Application WITH Financial Help
- Use this application to see if you qualify for financial help to help pay for health coverage.
- Use this application to apply for anyone in your household.
- Apply even if you or your child already has health coverage. You could be eligible for lower-cost or free coverage.
This application scans your income and other information to determine what coverage you qualify for and if you can get any help paying for it. After you submit this application, you’ll see a screen with the results, also known as the “eligibility determination”.
Application WITHOUT Financial Help
Use this application if you don't want financial help and prefer to pay full price for a health care plan. (This application does not include income information.)
Use this application to apply for anyone in your household. Include on this application only those people in your household who want health coverage.
Application for Certain Populations
Use this application for special circumstances where your eligibility cannot be determined online through MNsure. Download this application as an electronic PDF form (DHS-3876). Only use this application if at least one of the following is true:
- all applicants are age 65 or older
- all applicants are requesting help only with Medicare costs
- all applicants are children in foster care
- all applicants are age 21 years or older with no dependents and have Medicare coverage
- all applicants are receiving Supplemental Security Income (SSI)
- all applicants are applying for Medical Assistance for Employed Person with Disabilities (MA-EPD)