A is the Health Coverage Tax Credit (HCTC) Monthly Registration and Update form, used to register for or update monthly HCTC eligibility. The last eligible coverage month for this credit is December 2021.
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IRS Form 13441A - Health Coverage Tax Credit (HCTC) Monthly Registration and Update
IRS Form 13441A is the Health Coverage Tax Credit (HCTC) Monthly Registration and Update form, used to register for or update monthly HCTC eligibility. The last eligible coverage month for this credit is December 2021.
Risk Radar
Scan points- 1Faxing without putting your HCTC PIN or Last 4 of SSN on every page may delay processing.
- 2Filing without providing a copy of a health insurance bill dated within the last 60 days.
- 3Omitting the required information from the supporting bill, such as the Monthly premium amount or Dates of coverage.
- 4Forgetting to include your HCTC PIN or Last 4 of SSN on each page when faxing Form 13441A.
- 5Failing to provide an effective date of coverage in Part 4: Health Plan Information for updates.
Plain English
This form registers you for the Health Coverage Tax Credit on a monthly basis so you can receive payments throughout the year. You use it to enroll in the program or inform the IRS of any changes to your health plan, family members, or costs. Filing this ensures you get credited for payments made toward qualifying health coverage.
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 registering for or updating your monthly enrollment in the HCTC Program, which covers eligibility for up to 24 months following an eligible individual’s Medicare enrollment, death, or divorce.
- Do not use it when you are enrolling as a Qualifying Family Member and need to provide documentation related to a specific life event (such as death or divorce) that is outside the scope of this form's updates.
- Check Form 8885 instead when determining eligibility for a Qualifying Family Member, as referenced in the instructions.
Form selector
Use this form or another form?
Enrolling after Medicare enrollment
A Medicare enrollment letter or card is required to prove eligibility.
✓ Verify your supporting document checklist.
Enrolling due to divorce
A divorce decree or similar legal document must be submitted as proof of the change.
✓ Ensure the document includes the date of the divorce.
Updating family member status
You must complete Parts 1, 2, and 6 with current information when updating your registration.
✓ Check Part 7 to confirm if you are updating your monthly registration.
Deadline or filing window
The last eligible coverage month for receiving the Health Coverage Tax Credit (HCTC) through this monthly registration is December 2021. When filing Form 8885 annually, you must do so by the due date (including extensions) to confirm the months elected under the monthly HCTC.
Checklist
What you need before filling it out
Part 4: Policy holder's name
Your name (as the eligible individual) · Form p.1
Health Insurance Bill
Monthly premium amount, Dates of coverage, Health Plan name/phone number, ID numbers, Address for payments · Form p.1
Total HCTC (Line 5)
Total Monthly Medical Premium (Line 1) minus line (4), multiplied by 27.5% (.275) · Form p.4
Qualifying Family Member Eligibility
Medicare enrollment letter, death certificate, or divorce decree · Form p.2
Email Submission
Password-protected attachments sent to [email protected] · Form p.1
Before you submit
- 1Complete Parts 1, 2, and 6 with current information on IRS Form 13441A.
- 2Provide an effective date of coverage if there are changes to Part 3 or Part 4.
- 3Include a copy of your health insurance bill dated within the last 60 days that contains all required details.
- 4If emailing, password protect all attachments and send the password in a separate email.
- 5Ensure you include your HCTC PIN or Last 4 of your SSN on every page if faxing.
- 6Include a cover sheet when mailing/faxing with Date, Name, Your HCTC PIN or Name and Last 4 of your SSN.
- 7Check the box in Part 7 if you are updating your current monthly registration.
How to file this form
- 1Complete Parts 1, 2, and 6 with current information on IRS Form 13441A.
- 2Gather all required supporting documents, ensuring the health insurance bill is dated within the last 60 days.
- 3Choose submission method: Fax to 855-250-1731 (including a cover sheet) or Email to [email protected] (password protected).
- 4Mail the completed form and documents to the address provided on Form p.1, keeping a copy for your records.
- 5Receive registration confirmation within up to 6 weeks if all requirements are met.
Known limitations
- 1The Health Coverage Tax Credit (HCTC) is not available for months starting with January 2022.
- 2If coverage is through a spouse’s employer but is not a COBRA plan, the Monthly HCTC cannot be received through Form 13441-A Part 4; however, the Yearly HCTC can still be claimed by filing Form 8885 with a federal income tax return.
- 3Qualifying 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 current edition is Revision 4-2021, and users can find the latest information regarding developments related to the Health Coverage Tax Credit at IRS.gov/individuals/hctc/. The source does not explicitly detail changes between this revision and others.
What changed or needs a fresh check
- Edition date — confirm the revision reads 04/21.
- Mailing address — confirm mailing instructions are listed on Form p.1.
- Fax number — confirm the required fax number is 855-250-1731 (Form p.1).
- Required supporting document — confirm a copy of your health insurance bill dated within the last 60 days is included (Form p.1).
- Certification — confirm you certify that you are not enrolled in an Affordable Care Act Marketplace insurance (Form p.3).
Quick Facts
Downloads
After you file
- 1Keep a copy of the completed Form 13441-A and all required supporting documents.
- 2If mailing the form, continue to pay 100% of health insurance bills directly to the health plan while waiting for registration confirmation.
- 3Allow up to 6 weeks after mailing for registration confirmation if all requirements are met.
- 4When filling out the form, complete Parts 1, 2, and 6 with current information to ensure timely processing.
Sources
- SRCInstructions p.1 — The last eligible coverage month for HCTC is December 2021.
- SRCInstructions p.1 — To register for the Monthly HCTC, one must collect required documents and fill out Form 13441-A.
- SRCInstructions p.1 — When mailing the form, a cover sheet must include the Date, Name, Your HCTC PIN or Name and Last 4 of your SSN.
- SRCInstructions p.2 — A death certificate including the date of death is a required supporting document.
- SRCInstructions p.3 — Part 1 requires the HCTC Eligible Recipient's name, SSN, Date of birth, Primary telephone number, Alternate telephone number, Mailing Address, and Email address.
- SRCInstructions p.4 — If family members are on separate health plans, a copy of Part 4 must be made before filling it out for their qualified health insurance information.
Common confusion points
What do I do if my family members have different health plans?
Fill out a copy of Part 4 for each separate health plan your family members are on.
Should I mail the form or email it?
The instructions list three options (Fax, Email, Mail), but faxing is preferred as mailing alone could delay processing.
What must be on the cover sheet if I am sending by mail?
The cover sheet must include the Date, Name, Your HCTC PIN or Name and Last 4 of your SSN.
When do I need to update my registration?
You must inform the IRS about all changes that affect your eligibility, your family members, or your health insurance cost when updating your monthly registration.
If I am registering as a Qualifying Family Member, what is a key detail on Part 4?
In Part 4 (Health Plan Information), you must provide the Health Plan Provider name and Effective date of coverage for each plan.
What if my spouse's employer covers me but it isn't COBRA?
You cannot receive the Monthly HCTC through this form, but you can claim the Yearly HCTC by filing Form 8885.
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- Form 8885 — Use this form to claim the Yearly HCTC if you have coverage through a spouse’s employer that is not COBRA.
Questions about IRS Form 13441A
What is IRS Form 13441A used for?
This form registers you for the Health Coverage Tax Credit on a monthly basis so you can receive payments throughout the year. You use it to enroll in the program or inform the IRS of any changes to your health plan, family members, or costs. Filing this ensures you get credited for payments made toward qualifying health coverage.
Who must file IRS Form 13441A?
Individuals who are eligible for the Health Coverage Tax Credit must file Form 13441A to register for the monthly HCTC program.
What information does IRS Form 13441A require?
The form collects general information in Part 1, details about your family members in Part 3, health plan specifics in Part 4, and change/status updates in Parts 2, 5, and 6. If registering as a Qualifying Family Member, the eligible recipient's name is entered in Part 4: Policy holder's name.
When is IRS Form 13441A due?
The HCTC is not available for months starting with January 2022; the last eligible coverage month is December 2021. When updating, changes must have an effective date of coverage listed in Part 4: Health Plan Information.
Where do I file IRS Form 13441A?
The form can be submitted by faxing to 855-250-1731 (with a cover sheet) or by emailing attachments to [email protected]. Mail submissions go to the Internal Revenue Service Stop 6098 AUSC, Austin, Texas 78741.
How do I complete IRS Form 13441A?
To register, complete Part 1, then check if it is a new enrollment (and optionally Part 6 for Qualifying Family Members). Fill out Parts 3 and 4 with current information, noting any changes' effective dates. Finally, sign the form, print your full name, and date it before sending.
What happens if IRS Form 13441A is filed incorrectly?
Failing to submit a timely election for monthly HCTC will require repayment of all Advance Monthly Payment amounts and any reimbursements received because you filed Form 14095. Not submitting documents can delay the processing of your registration.
What do I do if my family members have different health plans?
Fill out a copy of Part 4 for each separate health plan your family members are on.
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