Stop Guessing. Get your 2026 Rate in 60 Seconds via Phone.

Navigate the marketplace with confidence. Find the subsidies you deserve in under 2 minutes.

• ACA / Marketplace Compliant

• $0 Premiums Available

• No Waiting periods

Gender *

Male

Female

Applicant Date of Birth *

MM-DD-YYYY

Do you have a Spouse? *

Yes

No

Will You File Your Taxes Jointly Or Separately With Your Spouse? *

Jointly

Separately

Important - If you are married, you must file taxes jointly to be eligible for tax credits towards your insurance, even if the spouse will not be on the plan.

Is your Spouse employed? *

Yes

No

Spouse's Employer Name *

Does your Spouses Employer Offer Health Insurance?

Spouse Income *

Do you want to enroll your Spouse on the Health plan? *

Yes

No

Spouse Legal First Name *

Spouse Legal Last Name *

Spouse Gender *

Spouse Birthday *

Spouse Social Security Number *

Are you Employed Currently? *

Yes

No

Employer Name *

If your job offers health insurance and you reject it, you will be liable to pay back your tax credit for your Marketplace plan at the end of the year!

Does your Employer Offer Health Insurance?

Important - If you have job-based insurance now or get an offer for job-based insurance, you won’t qualify for savings on a Marketplace plan if the job-based plan is considered affordable and meets minimum standards. Most job-based plans meet these standards.

If you have a Marketplace plan and get an offer of health insurance through a job, you may no longer qualify for savings on your Marketplace plan even if you don’t accept the job-based coverage offer.

Do you have any Dependents? *

Yes

No

Enroll Dependent 1 on the Health Plan? *

Yes

No

Dependent 1 Legal First Name *

**IMPORTANT** We will need to know all dependents' information, whether they will be enrolling in the health plan or not. Accurate dependent details will help us determine your subsidy amount (if any). We will need to know all dependents' information, whether they will be enrolling in the health plan or not. Accurate dependent details will help us determine your subsidy amount (if any). ONLY SELECT YES IF DEPENDENTS ARE CLAIMED BY YOU ON THE TAX RETURN

*IMPORTANT** We will need to know all dependents' information, whether they will be enrolling in the health plan or not. Accurate dependent details will help us determine the subsidy amount (if any) you will receive.

ONLY SELECT YES IF DEPENDENTS ARE CLAIMED BY YOU ON TAX RETURN

Dependent 1 Legal Last Name *

Dependent 1 Gender *

Dependent 1 Date of Birth MM-DD-YYYY *

Relationship to dependent 1 *

Dependent 1 on Medicaid or CHIP? *

Yes

No

Dependent 1 Denied Medicaid Or CHIP Within Last 90 Days? *

Yes

No

Dependent 1 Social Security Number *

Do You Have A 2nd Dependent? *

Yes

No

Enroll Dependent 2 on the Health Plan? *

Yes

No

Dependent 2 Legal First Name *

Dependent 2 Legal Last Name *

Dependent 2 Gender *

Dependent 2 Date of Birth MM-DD-YYYY *

Relationship to dependent 2

Dependent 2 on Medicaid or CHIP? *

Yes

No

Dependent 2 Denied Medicaid or CHIP? (Last 90 days) *

Yes

No

Dependent 2 Social Security Number *

Do You Have A 3rd Dependent? *

Yes

No

Enroll Dependent 3 on the Health Plan? *

Yes

No

Dependent 3 Legal First Name *

Dependent 3 Legal Last Name *

Dependent 3 Gender *

Dependent 3 Date of Birth MM-DD-YYYY *

Relationship to Dependent 3

Dependent 3 on Medicaid or CHIP? *

Yes

No

Dependent 3 Denied Medicaid or CHIP? (Last 90 days) *

Yes

No

Dependent 3 Social Security Number *

Do You Have A 4th Dependent? *

Yes

No

Enroll Dependent 4 on the Health Plan? *

Yes

No

Dependent 4 Legal First Name *

Dependent 4 Legal Last Name *

Dependent 4 Gender *

Dependent 4 Date of Birth MM-DD-YYYY *

Relationship to Dependent 4

Dependent 4 on Medicaid or CHIP? *

Yes

No

Dependent 4 Denied Medicaid or CHIP? (Last 90 days) *

Yes

No

Dependant 4 Social Security Number *

Do You Have A 5th Dependent? *

Yes

No

Enroll Dependent 5 on the Health Plan? *

Yes

No

Dependent 5 Legal First Name *

Dependent 5 Legal Last Name *

Dependent 5 Gender *

Dependent 5 Date of Birth MM-DD-YYYY *

Relationship to Dependent 5 *

Dependent 5 on Medicaid or CHIP? *

Yes

No

Dependent 5 Denied Medicaid or CHIP? (Last 90 days) *

Yes

No

Dependent 5 Social Security Number *

ESTIMATED Household Annual Income *

Please select a range above for your ESTIMATED 2026 TOTAL TAX HOUSEHOLD gross (before tax) income for all individuals that will be enrolled on the health plan. This includes yourself, your MARRIED spouse, and any child who will be enrolled or is your dependent you claim on your taxes. If you are self-employed or own a business, PLEASE ENTER YOUR NET PROFIT AFTER ALL EXPENSES/DEDUCTIONS.

I acknowledge that if I am earning less than 100% of the Federal Poverty Line, I am actively seeking and expect to bring my annual income at or above 100%Click here to view FPL chart

First Name *

Last Name *

Phone *

Email *

I agree to terms & conditions provided by the company. By providing your contact information, you consent to receive calls, texts, and emails from Empathy Insurance Advisors at the number and email provided, including communications generated by artificial intelligence (AI). Standard message and data rates may apply.

Privacy Policy | Terms of Service

Your information is 100% secure & encrypted with us. We will NEVER sell or rent your data out to anyone. Your information will only be shared with a licensed health agent on our team to enroll you in the best/cheapest health plan available to you and your family, based on the information in the survey.

What is your Physical Address?

Address

Street Address

City

State

Country

Postal Code

Medicaid Denied Date

Primary Applicant's Social Security Number *

I hereby grant my permission for Alexander James to act as my health insurance agent for both myself and my entire household, if applicable. This permission is specifically for the purpose of enrolling in a Qualified Health Plan offered on the Federally Facilitated Marketplace. By agreeing to this arrangement, I authorize the aforementioned agent to access and utilize the confidential information provided by me, whether in writing, electronically, or via telephone, solely for one or more of the following purposes:

Searching for an existing Marketplace application.
Completing an application for eligibility and enrollment in a Marketplace Qualified Health Plan, or other government insurance affordability programs, such as Medicaid and CHIP, or advance tax credits to assist in paying for Marketplace premiums.
Providing ongoing account maintenance and enrollment assistance, as required.
Addressing inquiries from the Marketplace regarding my Marketplace application.
In the event that I already have a Marketplace plan, granting permission to switch to a more suitable plan if available. If I am already on the optimal plan, I request that the agent take over as my agent of record from this point forward, unless notified of any changes.

I understand that the agent will not utilize or disclose my personally identifiable information (PII) for any purposes other than those explicitly enumerated above. The agent will take necessary measures to ensure the confidentiality and security of my PII when collecting, initiating, and utilizing it for the aforementioned purposes. I affirm that the information I have furnished for my Marketplace eligibility and enrollment application is accurate to the best of my knowledge. I am aware that I am not obligated to provide additional personal information about myself or my health to my agent beyond what is necessary for the application for eligibility and enrollment.

I also understand that my consent remains in effect until I choose to revoke it, and I retain the right to revoke or notify my consent at any time by sending an email, text, or making a phone call to the following:

Consent remains valid for 365 days

Name of Primary Writing Agent: Alexander James

Agent National Producer Number: 19291077

Phone Number: (954) 807-1376

Email Address: [email protected]

Authorization Signature *

Clear

I acknowledge and understand the following:

I must provide accurate information for eligibility and may need to provide proof.
If I'm enrolled in Marketplace coverage and later found to have other qualifying health coverage (e.g. Medicaid, Medicare, CHIP, job-based plan), my Marketplace plan will be terminated automatically.
I permit the Marketplace to use my income data for 5 years to determine my eligibility for assistance.
I'm not eligible for a premium tax credit if I have other qualifying health coverage.
I must inform the Marketplace if I become eligible for other coverage to avoid repayment of the premium tax credit.
I must file a federal income tax return for the 2025 tax year.
If I’m married at the end of 2025, I must file a joint income tax return with my spouse.
No one else will be able to claim me as a dependent
I understand, this does not constitute tax advice, and I should consult a tax advisor for tax-related matters.
I consent to receive electronic notices and use electronic signatures during enrollment.
I confirm I'm authorized for the provided phone number and agree to receive marketing calls/messages.
Alexander James will use my information to complete and submit the Marketplace application on my behalf.
I know I can make changes in my Marketplace account or by calling the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325)

I’m signing this application under penalty of perjury, which means I’ve provided true answers to all of the questions to the best of my knowledge. I know I may be subject to penalties under federal law if I intentionally provide false information.

Check The Box Below *

I have reviewed the Attestation Explanations

The attestation explanations are located HERE

Authorization Signature *

Clear

Affordable Coverage

Thanks to the ACA, 4 out of 5 Americans qualify for plans under $10/mo. See if you qualify for a $0 premium

Full Major Medical Coverage

You cannot be denied coverage due to pre-existing conditions. No health questions asked. Guaranteed acceptance.

Full Major Medical Coverage

All ACA plans must cover the 10 Essential Health Benefits: Prescriptions, ER visits, Maternity, and Preventive Care

Affordable Coverage

Thanks to the ACA, 4 out of 5 Americans qualify for plans under $10/mo. See if you qualify for a $0 premium.

No Waiting Periods

You cannot be denied coverage due to pre-existing conditions. No health questions asked. Guaranteed acceptance.

Full Major Medical

All ACA plans must cover the 10 Essential Health Benefits: Prescriptions, ER visits, Maternity, and Preventive Care.

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Licensed Experts Serving Your Community.

"We are currently licensed to serve families in 28 states across the US, including:" FL, GA, AL, SC, NC, TN, MS, LA, TX, OK, MO, AR, KS, AZ, NE, IA, UT, MT, WI, IN, OH, MI, WV

Privacy Policy | Terms & Conditions

Not a Government Agency: This website is an independent digital media & advertising publisher. This website is not a federal or state Marketplace website and is not affiliated with the Affordable Care Act (ACA) or any government entity.

Availability: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Healthcare.gov or your local State Marketplace to get information on all of your options.

TCPA Consent: By clicking the button above, you consent to receive marketing calls, text messages, and emails from a licensed insurance agent at the number provided, including through the use of an automated dialing system. Consent is not a condition of purchase. Message and data rates may apply.

Stop Guessing. Get your 2026 Rate in 60 Seconds via Phone.

Navigate the marketplace with confidence. Find the subsidies you deserve in under 2 minutes.

Stop Guessing. Get your 2026 Rate in 60 Seconds via Phone.

Navigate the marketplace with confidence. Find the subsidies you deserve in under 2 minutes.

WE WORK WITH TOP RATED CARRIERS

WE WORK WITH TOP RATED CARRIERS

Licensed Experts Serving Your Community.

2026 Empathy Insurance Advisors. All Rights Reserved. | NPN: 19291077