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Online Application For Affordable Care Act (ACA) Coverage
Online Application For Affordable Care Act (ACA) Coverage
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Do you have a current or existing Affordable Care Act (ACA) Marketplace plan?
Yes
No
I give permission to Compare Health Care and its affiliates to access and/or create my application for health insurance on the Federally Facilitated Marketplace (FFM) based on the information I am providing below.
Yes
Do you have insurance through your employer, Medicare, Medicaid or VA? *
Yes
No
Main Applicant Date of Birth
First Name
Last Name
Phone/Mobile
Email
Address
City
State
Zip Code
Social Security Number
Gender
Male
Female
Radio Field
Married
Single
Will you be claiming any dependents on your taxes in 2024?
Yes
No
What is your estimated Household Income for 2024?
0
Is that
Yearly
Monthly
Weekly
Which $0 plan carriers are you interested in?
Best Option (Recommended)
Ambetter
Aetna
Blue Cross / Blue Shield
Cigna
Molina
UHC
Oscar
Income Verification
Do you Agree with the Income Verification?
Yes, I Agree
Consent to Enrollment; Verification of Information
Do you Agree with the Consent?
Yes, I Agree
No
Authorization and Tax attestation
Do you Agree with Authorization and Tax attestation?
Yes, I Agree
Consent Acknowledgement
Do you Agree with Consent Acknowledgement?
Yes, I Agree
Signature
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