Affordable Care Act

CVIM offers case management services to help patients navigate the Affordable Care Act. Please bring the items listed below to your appointment.  You can print this here: Marketplace Application Checklist

  1. Information about your household size. Figure out who in your household should apply before you start your application. Visit household size for help figuring out who needs coverage.
  2. Home and/or mailing addresses for everyone applying for coverage.
  3. Information about everyone applying for coverage, like addresses and birth dates.
  4. Social Security Numbers.
  5. Information about the professional helping you apply (if you’re getting help completing your application). 
  6. Document information for legal immigrants. Visit immigrant’s documentation for more information.
  7. Information on how you file your taxes.
  8. Employer and income information for every member of your household (for example, from pay stubs or W-2 forms—Wage and Tax Statements). Visit Income and household information to learn more about what types of income to include and not include.
  9. Your best estimate of what your household income will be in 2017. Visit how to report income for help estimating your income.
  10. Policy numbers for any current health insurance plans covering members of your household.
  11. A completed “Employer Coverage Tool” for every job-based plan you or someone in your household is eligible for. (You’ll need to fill out this form even for coverage you’re eligible for but don’t enroll in.) Visit employer coverage tool to view or print the tool.
  12. Notices from your current plan that include your plan ID, if you have or had health coverage in 2016.
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