Health Coverage Preparation & Subsidy Checklist

Health Coverage Preparation & Subsidy Checklist

Please gather your personal, income, and coverage information to complete the checklist accurately. Licensed review included.
Personal Details
Household Member Details
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Income Details (Full-Year 2027 MAGI Estimate)
Wages (W-2 Projections)
Self-Employment/1099 Income
Unemployment Benefits
Social Security Income
Investment Income
Household Size
Tax Filing Status
Coverage History
Current Health Coverage

Other
Did you have a 1095-A form for prior coverage?
Will your household have any changes in 2027 that may affect eligibility (e.g., job loss, move, marriage, birth, etc.)?
Do you believe you qualify for a Special Enrollment Period (SEP) in 2026 or 2027?
Immigration Status
Key 2027 Updates
- No enhanced subsidies; 400% FPL cap applies.
- Pre-enrollment verification mandatory.
- No low-income SEP (≤150% FPL).

Contact First Cover Health, LLC for a subsidy audit in TX, FL, CA, CO, NJ, or IN.
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