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Department of Health and Human Services
(Health Insurance Marketplace 465 Industrial Boulevard
London, Kentucky 40750-0001
Aug 06, 2016
B6181-1L P-OOII T-0628 00061906 2 AT .416
2207 LAUREL BRANCH WAY
HOUSTON, TX 77014-2451
Application Date: August 06, 2016
Application ID: 1948498523
Important: Your Eligibility Results for Health Insurance Marketplace coverage
We reviewed your application to see if you can get health coverage through the Marketplace and help paying for coverage and health services through.
A premium tax credit that can be used right away to lower your monthly premium costs • Health plans that lower your out-of-pocket costs
Medicaid (Medicaid) and CHIP (Children's Health Insurance Program (CHIP)), which are joint federal and state programs that help with medical costs for people with limited income or special health care needs
Save this notice. It includes information about important Marketplace deadlines that may affect your eligibility for coverage, your costs, and your next steps.
Your Eligibility Results
Review the table below for the results of your application. Brandon Rice - Based on the information provided, you would be eligible for free or low cost health care through Medicaid. However, the state of TX has chosen not to offer you this health coverage at this time.
You won't owe a fee for not having health coverage. This is because of your income, and because the state of TX declined to expand Medicaid to cover individuals in your situation. When you file your tax return, you'll need to enter the Exemption Certification Number (ECN) shown in the "Results" column below.
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