Enter Information About Your Household

1.

Select a State

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Enter your zip code

Select county

2.

Enter your yearly household income (dollars)

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3.

Is coverage available from your or your spouse’s job?

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4.

Number of people in family

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5.

Which members of your family are enrolling in Marketplace coverage?

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5.

Number of adults (21 to 64) enrolling in Marketplace coverage

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6.

Number of children (20 and younger) enrolling in Marketplace coverage

How many children use tobacco?