To make it easier to determine my eligibility for help paying for health coverage for future years, I agree to allow the Marketplace to use income data, including information from tax returns, for the next 5 years (the maximum number of years allowed).
The Marketplace will send me a notice, let me make any changes, and I can opt-out at any time.
I know that I must tell the program I'll be enrolled in if the information I listed on this application changes.
I know I can make changes in my Marketplace account or by calling (888) 244 -1129
I understand that a change in my information could affect my eligibility for member(s) of my household.
100% Of the plans we offer cover 100% of preventative services with no deductible or co pay. Do you want the lowest priced best plan or a plan with specific Dr's or Prescriptions included?
By clicking the Enroll Now and submitting this form, I agree that I am 18+ years old and agree to the Privacy Policy and Terms and Conditions.
By clicking the button and submitting this form, I provide my signature giving express consent to receive marketing communications via automated telephone dialing systems, artificial or pre-recorded voices, emails, live phone calls, pre-recorded calls, postal mail, text messages via SMS or MMS and other forms of communication regarding offers Life Insurance, Final Expense, Medicare, Health Insurance, Home/Auto Insurance or other products from Senior Benefits and Health Services or from our marketing partners and agents to the number(s) and/or email I provided, including a mobile phone, even if I am on a state or federal Do Not Call and/or Do Not Email registry. The list of companies participating are subject to change.
Message frequency varies and represents our good faith effort to reach you regarding your insurance inquiry. Message and data rates may apply. Text HELP for help or text STOP to cancel. I understand that my consent to receive communications is not a condition of purchase and I may revoke my consent at any time.
