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HELP WITH MY DISABILITY APPLICATION
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Healthcare
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I want help paying my insurance
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Name
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First
Last
Phone Number
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Your state of residence
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Select One
Florida
Georgia
South Alabama
Florida, Georgia and South Carolina only, at this time. If you live in other states, you definitely qualify for a subsidy and you should call (800) 318-2596 for a direct quote.
Your Zip Code
*
2015 Gross Income
*
Your house income must be above $11,700 to even qualify for help paying your insurance cost. Please make sure your household income fits in the chart below before completing this step.
Your County
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Please specify both county and (zip code). Example Chatham county (31404)
Dependents
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How how dependents do you expect to file on your income in 2016 for 2015 (next year)
Your Age
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Filing Status
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