healthcare.gov

Please begin entering your information below this line.

Personal Information:

I need a quote for- *

- Health Insurance - Basic Dental Insurance - Whole Life Insurance

* Indicates required field

Name *

First

Last

Date of Birth *

Physical address *

Line 1

Line 2

City

State

Zip Code

Country

P.O. BOX or Alternate Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Who needs coverage?

Do you need Coverage *

Yes No, I already have coverage I just want to compare coverages.

How do you file *

Do you smoke or use any other tobacco products (rates will increase for tobacco users) *

What's your race (optional) *

You can still verify each dependent's race

What was your assigned sex at birth? (Optional) This can be found on an original birth certificate or similar document. *

What's your gender identity? (Optional) *

What's your sexual orientation? (Optional) *

Your Social Security Number *

Please note, if you plan to file joint next year (for this 2021 tax year), you must fill out both sides of the electronic form going forward.

Tax Information:

To qualify, you must make at least $16,000 or allow someone else to file you.

Your annual gross income on 2025 taxes *

Your current income source *

If self-employed, what type of work *

Employer name (Self if self-employed) *

How much do you pay monthly for student loans *