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Other Health Insurance Coverage

Tax and Income Information

Important: Income Documentation Required

You must provide documentation to verify your household income. This information is used to determine your eligibility for premium assistance programs.

MAGI is your Adjusted Gross Income (AGI) plus: tax-exempt interest, non-taxable Social Security, and foreign earned income exclusions. Enter your total for the most recent tax year.
Include everyone in your tax household (you, spouse, and all dependents).
If your income changes in the future, you must report it.

Income Documentation

Please provide proof of all types of income. Common examples include:

  • 1040 Federal Tax Return – Most recent return within the past three tax years with Schedule 1, if applicable
  • W-2 Forms – Wage and tax statements from all employers
  • 1099 Forms – 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099SS, 1099INT
  • Pay Stubs – Recent pay stubs showing YTD income
  • Self-Employment – Schedule C or most recent quarterly/year-to-date profit and loss statement
  • Social Security Benefits Letter – SSA benefit statements
  • Unemployment Benefits Letter – Benefit statements

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  • Smaller than 5MB
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Income Proof Guide

Type of Income Type of Proof Instructions
All income 1040 federal or state tax return Must contain your first and last name, income amount, and tax year.
If you file Schedule 1, you must submit it with your 1040.
Recent tax return
Wages and 1099 Income (including foreign income, capital gains, interest, dividends, other investment income) Wages and tax statement (W-2 and/or 1099, including 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099SS, 1099INT) Must contain your first and last name, income amount, tax year, and employer name (if applicable).
Wages/Salaries/Bonuses/Tips and Gratuities Paystub Must contain your first and last name, income amount, and pay period or frequency of pay with the date of payment.
If a paystub includes overtime, tell us the average overtime amount per paycheck.
Self-employment Income Self-employment ledger documentation (can be a Schedule C, the most recent quarterly or year-to-date profit and loss statement, or a self-employment ledger) Must contain your first and last name, company name, and income amount.
If you’re submitting a self-employment ledger, include the dates covered by the ledger, and the net income from profit/loss.
Annuities Annuity statement
Social Security Income (non-taxable, retirement, disability) Social Security Administration Statements (Social Security Benefits Letter) Must contain first and last name, benefit amount, and frequency of pay.
Unemployment Benefits Self-employment ledger documentation; 1040 SE with Schedule C, F, or SE; 1065 Schedule K1 with Schedule E; Tax return; Bookkeeping records; Receipts for all allowable expenses; Signed time sheets and receipt of payroll (if you have employees); Most recent quarterly or year-to-date profit and loss statement For Self-Employment Ledger: Must contain your first and last name, source/agency, benefits amount, and duration (start and end date, if applicable).
Retirement/Pension Statement of pension distribution from any government or private source
Alimony (if finalized before Jan. 1, 2019) Proof of alimony received Provide the original divorce decree or separation agreement along with documentation such as bank statements, copies of canceled checks, or digital payment receipts from the last 12 months that show payments were deposited into your account.
Rent/Royalty Royalty income statement or 1099-MISC; Proof of rental income To prove rental income, gather tax returns (especially Schedule E) with associated income, current and previous lease agreements, bank statements showing consistent rent payments, profit and loss statements, and appraisal reports with a market rent analysis.
Farming/Fishing Income Proof of farming/fishing income Farming income: Schedule F (Form 1040) or other tax documents that prove farming income.
Fishing income: Schedule C (Form 1040) or other tax documents that prove fishing income.
Tax-exempt Interest 1099 Tax Forms
Strike Pay and Other Benefits From Unions Proof of strike pay and other benefits from unions
Foreign Income Official documents like foreign tax returns, wage statements, bank statements, tax forms, and contracts
Retirement, Survivors, and Disability Insurance (RSDI) except for children under 19 Social Security Administration benefit verification letter
Refugee Cash Assistance Official documentation from the state or local agency that administered RCA benefits, including benefit statements, payment records, or official letters from the agency confirming receipt of funds
Severance Pay Proof of severance pay
Sales of Property (installment payments) Official sales contract and annual IRS tax filing
Inheritances in Cash or Property Proof of inheritances in cash or property
Prizes, settlements, and awards, including court-ordered awards Prizes, settlements, and awards letter
Gifts and Contributions Proof of gifts and contributions
Any income for which you do not have proof Complete a Written Explanation Form To submit this form, select “Other” from the drop-down menu when you’re on the upload screen in the application.
Zero income affidavit HCA approved form Complete form if attesting to zero household income for a household member.
Dependent income should be included in household income if the dependent would be required to file taxes if not filing under a parent or guardian.
The following types of income do not require proof:
  • Supplemental Security Income (SSI)
  • Child support
  • Child Foster Care
  • Workers’ Compensation
  • Temporary Assistance for Needy Families (TANF)
  • Out of State Diversion Payment
  • Refugee reception and replacement program one-time payments by Dept. of State or Justice
  • Veterans’ benefits
  • Insurance proceeds (accident, health, and life)
  • Loan proceeds
  • Disaster relief
  • Foster Grandparent
  • Foster Care payments
  • Sickness and injury payments
  • Tax credits and refunds
  • Housing Assistance - HUD or FMHA
You can submit income documentation later if needed. Be sure to include the applicant’s full name and date of birth on each document, and include your account/reference ID from your eligibility notice if you have it.
Income Verification Process

Your income documentation will be reviewed to determine your eligibility for premium assistance. You will be notified as quickly as possible (typically sooner than 30 days).

DACA Approval

Important: Approval Required

To qualify for the DACA Coverage Program, an individual must:
  • Be a current DACA recipient;
  • Be a resident of New Mexico;
  • Not be incarcerated;
  • Have a household income at or below 400% of the Federal Poverty Level (FPL);
  • Not have access to other Minimum Essential Coverage (MEC), such as employer-sponsored insurance or TRICARE;
  • Not be eligible for other third-party payor programs.

You must be approved for DACA before you can enroll in the program.

Your Coverage will be effective within your Approval Date Range.

  • DACA Employment Authorization Document (EAD): Form I-766
  • The most recent DACA approval notice from U.S. Citizenship and Immigration Services.

Rights and Responsibilities

By submitting this application, you affirm that the information provided is true and complete to the best of your knowledge. You understand your responsibility to report changes that may affect eligibility, including changes in income, household size, or other coverage.

Optional: Enrollment Options

After eligibility is confirmed, you may select medical and dental plans. Please review plan documents and provider directories. Always confirm your providers accept this coverage.

View Summary of Benefits and Coverage (SBCs) • Check provider directories