Form 1095-B: Health Coverage

Form 1095-B: Health Coverage

If you, your spouse, or one of your dependents were enrolled in Medicaid, ARKids, or the Arkansas Works Program at any time in 2020, DHS will mail you an IRS tax form 1095-B, upon request. Forms will be mailed throughout the year, upon request, beginning January 22, 2021. Some people could receive their form before others.

  • You will want to keep it with your important tax documents.
  • Check WWW.IRS.GOV or tax form 1040 instructions to see if you are required to file a federal income tax return.
  • A person does not need the information on Form 1095-B to file an income tax return.

Requests for 1095-B forms can be made by:

Information You Need to Give DHS with Your Request

For requests made by email and U.S. mail, please include the recipient’s name, the tax year for which you are requesting a form, a phone number where you can be reached for questions, and a return email or mailing address to where the form will be sent.

Please contact your local DHS county office or the helpdesk for questions.

A person does not need the information on Form 1095-B to file an income tax return.

DCO Address

PO Box 1437, Slot S301
Little Rock, AR 72203

DCO Phone Number

501-682-8375
855-372-1084 Statewide
TDD: 501-682-8820

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