Marine Professional
Dustin ledet
OMB control number. The OMB control number for this information collection is .
Skills & certifications
About
Application date: January 16, 2025
Experience
8962 using the information from “Form A, Health Insurance Marketplace Statement,”
Company
Jan 1095 –
which you get from the Marketplace early each year.
• To get Form A, visit HealthCare.gov, log into your Marketplace account, and check your
Company
Jan 1095 –
notices from the Marketplace. You can also call the Marketplace Call Center at 1-800-318-2596. • For more information on filing a tax return using IRS Form 8962, visit HealthCare.gov/taxes or IRS.gov/aca. • Filing electronically can help avoid mistakes and find credits and deductions that may be available. In many cases filing electronically is free. For information about Free File and e-file, visit IRS.gov. If you filed the tax return but didn’t include IRS Form 8962, you may need to file an a
OMB control number. The OMB control number for this information collection is .
Company
Jan 0938 – Jan 1207
Nondiscrimination: The Health Insurance Marketplace® doesn’t exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, sex (including sexual orientation and gender identity), or age. If you think you’ve been discriminated against or treated unfairly for any of these reasons, you can file a complaint with the Department of Health and Human Services, Office for Civil Rights by calling 1-800-368-1019 (TTY: 1-800-537-7697), vis
LONDON, KENTUCKY 4
Company
Jan 0750 – Jan 1901
-- 2 of 12 -- 1 Welcome to the MARKETPLACE ELIGIBILITY GUIDE How to enroll in a Marketplace plan Compare available health plans online at HealthCare.gov by logging into your Marketplace account and opening your most recent application. Or, call the Marketplace Call Center at 1-800-318-2596 to compare plans and enroll. TTY users can call 1-855-889-4325. If you don’t already have a Marketplace account, you’ll need the Application ID on your Eligibility Notice. You can find an assister in your loc
London, KY 4
Company
Jan 0750 – Jan 1961
If you live in Alabama, Alaska, Louisiana, Montana, North Carolina, West Virginia or Wyoming, you can appeal a denial of Medicaid or CHIP eligibility through the Marketplace Appeals Center or with your state. Follow the instructions above to file an appeal with the Marketplace Appeals Center, or contact your state agency for instructions about how to file an appeal with your state. Income still being processed? If the “Results” section of your Eligibility Notice says “income information is stil
Resume
January 16, 2025
Application ID # 6562613460
Application date: January 16, 2025
Primary contact
Dustin Ledet
18274 west main
Galliano, LA 70354
2025
Marketplace Eligibility Notice
Remember to update your application during the year with any changes.
Results
Household not eligible for a premium tax credit Estimated 2025 income used to determine eligibility for financial help:
$0/year
Dustin
Ledet
Applied for coverage. •
Eligible for Medicaid based on this month's household income of $0. We're sending this information to your state
agency. •
ACTION: Next steps
Wait for more information from your state agency about Medicaid coverage. You may need to provide more
information to the state. See Eligibility Guide, page 7. •
You can appeal your eligibility results now. See Eligibility Guide, page 8. •
See next pages to learn why you may not have qualified for other programs.
To learn when and how you can appeal, see Eligibility Guide, page 8.
Questions about results or next steps? See the Eligibility Guide included with this notice.
For more help
HealthCare.gov
Marketplace Call Center:
1-800-318-2596
TTY: 1-855-889-4325
LocalHelp.HealthCare.gov
(for help in your area)
Louisiana Medicaid Program:
1-888-342-6207
TTY: 1-800-220-5404
Louisiana Children's Health
Insurance Program (LaCHIP):
1-888-342-6207
TTY: 1-800-220-5404
-- 1 of 12 --
Why don’t I qualify for other programs?
Your Marketplace application was reviewed to see if you may be eligible for help with the cost of health coverage, including free or low-cost
coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Your state runs these programs and they may go by different
names in your state.
Dustin
Ledet
You were reviewed for CHIP but don’t meet eligibility criteria (age, pregnancy and/or health coverage status). •
What you can do
You can appeal your eligibility results now. See Eligibility Guide, page 8. •
To learn when and how you can appeal, see Eligibility Guide, page 8.
Questions about results or next steps? See the Eligibility Guide included with this notice.
For more help
HealthCare.gov
Marketplace Call Center:
1-800-318-2596
TTY: 1-855-889-4325
LocalHelp.HealthCare.gov
(for help in your area)
Louisiana Medicaid Program:
1-888-342-6207
TTY: 1-800-220-5404
Louisiana Children's Health
Insurance Program (LaCHIP):
1-888-342-6207
TTY: 1-800-220-5404
The determinations or assessments in this letter were made based upon 45 CFR 155.305, 155.410, 155.420-430; 42 CFR 435.911, 435.603,
435.403, 435.406; and 42 CFR 457.348, 457.350, 457.315, 457.340.
Privacy Disclosure: The Health Insurance Marketplace® protects the privacy and security of the personally identifiable information (PII) that you
have provided (see HealthCare.gov/privacy). This notice was generated by the Marketplace based on 45 CFR 155.230 and other provisions of 45
CFR part 155, subpart D. The PII used to create this notice was collected from information you provided to the Health Insurance Marketplace. The
Marketplace may have used data from other federal or state agencies or a consumer reporting agency to determine eligibility for the individuals
on your application. If you have questions about this data, contact the Marketplace at 1-800-318-2596 (TTY: 1-855-889-4325). You can also call
the Marketplace Call Center to get information from this notice in your language, or request a reasonable accommodation if you have a disability.
You can ask for information in an accessible format, like large print, braille, or audio at no cost.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid
OMB control number. The OMB control number for this information collection is 0938-1207.
Nondiscrimination: The Health Insurance Marketplace® doesn’t exclude, deny benefits to, or otherwise discriminate against any person on the
basis of race, color, national origin, disability, sex (including sexual orientation and gender i