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470-5170 Application for Health Coverage and Help …

470-5170 (Rev. 12/17) Cover Page Iowa Department of Human Services Application for Health Coverage and Help Paying Costs Use this Application to see what Coverage choices you qualify for Affordable private Health insurance plans that offer comprehensive Coverage to help you stay well A new tax credit that can immediately help pay your premiums for Health Coverage Free or low-cost insurance from Medicaid or the Children s Health Insurance Program (CHIP) You may qualify for a free or low-cost program even if you earn as much as $94,000 a year (for a family of 4). Who can use this Application ?

470-5170 (Rev. 12/17) Cover Page Iowa Department of Human Services Application for Health Coverage and Help Paying Costs . Use this application to see what coverage choices you qualify for

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