Use this form if you filed a tax return last year and have not had any significant changes in your household size or income this year.
This form will calculate your Modified Adjusted Gross Income (MAGI). You will need this number when you apply. In your application, be sure to leave questions about deductions and allowable deductions blank. These are included in this MAGI calculation.
Enter annual income amounts below. Include amounts for a spouse if you are married filing jointly for the year or for any dependents who make or expect to make taxable income.
Maryland Health Connection P.O. Box 857 Lanham, MD 20703.