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ESTIMATED HOUSEHOLD SIZE & INCOME FOR 2021 (.pdf)
Click on the above link to download the pdf form to your computer.
Open and fill out the form.
When finished, click the SUBMIT button to email the finished form.
Fill out the form, print, then fax the form to 1-662-594-1851.
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- Income Limits for 2020 (These income limits are not published until AFTER Open Enrollment each year. That means that the tax credits assigned during Open Enrollment each year are based on the income limits from the previous year.) U.S. FEDERAL POVERTY GUIDELINES USED TO DETERMINE FINANCIAL ELIGIBILITY FOR CERTAIN FEDERAL PROGRAMS, including tax credits and cost share reduction from the Health Insurance Marketplace.