Applications Solely Used by the Marketplace

The online Marketplace application is a single interactive application based on an applicant's selections. In addition, there are three paper applications for the Marketplace:

Application for Health Coverage — for anyone who needs health coverage, but does not need help paying for health insurance costs. Used by applicants who want to purchase a Qualified Health Plan (QHP) through the Marketplace.

Application for Health Coverage & Help Paying Costs (Short Form) — for single adults who need help paying for health care coverage (mostly for states offering Medicaid expansion coverage to single adults ages 19 through 64) and who: are not married, do not claim any tax dependents, and cannot be claimed as a tax dependent on someone else's federal income tax return; were not formerly in the foster care system; and are not American Indian (AI)/Alaska Native (AN).

Application for Health Coverage & Help Paying Costs — for anyone who needs help paying for health care coverage, including: people who are married, have tax dependents, or can be claimed as a tax dependent on someone else's federal income tax return; people with or without current health care coverage; families that include immigrants; and people who were formerly in the foster care system.

Since these applications do not contain additional questions that were included on Form H1205, Texas Streamlined Application, send out Form H1020 , Request for Information or Action, to request any additional information necessary to make an eligibility determination.