Find Out If You Qualify for Free Health Insurance

If you don’t want to fill out this form, please call us at (314) 481-1100 or come to our office at 7532 W Florissant Ave. We’ll make it easy and do the paperwork for you. No extra charge. Promise. We are here to help you!

Your Estimated Annual Income Must Be EQUAL or HIGHER to Qualify for Free Insurance

Many people don’t qualify for free healthcare insurance because they under-estimate their annual income. Don’t estimate too low! And it doesn’t have to be perfect. All we’re looking for is your best guess estimate for next year’s income. Call Missouri Insurance Exchange at (314) 481-1100 if you’d like help.

At least $20,784 per year for a family of 1
At least $28,208 per year for a family of 2
At least $35,632 per year for a family of 3
At least $43,057 per year for a family of 4
At least $50,481 per year for a family of 5
At least $57,905 per year for a family of 6
At least $65,330 per year for a family of 7
At least $72,754 per year for a family of 8

Enroll by January 16 Deadline

Hidden

Are You a Customer

I am a customer

I am a MIE associate

Hidden

Household Information

What is your Federal Tax Status?(Required)

How many Dependents will you claim on your 2024 Federal Tax Return?(Required)

Enter number of Dependents, enter 0 if you don't have dependents.

Hidden

This is your Family Size for Obamacare financial help.

Now that you know your Family Size, please match it to the chart below to find the minimum amount required to qualify for government financial assistance. Please use your Best Guess Estimate of the income you think you will have in 2024.

What is your Best Guess Estimate of your household income for 2024?(Required)

Source of income for Yourself(Required)

Employer Name(Required)

Employer Phone

Nature of Self Employment(Required)

Other Source of Income(Required)

Source of income for Spouse(Required)

Employer Name(Required)

Employer Phone

Nature of Self Employment(Required)

Other Source of Income(Required)

Applicant Information

Name(Required)

Date of Birth(Required)

Date of Birth

Address(Required)

Phone(Required)

Social Security Number(Required)

Are you a US citizen or a US National?(Required)

US citizenship is required to submit this application.

Are you applying for healthcare coverage?(Required)

Do you have an Employer Health Reimbursement Arrangement?(Required)

Spouse Information

Name(Required)

Date of Birth(Required)

Date of Birth *

Social Security Number(Required)

Are you a US citizen or a US National?(Required)

Do they need healthcare coverage?(Required)

If not, where are they covered?(Required)

Dependents Information

Dependent Name(Required)

Relationship(Required)

Date of Birth(Required)

Date of Birth *

Do they need healthcare coverage?(Required)

Social Security Number(Required)

Dependent 2

Dependent Name(Required)

Relationship(Required)

Date of Birth(Required)

Date of Birth *

Do they need healthcare coverage?(Required)

Social Security Number(Required)

Dependent 3

Dependent Name(Required)

Relationship(Required)

Date of Birth(Required)

Date of Birth *

Do they need healthcare coverage?(Required)

Social Security Number(Required)

Find Out If You Qualify for Free Health Insurance

Your Estimated Annual Income Must Be EQUAL or HIGHER to Qualify for Free Insurance

Household Information

Applicant Information

Spouse Information

Dependents Information

Please make sure to enter the correct income amount or you will be rejected

Please make sure to enter the correct income amount or you will be rejected