Healthcare marketplace printable application form 2025

1. Click ‘Get Form’ to open the healthcare marketplace printable application form in the editor.
2. Begin by filling out Step 1, which requires personal information. Enter the first name, middle name, last name, and home address of the primary contact person for your application.
3. Proceed to Step 2 to provide details about your family. Include all members living in your household, even if they already have health coverage. This ensures accurate eligibility assessment.
4. In Step 3, indicate if any family member is American Indian or Alaska Native. If yes, complete Appendix B for additional benefits.
5. For income verification in Step 4, provide current job and income information for each family member applying for coverage. Ensure accuracy as this affects eligibility.
6. Finally, review all sections for completeness and accuracy before signing the application in Step 5. Submit it as instructed on page 7.

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