Documents You Need to Apply for Health Insurance

1. Personal identification

The Marketplace needs to verify the identity of every person applying for coverage. For each household member you plan to cover, gather:

If you’re applying for a child or dependent without an SSN, you can still apply — you’ll just provide their basic identifiers. The IRS issues an Individual Taxpayer Identification Number (ITIN) for tax purposes when an SSN isn’t available, and ITINs are accepted by the Marketplace for income reconciliation.

2. Income documentation

Income drives both your subsidy eligibility and your subsidy amount. The Marketplace uses your projected Modified Adjusted Gross Income (MAGI) for the coverage year — not last year’s actual income — so you’ll be making an estimate. Documents that help you build an accurate estimate:

What counts as income for ACA

The Marketplace uses MAGI, which for most people equals their tax return’s Adjusted Gross Income plus three add-backs: tax-exempt interest, untaxed Social Security benefits, and foreign earned income exclusion. Income that counts:

• Wages, salaries, tips, self-employment net income
• Social Security benefits (taxable and untaxed portions)
• Pensions, annuities, retirement account distributions
• Rental income, capital gains, dividends, interest
• Alimony from pre-2019 divorces
• Unemployment compensation

What does NOT count

• Child support received
• Gifts, inheritances, life insurance death benefits
• Workers’ compensation, veterans’ disability benefits
• Federal tax refunds
• Qualified withdrawals from Roth IRAs

3. Household composition

Marketplace household isn’t the same as everyone living under your roof — it’s defined by tax filing status. Your household includes:

• You, the tax filer
• Your spouse if you file jointly
• Every dependent you claim on your tax return, whether or not they live with you

This means your roommate is not in your household even if you share a fridge. Your 23-year-old college kid in another state IS in your household if you still claim them as a dependent. Same for an aging parent you claim. Get this right because subsidies scale with household size relative to the Federal Poverty Level.

4. Citizenship & immigration status

The Marketplace verifies citizenship or lawful presence for every person applying for coverage. U.S. citizens typically only need to confirm SSN — the Marketplace cross-references with SSA records automatically. No physical documents required in most cases.

Non-citizens with lawful immigration status need to provide their document number from one of these:

• Permanent Resident Card (Green Card, Form I-551)
• Employment Authorization Card (Form I-766)
• Visa with I-94 Arrival/Departure Record
• Reentry Permit (Form I-327)
• Refugee Travel Document (Form I-571)
• Certificate of Naturalization (Form N-550 or N-570)
• Certificate of U.S. Citizenship (Form N-560 or N-561)
• Notice of Action (Form I-797) for asylum applicants and others

5. Current coverage information

The Marketplace asks about coverage you (or anyone in your household) currently have because some types disqualify you from subsidies:

If you have access to “affordable” employer coverage (under 8.39% of household income for self-only coverage as of 2024), you generally can’t claim Marketplace subsidies. The Marketplace will ask you to confirm employer affordability based on what your employer offers.

6. The 1095 tax forms explained

The 1095 series is the tax documentation for health coverage. There are three versions, each with a different source and purpose:

Form 1095-A — for Marketplace enrollees

If you had ACA Marketplace coverage in the prior calendar year, the Marketplace sends you Form 1095-A in January. It shows which months you had coverage, your monthly premium, the benchmark Silver premium for your area, and the advance premium tax credit applied.

You use 1095-A to fill out IRS Form 8962 at tax time, which reconciles the subsidy you received against what you should have received based on actual income. If you got too much subsidy, you owe the difference. Too little, you get a refund.

Form 1095-B — for non-Marketplace coverage

Form 1095-B comes from your insurance company (or Medicaid/Medicare) and confirms you had qualifying health coverage. It’s primarily informational. You don’t need to attach it to your tax return, but keep it for your records. Common senders: small-employer insurance carriers, Medicaid agencies, Medicare, and self-insured small employers.

Form 1095-C — for large-employer employees

Form 1095-C comes from employers with 50+ full-time-equivalent employees. It shows what coverage your employer offered, what coverage you accepted, and which months you had it. Like 1095-B, you don’t attach it to your return, but you may need information from it to complete your tax filing — especially if you also had Marketplace coverage during the year and need to confirm employer offer details.

How to get a missing 1095-A

If your Marketplace 1095-A hasn’t arrived by mid-February:

1. Log into your account at Healthcare.gov (or your state exchange)
2. Go to “Tax Forms” or “My Documents”
3. Download the PDF for the relevant tax year
4. If it’s missing or wrong, call the Marketplace at 1-800-318-2596 to request a corrected form

FreedInsure members can ask their advisor to pull it for them — we have access to retrieve enrollment documents on behalf of members. More on Form 1095-A →

7. Documents by employment type

W-2 employee (one job)

The simplest scenario. You need:

• Most recent pay stub (year-to-date earnings)
• Prior year W-2
• Information on whether your employer offers health coverage and what your share would be
• 1095-C if your employer has 50+ employees (received in January-February)

Self-employed or 1099 contractor

More complex because income varies. You need:

• Last year’s tax return, especially Schedule C (profit/loss from business)
• Year-to-date profit and loss statement or bookkeeping summary
• 1099-NEC or 1099-MISC forms from clients
• Estimated projected net income for the coverage year (gross minus deductible business expenses)

Project conservatively but realistically. Self-employed people often forget that health insurance premiums are 100% deductible on Schedule 1, which lowers your MAGI, which can increase your subsidy.

Mixed household (W-2 spouse + self-employed spouse)

Bring both: W-2 documents for one spouse + Schedule C/1099 documentation for the other. The Marketplace combines all household income for the MAGI calculation.

S-Corp owner

S-Corp owners with over 2% ownership are treated as self-employed for health insurance purposes. You need:

• Your W-2 from the S-Corp (including any insurance premiums in Box 1 wages)
• K-1 showing your share of S-Corp distributions
• Last year’s Form 1040 with Schedule E and Schedule 1

Retired or pre-retiree

If you’re between retiring and Medicare eligibility (age 65):

• Social Security benefit statement (SSA-1099) or current benefit letter
• Pension benefit statement
• IRA / 401(k) withdrawal records or planned distribution amounts
• Any earned income from part-time work or consulting

8. Special Enrollment Period documentation

If you’re applying outside Open Enrollment (Nov 1 – Jan 15), you need a qualifying life event (QLE) and the documentation to prove it. The Marketplace verifies QLEs before activating coverage. Common QLEs and required docs:

9. What you DON’T need

Common things people gather unnecessarily because they confuse Marketplace enrollment with applying for credit, a mortgage, or employer benefits:

• Medical records. The Marketplace does not see or care about your medical history. Pre-existing conditions don’t affect eligibility or pricing.
• Doctor or specialist names. The application doesn’t ask about your providers. Your advisor uses provider info to recommend a plan, but it’s not part of the formal application.
• Prescription list. Same as above — helpful for plan selection, not required for application.
• Bank statements or credit reports. Marketplace doesn’t look at credit. No financial review beyond income reporting.
• Voter registration. Marketplace asks if you want to register to vote, but it’s optional and doesn’t affect your application.
• Proof of car insurance, life insurance, etc. Only health-related coverage matters.
• Tax returns (the full PDF). You’ll reference your prior return for income estimation, but you don’t upload it to Healthcare.gov.

10. How to upload documents

Some Marketplace verifications require you to upload documents — usually for income verification or SEP documentation. Tips:

• Accepted formats: PDF, JPG, PNG, BMP, GIF, TIF. PDF is most reliable.
• File size limit: typically 10 MB per file. Compress large scans if needed.
• Use a real scan or clear phone photo — not a screenshot of a screen. Blurry uploads get rejected.
• Include all pages of multi-page documents (W-2s often have multiple parts; tax returns have schedules).
• Upload through Healthcare.gov directly — navigate to your application → “Notices” → respond to the data matching issue (DMI). Don’t email documents to the Marketplace.
• Watch your deadline. Most DMIs give you 90 days. If you miss it, your coverage or subsidy can be terminated.

What happens after you apply

Once you submit your application:

1. The Marketplace runs automated verification against SSA, IRS, DHS, and state Medicaid databases — usually instant.
2. If everything matches, you immediately see your subsidy amount and can browse plans.
3. You compare plans, pick one, and complete enrollment.
4. You’ll get a “Data Matching Issue” notice if anything didn’t auto-verify — you’ll need to upload supporting documents within the deadline (usually 90 days).
5. Coverage starts the 1st of the month after enrollment if you enrolled by the 15th, or the 1st of the month after that if enrolled later. SEP rules vary by event.
6. You’ll get your insurance card from the carrier within 7–14 days, often digital first.