SEP Eligibility Check
(Cost + Doctors + Subsidy)
Step 1 of 2
What's your ZIP code?
*
What’s your age range?
*
Select your age range
Under 26
26 – 60
61 - 64
65+
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What’s your estimated total household income?
*
Select your income range
Under $50,000
$50,000 – $100,000
$100,000+
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What would you like help with?
*
Select your main concern
I’m losing coverage
I have no health insurance
I’m paying too much for health insurance
I can’t see the providers that I want
I need better health insurance benefits
I have a life event (baby, marriage, divorce, moved)
Other
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Where should we send your
eligibility result?
First Name
Email
*
Phone
*
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