Draft Individual Health Insurance Marketplace Application

The Centers for Medicare and Medicaid Services (CMS) has released draft versions of the health insurance marketplace applications for individual health insurance coverage. CMS says the individual application will represent a single point of entry to purchase private insurance on health insurance exchanges (which are being rebranded as Marketplaces) and to assess eligibility for assistance including Medicaid, CHIP and the advance payment of premium tax credits.

Overview of the Health Insurance Marketplace Applications

The 21-page application draft is intended to help employees determine what, if any, federal tax credits, subsidies or programs they are eligible for. It does not enroll applicants in an insurance plan and employers and employees must fill out separate applicationsThe draft applications are embedded below for your convenience. What do you think?

There are two versions of the draft applications:

1. A draft application for Individuals Seeking Financial Assistance (21 pages), and 

2. A draft application for Individuals NOT Seeking Financial Assistance (8 pages).

Video Overview Example

Frequently Asked Questions (FAQs) about the Draft Applications

Why would I use application #1 vs #2?

You would use application #1 to see what health insurance choices (and financial assistance) you qualify for, including:

• Free or low-cost insurance from Medicaid or the Children’s Health Insurance Program (CHIP), and

• New premium tax credits that can help pay your health insurance premiums.

Will I be able to apply online?

Yes. However, the official online application has not yet been released.

What do I need to apply?

You may need the following to complete the application:

• Social Security numbers (or document numbers for any legal immigrants who need insurance) 

• Birth dates 

• Employer & income information for everyone in your family (for example, from paystubs or Forms W-2, Wage and Tax Statements) 

• Policy numbers for any current health insurance 

• Information about any job-related health insurance available to your family

Why is application #1 longer than application #2?

Application #1 asks about income and other information to make sure you and your family get the appropriate financial assistance (e.g. tax credits).

Draft Application for Individuals Seeking Financial Assistance

Draft Application for Individuals NOT Seeking Financial Assistance

How do I comment on the applications?

CMS has asked that people review the paper and online applications and provide feedback in the way of comments, which can be done by accessing the documents at the PRA website.

Note: This should not be taken as legal or tax advice.