Individual Health Coverage Checklist

This checklist is adapted from, the health insurance marketplace operated by the federal government. Download original PDF here. You can apply for or re-enroll in coverage by visiting or by calling the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325.

To help make the application process quicker and easier, we recommend gathering this information before you start your application.


Information about your household

Quick Overview

Your Marketplace application will ask you about each person in your household, even those not applying for coverage.

For the Marketplace, your household usually includes the tax filers and their tax dependents, but there are exceptions. Sometimes the Marketplace includes people you live with who aren’t in your tax household.

You should include yourself on your application. Here’s a basic list of the other people you should generally include, if these people are in your household:

  • Your spouse
  • Your children who live with you, even if they make enough money to file a tax return themselves
  • Anyone you include on your tax return as a dependent, even if they don’t live with you
  • Anyone else under 21 who you take care of and who lives with you
  • Your unmarried partner, only if one or both of these apply:
    • They’re your dependent for tax purposes
    • They’re the parent of your child

If you need more information, visit, or call the Marketplace Call Center.

Home and/or mailing addresses (for everyone applying for coverage)

Quick Overview

Where you live can affect what health coverage you’re eligible for.

You’ll enter your home address to show if you’re a resident of the state where you’re seeking coverage. You’ll select your state at the beginning of the application.

You’ll be asked for your mailing address. Often, this will be the same as your home address. If it’s not, provide a mailing address in the state you live in, if you can.

If anyone on your application has a different home and/or mailing address, you’ll need to have it also.

Social Security Numbers (SSNs) for everyone on your application

Quick Overview

Your Marketplace application will ask you to enter each person’s 9-digit SSN, even those not applying for coverage. The Marketplace will verify the SSNs with Social Security, based on the consent you’ll give at the start of your application. If you don’t enter an SSN, you may need to provide more information at a later time.

This information will only be used for eligibility for health coverage.

Employer & income information for everyone in your household

Quick Overview

Your Marketplace application may ask you about the income, expenses, and deductions of everyone in your household, even those not applying for coverage.

The Marketplace accounts for income sources, including:

  • Wages and salaries, as reported on your W-2 form and pay stubs
  • Tips
  • Net income from any self-employment or business
  • Unemployment compensation
  • Social Security payments, including disability payments (but not Supplemental Security Income (SSI))
  • Alimony
  • Retirement or pension income, including most IRA or 401k withdrawals
  • Investment income, like dividends or interest
  • Rental income
  • Other taxable income

For more information on income or what income sources to include, visit

Your best estimate of your household income

Quick Overview

Your Marketplace application may ask you to estimate what your household’s income will be in the year you’ll be covered.

If you’re not sure, it’s okay to make your best estimate. If your income changes, or is different than what you estimated, you’ll need to update this information later. For more information, visit

To help you make a ballpark estimate of your household income, visit

Health coverage information (this only applies if anyone in your household currently has a health plan)

Quick Overview

Your Marketplace application will ask if anyone in your household is currently enrolled in health coverage, including Medicaid, the Children’s Health Insurance Program (CHIP), Medicare, TRICARE, VA health care program, Peace Corps, or coverage through individual insurance (including Marketplace coverage) or an employer.

If anyone has coverage now, gather their policy numbers. You can find this information on their insurance card or documents they get from their plan.

A completed “Employer Coverage Tool” (this is optional and only applies if anyone in your household has or is eligible for coverage through their employer)

Quick Overview

You should fill out an “Employer Coverage Tool” for each member of your family who’s eligible for a job-based plan, even if that person isn’t enrolled in the job based plan or isn’t applying for Marketplace coverage. You can get this information from your employer. This optional tool helps you gather information you may need for your application in one spot.

To get a copy of this form, visit Your employer can help you fill this out.