MA ACA-3 2017 free printable template
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Massachusetts Application for Health
and Dental Coverage and Help Paying Costs
HOW TO APPLYYou can submit your application in any of the following ways.
Sign on to your account at MAhealthconnector.org.
You
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How to fill out MA ACA-3
How to fill out MA ACA-3
01
Gather your personal information, including your name, address, and Social Security number.
02
Locate the MA ACA-3 form, available from your local Department of Revenue or online.
03
Fill out Part 1 with your demographic information accurately.
04
Proceed to Part 2 and provide information about your income sources.
05
Complete Part 3 by detailing any deductions or credits you plan to claim.
06
Review all entries for accuracy and completeness.
07
Sign and date the form in the designated areas.
08
Submit the form to the appropriate agency by the deadline.
Who needs MA ACA-3?
01
Individuals who have received premium assistance for health insurance through the Massachusetts Connector.
02
Residents of Massachusetts who meet certain income and eligibility criteria for health coverage.
03
Anyone who has filed a state tax return and needs to report information related to health care coverage.
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People Also Ask about
What is proof of income for MA Health?
Acceptable income documents include: Your most recently federal income tax return 1040, 1040A, or 1040EZ. Social Security benefit award letter or annual benefit statement (SSA-1099)
What is the Massachusetts Health Connector?
The Massachusetts Health Connector is the state's Marketplace for health and dental insurance. Before your get started, be sure to check the Help Center for information, guides, and where to find free, in-person help near you.
What can be used as proof of residency for Masshealth?
Massachusetts Residency Copy of deed and record of most recent mortgage payment (if mortgage is paid in full, provide a copy of property tax bill from the most recent year) Copy of lease and record of most recent rent payment. Mortgage deed showing primary residence.
What documents are needed for MA Health Connector proof of residency?
Annual Social Security Statement (most current) Property Tax Bill (most current) Utility Bill (no more than 60 days old) with Massachusetts address. Voter Registration card (current)
What documents are needed for Masshealth?
What you need Social Security numbers, if you have them, for every household member who is applying. Federal tax returns, if you file. Information about citizenship or national status or immigration status. Employer and income information for everyone in your household (for example, from paystubs or wage statements)
Is ma health medicaid?
In Massachusetts, Medicaid and the Children's Health Insurance Program (CHIP) are combined into one program called MassHealth. MassHealth members may be able to get doctors visits, prescription drugs, hospital stays, and many other important services.
Is health insurance mandatory in MA?
Requirements. Whether or not you have to file a Massachusetts personal income tax return, anyone 18 years old or over must get and maintain creditable health insurance coverage as long as it's considered affordable under the schedule set by the Massachusetts Health Connector.
What is proof of income for MA health?
Acceptable income documents include: Your most recently federal income tax return 1040, 1040A, or 1040EZ. Social Security benefit award letter or annual benefit statement (SSA-1099)
Is MA the same as Medicare?
Original Medicare helps cover hospital and doctor visits. MA plans bundle Part A and Part B benefits, and some include prescription drug coverage. Many MA plans also include routine dental, vision and hearing care—benefits not offered by Original Medicare.
What is MA health insurance?
Medical Assistance (MA) (you are on this page)
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What is MA ACA-3?
MA ACA-3 is a form used in Massachusetts to report information related to health care coverage as required by the Affordable Care Act (ACA).
Who is required to file MA ACA-3?
Employers and organizations with 50 or more full-time equivalent employees, as well as certain small employers, are required to file the MA ACA-3 if they provide health insurance coverage.
How to fill out MA ACA-3?
To fill out MA ACA-3, gather necessary information such as employee details, health plan information, and coverage months, and follow the instructions outlined by the Massachusetts Department of Revenue or use an approved software.
What is the purpose of MA ACA-3?
The purpose of MA ACA-3 is to ensure compliance with state and federal health care coverage mandates and to facilitate the reporting of health insurance offerings to the state.
What information must be reported on MA ACA-3?
MA ACA-3 requires reporting of the employer's information, employee details, months of coverage provided, and the type of health insurance plans offered.
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