Get Low Income Premium Program Application - Nmmip
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How to fill out the Low Income Premium Program Application - Nmmip online
The Low Income Premium Program (LIPP) assists individuals who qualify by providing a reduced premium for coverage. This guide will walk you through the online application process, ensuring you have step-by-step instructions to complete the form correctly.
Follow the steps to successfully fill out your application online.
- Click the ‘Get Form’ button to access the Low Income Premium Program Application and open it in your preferred online editor.
- Begin by providing your applicant information. Fill in the ID number, last name, first name, middle initial, address, city, state, and ZIP code.
- Complete the premium payment certification by indicating who will be responsible for paying the monthly premiums. Write the name in the designated space.
- Add the household size and total combined income information. List all members of your household, ensuring to include their Relationship to you and their Date of Birth.
- Input the total annual income amount for adults. Exclude any income from members whose income comes solely from Supplementary Security Income (SSI) or Temporary Assistance for Needy Families (TANF). Reference the relevant line from the Federal Tax Form: Line 4 of Form 1040EZ, Line 15 of Form 1040A, or Line 22 of Form 1040.
- Attach a copy of the previous year’s Federal Income Tax forms filed by each adult household member who earned an income, unless they fall under the exclusions mentioned previously. Ensure to complete and sign the Federal Tax Form Affidavit (Affidavit A) as part of this application.
- If an adult in your household did not file a Federal Income Tax form, instruct them to complete, sign, and notarize the Other Income Source Affidavit (Affidavit B) and provide the necessary income details.
- After filling out all sections, review your application for accuracy and completeness. Save changes, print or download the completed application, and share it as required.
Start your application online today to take advantage of the reduced premium.
In New Mexico, the income cutoff for Medicaid eligibility primarily depends on your household size and the Federal Poverty Level. For most adults, an income at or below 138% of the FPL qualifies you for assistance. Specifically, that translates to around $20,120 for a single individual. When you complete the Low Income Premium Program Application - Nmmip, ensure you provide accurate income details to determine your eligibility.
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