Find affordable health coverage in minutes
Answer a few questions for a personalized quote — no obligation. A licensed OnePoint agent will review and help you enroll.
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?
Tell us about your work
Enter the name of your employer and your job title or occupation.
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.
Are you currently enrolled in Medicare?
Medicare eligibility affects Marketplace plan options and premium tax credit eligibility.
Would you like to add extra protection?
These plans can help reduce out-of-pocket costs and provide extra financial protection during unexpected situations. Select your preferences below.
Standalone dental and vision plans are often available alongside your health plan.
- Routine cleanings and exams
- Fillings and major dental work
- Orthodontic benefits (select plans)
- Eye exams
- Glasses and contact lenses
- Vision correction benefits
Accident plans can provide lump-sum cash benefits up to $30,000 for covered accidental injuries, emergency treatment, hospital stays, fractures, ambulance services, and more. Benefits are paid directly to you and can help with medical bills, lost income, or everyday expenses.
Pay up to $2,000/day for each covered hospital day. Helps with:
- Hospital stays
- Deductibles and copays
- Lost income & household bills
Lump-sum benefit up to $100,000 for serious diagnoses:
- Heart attack & stroke
- Cancer
- Major organ failure
Benefits are paid directly to you and can be used however you choose.
Please read the attestations
Select a response for each statement below.
I know that I must tell the program I'll be enrolled in within 30 days if information I listed on this application changes. I know I can make changes by contacting my licensed agent or by calling OnePoint Insurance Agency at (888) 899-8117. I know a change in my information could affect eligibility for member(s) of my household.
If anyone on your application is enrolled in marketplace health coverage and is also found to have Medicare coverage, the marketplace will automatically end their health plan coverage. They will get a notice before coverage is terminated in case they need to keep it or make changes. During all the months of overlapping coverage, they're responsible for paying the full cost for the marketplace plan premium and covered services.
Consent and tax agreements
Select a response for each statement below.
By signing below, I consent to my information being shared with my state's Medicaid agency and the Children's Health Insurance Program (CHIP) for the purpose of making a Medicaid or CHIP eligibility determination if my application fits specific criteria to be potentially eligible, or if I otherwise request Medicaid or CHIP eligibility directly.
I understand that any financial help I receive from the federal government through Advance Premium Tax Credits is connected to my taxes. I understand that I may owe taxes, or receive more tax credit, if my income for this year is different than what I estimated. I agree to file federal income taxes (jointly if married) and report the amount of Advance Premium Tax Credits received on my Tax Return for any year I have federal financial help to lower premium costs.
Electronic signature
I declare under penalty of perjury under the laws of the United States of America and the laws of the state in which I reside that the foregoing is true and correct. I understand and acknowledge that I will be subject to penalties under both State and Federal law if I knowingly or willfully provide false information in support of this application.
Type your full name below to sign electronically.
Please sign the required documents
Before submitting, you must sign both documents below. Click each button to open the form in a small popup window — it won't take over your screen.
Review your application
Check everything and jump back to any section to edit. When ready, click Finalize to submit.
Submitting your application…
Please don't close this window.
Upload your supporting documents
To complete verification, please upload a clear photo or scan of the documents below. Once you're done, click Continue & Submit to finalize your application.
Application received!
Thank you — your application has been submitted. A licensed OnePoint agent will reach out within one business day to review your options and help you enroll.
A confirmation has been sent to the email on file. If you need immediate help, please call 888-899-8117.