Affordable Care Application Forms
As of October 1, 2013 The Health Insurance Market place is officially open. Many individuals are having issues logging on the last couple of days to setup their account online. Below you will find copies of the paper form of the Marketplace Health Insurance Applications, for Individuals, Families, and Individuals looking for additional financial support. Many people are still asking the question ”How do I sign up for Obamacare”, or where can i download a copy of the Affordable Care Act, Health Insurance Market place application. We have updated the copies of our documentation as of September 26, 2013 form the CMS site. While the majority of Americans will want to use Healthcare.gov to apply for Health Insurance in the market place, for those that are having issues or feel more comfortable in printing out a paper copy please download and print below.
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The Applications provided are grouped in three categories. Individual, Family, and Individuals who do not need financial assistance.
Marketplace Consumer Application
- Marketplace Application No Assistance Needed (Form)
- Marketplace Application No Assistance Needed (Instructions)
The total length of this application is just three pages long; the family version is seven pages, This is a stark contrast to the 21 page draft application released months ago.Completing the forms will require your most recent tax returned filed with the IRS. Once you have this information you are ready to go. The other questions should be things you can answer easily without having to refer to other forms.
Once you complete the paper application you will mail it in, and wait 1-2 weeks for a follow-up. The application clearly states, “Filling out this application doesn’t mean you have to buy health coverage.” Indicating exemptions that were set previously will still be recognized.
The application is broken into steps.
Step 1: Provide personal information. This includes proof of citizenship, Race, wether your pregnant, etc.
Step 2: Employment, and Income information.
( Have your Tax Return Handy)
Step 3: Health Care Coverage
Step 4: Read and Signed the Application
Step 5: Mail your Application
Mail your signed application to:
Health Insurance Marketplace
Dept. of Health and Human Services
465 Industrial Blvd.
London, KY 40750-000
If you get Stuck
- If you find you need help with the hardcopies of these forms you can call 1-800-318-2596.
- Para obtener una copia de este formulario en Español, llame 1-800-318-2596.
- If you need help in a language other than English, call 1-800-318-2596 and tell the customer service representative the language you need.
- TTY users should call 1-855-889-4325
In Person Resources
Navigators and other in-person assistance: The health-care reform has workers to help support with the application process. They can also help with the qualification for financial assistance, insurance and government benefits like Medicaid and the Children’s Health Insurance Program. These resources are here to help free of charge. Contact information for such organizations is available on a HealthCare.gov page not affected by technical problems. The navigators and In person Counselors can get you started and will follow up with you later about completing the process.
State Medicaid offices: If you qualify for Medicaid, and live in a state that is expanding Medicaid you can visit your local states Medicaid Office to complete an application. Here is a list of Sates Expanding Medicaid, and Application Forms