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    How to Apply WITHOUT Financial Help

    Who Can Use this Application?

    Use this application to apply for anyone in your household. Include on this application only those people in your household who want health coverage.

    Step 1. Primary Contact

    We will need one adult in the family to be the contact person for your application.

    Enter information including your name, address, Social Security number, and citizenship or immigration status.

    Step 2. Members of Your Household Who want Health Coverage

    Family members who may be eligible to be included under a family health plan include:

    • Yourself
    • Your spouse
    • Your children under 21
    • Adult children ages 21-26
    • Children who do not live with you
    • Children who are not included on your federal income tax return
    • Your unmarried partner who needs health coverage
    • Anyone you include on your federal income tax return, even if they do not live with you
    • Anyone else under 21 who you take care of and lives with you
    • Grandchildren who have resided with you continuously from birth and who are financially dependent upon you or your covered spouse
    • Children for whom you or your spouse are legal guardian

    Step 3. Other Health Care Coverage

    Medicare beneficiaries are generally not eligible to purchase insurance through MNsure. If you answer “Yes” to at least one of the questions in this section and you or a family member is seeking supplemental coverage, please contact the Senior LinkAge Line at 800-333-2433 to learn more.

    Step 4. American Indian or Alaska Native Family Members

    Enter information about members of your household who are American Indian or Alaska Native.

    Step 5. Read and Sign the Application

    The person who filled out step 1 should sign this application. If you are an authorized representative, you may sign here as long as you have provided the information required.

    We need Social Security numbers (SSNs) for anyone who wants coverage. We use SSNs to verify citizenship. If someone doesn’t have an SSN, visit www.socialsecurity.gov or call 1-800‑772‑1213. TTY users should call 1-800‑325‑0778.

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