The Alaska Statement of Health Care Expenses is a form issued by the Alaska Department of Health and Social Services (DSS) to document an individual’s out-of-pocket health care expenses. This form is typically used to apply for Medicaid, the state’s health insurance program for low-income individuals. The Alaska Statement of Health Care Expenses includes expenses such as doctor visits, hospital stays, prescription drugs, lab tests, medical equipment, and more. It also includes insurance premiums, copay, coinsurance, and deductibles. There are two types of Alaska Statement of Health Care Expenses: an individual form and a family form. The individual form is used for individuals who are applying for Medicaid on their own behalf. The family form is used for individuals who are applying for Medicaid on behalf of their family.
Alaska Statement of Health Care Expenses
State:
Alaska
Control #:
AK-DR-353
Format:
PDF
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Public form
Description
This official form is a statement of health care expenses.
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