Enter Your Information Below To Enroll In Your $0 Health Plan

Legal First Name *

Legal Last Name *

Enter Your Date Of Birth *

What Is Your Birth Gender? *

Male

Female

Phone *

Email *

Address *

City *

State *

Postal code *

Your Estimated Monthly Income (Including SSI)

Number of People In Household *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

What Is Your Social Security Number? *

Confirmation *

1) By Clicking this box I attest that all of the information entered is true and correct to the best of my knowledge. I also give my permission to Licensed Insurance, National License #16004323 and 17356930 and its agents to represent me and my household (if applicable), as my healthcare agent/broker and to process my application with the information provided. This includes searching any existing and/or duplicate plans, relaying and updating documents requested by CMS on my behalf, and protecting and keeping my personal identifying information (PII) safe and secure. I understand I may revoke or modify this permission at any time by contacting my agents, Jason McDowell and Sheena McDowell at any time. As a healthcare.gov certified broker, Licensed Insurance Advisors LLC has the authority to search for and add existing Healthcare.gov customers to our Account.

Signature *

Clear

🔒 100% Secure | We never sell your information.

Privacy Policy | Need Help?

Get in touch with us today!

Sunday - Friday

9am - 9pm EST

By using this site, you acknowledge that you have read and agree to the Terms of Service. and Privacy Policy. We are committed to protect your privacy. If you do not want to share your information please click on Do Not Sell My Personal Information for more details.