Free Medical Benefits Application Forms and Templates
If you need to reduce the costs associated with common medical occurrences or deal with expenses in the event of an accident, injury, or chronic illness, consider completing a Medical Benefits Application. In times of medical emergencies, proper health coverage provides people with a financial backup along with preventive care – check-ups, screenings, and vaccines. In addition, health insurance will cover the cost of ambulance transportation, hospitalization, surgeries, physical therapy, and prescription drugs.
How to Apply for Medical Benefits?
Whether you are a self-employed individual, a member of a multi-person household, or a former servicemember in need of medical care, the documents below are the first step to help you stay well and keep getting essential care. Your lifelong health problems will be dealt with, you will reduce the medical costs without depleting your savings when tackling health emergencies, and you may even receive an income tax benefit.
- Once you find an insurance plan that is right for you and your family members, you can file a Health Insurance Application with local authorities to enroll. The information you provide on the health care benefits application – the size of your family, your employment and medical history, income and assets you own – will help the insurance provider to make sure you get the most benefits possible.
- Fill out an Application for Health Coverage & Help Paying Costs to apply for Health Insurance Marketplace coverage. You need to provide information about yourself and the members of your household, including employment history, income, and insurance you currently have. The amount of assistance or type of program you qualify for, such as a new private health insurance plan or tax credit to pay the premiums for health coverage, will be decided by the Department of Health and Human Services based on the number of the members in your household and your income.
- Complete a Medicaid Renewal Form to resume your Medicaid membership. When it is time to renew your health insurance plan, you will need to confirm you are still eligible for Medicaid and update contact information and other details if necessary. Your local human services agency will send you the form that you fill out and mail along with any documents the form requests.
How to Apply for Medical Benefits From the VA?
File the VA Medical Benefits Application (VA 10-10EZ) if you want to apply for enrollment in the VA health care system, domiciliary and dental benefits, or nursing home care. Any veteran – an individual who served in the active military, air, or naval service and was discharged from service - can complete VA Form 10-10EZ to provide the VA with information that determines this veteran’s eligibility for medical benefits.
Check out these related forms:
- Complete an unemployment claim;
- Apply for child care assistance;
- Check eligibility for Social Security benefits.
Documents:
90
This Form is used for single adults in Arkansas to apply for health coverage.
PDF 
Word
This Form is used for applying for health insurance in the state of Delaware.
This Form is used to apply for health coverage in the state of Indiana.
This form is used for applying for health insurance in New York.
This document is used for applying for health coverage and financial assistance in New Hampshire.
This form is used for applying for health coverage and financial assistance for healthcare costs in the state of Virginia.
This type of document is used for applying for health coverage and financial assistance in Virginia.
The information provided on this form is used by the VA to determine eligibility for certain medical benefits.
This form is used for applying for medical benefits through mail in the state of Illinois.
This Form is used for applying for services in Alaska.
This Form is used for applying for Access Florida benefits in Florida. It is a Spanish version of the application form.
This Form is used for filing an Access Florida Application in the state of Florida. It allows individuals to apply for various assistance programs offered by the Department of Children and Families, such as food assistance, cash benefits, and medical coverage.
This form is used for applying for cash, food, or medical assistance in Ohio. It is a necessary document for those in need of financial support for basic needs.
This form is used for adults and children in Alaska who need long term care.
This form is used for applying for household health coverage in Arkansas.
This document is an application form for health insurance in Colorado. It also provides assistance for paying health insurance costs.
This document is for applying for health insurance and financial assistance for healthcare costs in Colorado.
This document is used for applying for long-term care or waiver in the state of Connecticut.
This document is a Form W-1 LTCS used to apply for Long Term Care Services and Exemption in Connecticut.
This form is used for applying for the Medicaid/Medicare Buy-In program in Florida.
This form is used for applying for extended family planning benefits under health insurance in the state of Florida.
This form is used for applying for health coverage and help with costs in the state of Georgia, United States.
This Form is used for applying for health coverage and financial assistance in paying for costs in Georgia.
This Form is used for applying for health coverage and financial assistance in Hawaii.
This Form is used for applying for health coverage and assistance with cost payments in Hawaii.
This document is a Spanish version of the HW2014S Form used for applying for health insurance assistance in the state of Idaho.
This form is used for requesting health coverage in Indiana. It is specifically designed for Spanish-speaking individuals in the state.
