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None of the above apply to me, but I need coverage before November 1st. Show me Short Term Medical options.

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Because open enrollment ended on December 15, 2017, you can only enroll if you've experienced a qualifying life event.

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  • No one applying for coverage is in jail.
  • I will notify the insurer if anything on this application changes. I can do this through the federal marketplace. I understand a change could affect our eligibility for plans and subsidies.
  • I give permission to the federal marketplace to access my tax returns for up to 5 years to verify my income for subsidy purposes. I can revoke this permission at anytime.
  • I'm signing this application under penalty of perjury, which means I've provided true answers to all of the questions to the best of my knowledge. I know that I may be subject to penalties under federal law if I intentionally provide false or untrue information.
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  • If a child on this application has a parent living outside the home, I know I'll be asked to cooperate with the agency that collects medical support from an absent parent. If I think that cooperating to collect medical support will harm me or my children, I can tell the agency and I may not have to cooperate.
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Estimated Annual Household Income

Please provide an estimate of your adjusted gross annual income to determine whether you qualify for a subsidy that will reduce the cost of your health premium

You and/or your family may qualify for other assistance

You may be eligible fo Medicaid. Learn more at www.medicaid.gov
Submit an application to the Federal Government on Healthcare.gov to confirm your eligibility and get more information on how to get covered.

We have many affordable plans for you!

Although your income appears to be too high to qualify for a government tax credit, we have found many affordable plans for you.

You are Qualified!

The government may pay per month for your insurance.
Please note: Your subsidy amount is a preliminary estimate. We will finalize your exact subsidy amount during the application process.

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