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What is your estimated yearly income?

Estimated income of under $24,000 is needed to qualify for single person.

Are you currently on Medicaid?

This plan is available only to those not on government benefits currently.

No, I am not on Medicaid

Yes, I am on Medicaid

Do you currently have a 2024 health insurance plan?

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By signing, I grant permission to act on my behalf and that of my entire household in matters related to enrollment in a Qualified Health Plan via the Federally Facilitated Marketplace. This authorization also extends to any authorized representative or power of attorney acting on my behalf. The agents empowered by this agreement are Michael Walker and Balance Benefits Group agents. These agents are authorized to locate existing Marketplace applications, complete applications for eligibility in various plans and programs, provide necessary ongoing maintenance, and respond to inquiries about my application from the Marketplace. I understand and agree that my personally identifiable information will be accessed and used solely for the objectives specified in this document. I attest that all the details I provide for the purposes of eligibility and enrollment will be accurate to the best of my ability. I am under no obligation to disclose additional personal or health-related information beyond what is required for these applications. My consent remains effective until I choose to revoke it. For any modifications or to revoke this consent, I can contact [email protected]. This agreement aligns with CMS regulations concerning consent documentation, review, and the protection of consumer PII.

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