Applying for affordable health insurance just got easier...

There are THREE ways to apply for the best health insurance on the market through Affordable Healthcare.

No matter which way you choose – the process is simple. Answer a few questions, and within 24 hours we’ll give you quotes from the best health insurance plans on the market.

With Affordable Healthcare you get more than a basic health insurance quote. We give you all the details about your healthcare plan options, and we’re right there to answer all your questions.

It’s free. It’s easy. Start saving now!

We understand not everyone has time to fill out a comprehensive form.

Give us a call instead or use our easy short form!

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Did someone assist you with application

Your full name

Age

Tobacco user

Social security number:

Date of birth required

List your prescription medications

Do you have health insurance?

Yes

Name of insurance company

Phone

Street Address

City

State

Zip code

Income per year/hour/month

Employer

Have you lost health insurance this year?

Your spouse's full name

Age

Tobacco user

Social security number:

Date of birth

Your dependent's full name

Age

Social security number:

Date of birth

Your dependent's full name

Age

Social security number:

Date of birth

I am applying for health insurance subsidies. I certify my answers are true. I consent to Antwain Vaughn submitting my application to Healthcare.gov.

Your Signature

Image of driver's license/ID

Upload File

Upload drivers license/ID

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