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2019 Form 1095-B

Beginning January 31, 2020, all Medicaid beneficiaries who had at least one day of Medicaid coverage in 2019, may request a copy of their Form 1095-B from the Department of Health and Human Services.

Recently, the IRS released Notice 2019-63 Adobe Acrobat Reader Symbol explaining that due to the individual shared responsibility penalty being reduced to zero for 2019, the IRS has expanded relief for enrollment information since individuals will not need this information to file their federal tax returns. The Notice states that the IRS will not assess a penalty against the Department of Health and Human Services (Department) for failing to furnish Form 1095-B to individuals if two conditions are met:

  1. The Department posts a notice prominently on its website stating that Medicaid beneficiaries may receive a copy of their 2019 Form 1095-B upon request, accompanied by an email address and a physical address to which a request may be sent, as well as a telephone number that responsible individuals can use to contact the reporting entity with any questions.

  2. The Department furnishes a 2019 Form 1095-B to any responsible individual upon request within 30 days of the date the request is received.

Request a copy of your Form 1095-B by:

    1. Email
      1095Brequest@dhhs.nh.gov


    2. Phone
      1-844-275-3447 (1-844-ASK-DHHS)

    3. Mail
      NH Department of Health & Human Services
      Bureau of Family Assistance
      129 Pleasant Street
      Concord, NH 03301
 
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New Hampshire Department of Health and Human Services
129 Pleasant Street | Concord, NH | 03301-3852


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