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Application for Health Coverage & Help Paying Costs

Print Form Print Form Application for Health Coverage & Help Paying Costs Affordable private Health insurance plans that offer comprehensive Coverage to help you stay well Use this Application to see A new tax credit that can immediately help pay your premiums for Health what Coverage choices you Coverage qualify for Free or low- cost insurance from Medicaid or North Carolina Health Choice (NCHC). 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 four). Use this Application to apply for anyone in your family Apply even if you or your child already has Health Coverage . You could be Who can use this eligible for lower- cost or free Coverage . Application ? If you're single, you may be able to use a short form: Families that include immigrants can apply. You can apply for your child even if you aren't eligible for Coverage . Applying won't affect your immigration status or chances of becoming a permanent resident or citizen.

Complete Step 2 for each person in your family. Start with yourself, then add other adults and children. If you have more than 4 people in your family, you’ll need to make a copy of the …

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