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  • Omb No 0938 1191

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Tion by email? Yes No Email address: 17. What is your preferred spoken or written language (if not English)? 18. Do you need health coverage for yourself? Yes. If yes, answer all the questions below. No. If no, skip to Step 2 on page 2. (Leave the rest of this page blank) 19. Social Security number - We need Social Security numbers (SSNs) for anyone who wants coverage. We use SSNs to verify citizenship. For help getting an SSN, visit socialsecurity.gov or call 1-800-772-1213. TTY user.

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Shorthand for the “Health Insurance Marketplace ®,” a shopping and enrollment service for medical insurance created by the Affordable Care Act in 2010. In most states, the federal government runs the Marketplace (sometimes known as the "exchange") for individuals and families. On the web, it's found at HealthCare.gov.

HealthSherpa is a California-based technology company focused on connecting individuals with health coverage. The site was initially developed as an alternative to research plans from Healthcare.gov. U.S.

You will find out by mail whether you are eligible for Medicaid within 45 days after you apply. (If you have a disability and it has to be determined, the process may take up to 60 days). If you are eligible for Medicaid, you will receive a Medicaid card in the mail.

The application will likely ask for common information such as your name, address, Social Security number, marital status, dependents and whether any of the applicants have other health insurance coverage in place or are covered under Medicaid/Medicare programs.

For help picking a plan, call 1-800-318-2596 or make an appointment with an assister. Visit HealthCare.gov to create an account and begin applying online.

Your Marketplace application will ask you for information about any job-based plan you or anyone in your household is eligible for. It will ask you for employer contact information for each person in your household who has a job.

Visit .gateway.ga.gov. Select Apply for Benefits to begin. Select Medical Assistance as a program. Follow the online prompts to apply for Medicaid.

Our website, HealthCare.gov, is the official Marketplace website. Look for official government seals, logos, or web addresses (which end in “. gov”) on materials in print or online. Compare insurance plans carefully before making your decision.

Verify information like your identity and any income history you provide. Give you accurate information about as many different cost-saving programs as possible.

You'll need to send different documents based on what we need to verify: Yearly income estimate. Immigration status. Citizenship.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232