What type of plan are you looking for?

This helps us narrow down plan options for you.

What's your date of birth?

We need this to check plan availability and pricing.

How many people are in your household?

Include yourself, spouse/partner, and any dependents you'll claim on taxes.

Annual Household Income

Include wages, self-employment income, Social Security, and investment income.

What's your gender?

Do you use tobacco or nicotine?

4 or more times per week in the past 6 months. Affects plan pricing under Affordable Care Act regulations.

Is anyone on this application pregnant?

This can affect eligibility for Medicaid and certain programs.

What's your employment situation?

How soon do you want coverage?

What's your name?

Use your legal name as it appears on your ID.

Do you have a Social Security Number?

SSN helps verify eligibility for subsidies and speeds enrollment. It's optional — you can continue without it.

Enter your Social Security Number

Stored securely and used only for verification.

How can we reach you?

What's your home address?

Physical address only — no P.O. Boxes.

Is your mailing address the same as your home address?

What's your mailing address?

What's your marital status?

What's your tax filing status?

How you'll file federal taxes this year — used to check subsidy eligibility.

Are you a US citizen or US national?

This helps determine program eligibility.

How did you become a US citizen?

Do you have eligible immigration status?

Deferred Action for Childhood Arrivals (DACA) is not eligible. If unsure, choose "Prefer not to say" and a licensed agent will help.

Add your household members

Include spouse/partner and any dependents you'll claim on taxes. If just applying for yourself, click Continue.

Do you have any other income sources to report?

Things like rental income, Social Security, self-employment, etc. beyond what you already entered.

Add your income sources

Have you had health coverage in the past 60 days?

Tells us whether you qualify for a Special Enrollment Period.

Did any of these happen in the past 60 days?

Qualifying life events can open a Special Enrollment Period outside open enrollment.

Are you a veteran or active duty military?

Have you received Advance Premium Tax Credits (APTC) before?

If yes, you'll need to reconcile on your tax return.

Are you currently incarcerated?

Required by the Affordable Care Act for eligibility determination.

Are you American Indian or Alaska Native?

Members of federally recognized tribes may qualify for special enrollment and cost-sharing.

How would you like to receive notices?

Would you like dental or vision coverage?

Standalone dental and vision plans are often available alongside your health plan. Pick what you'd like to hear about.

Quick final acknowledgments

Electronic signature

Type your full legal name exactly as you entered it. This serves as your electronic signature.

Review your application

Check everything and jump back to any section to edit. When ready, click Finalize to submit.

Sign your authorizations

Your application is in. Before an agent can pull live quotes, we need both of these signed. They take about a minute each. Open each link, complete the form, then check the box to confirm.

Please upload your documents

Your application has been received. To complete verification, we need a clear photo or scan of the documents below. A licensed agent will review within one business day.