EXISTING CLIENTS · 2027 COVERAGE

Plan Renewal

Please complete the form. Your information will be sent to your agent so they can prepare a quote. Completing this form does not enroll you in coverage. Once your agent has reviewed your information and prepared your quote, they will contact you to discuss your options.

A couple reviewing their information together at home

BEFORE YOU BEGIN

Prepare for your 2027 renewal

IT IS EXTREMELY IMPORTANT THAT YOU READ EVERYTHING BELOW CAREFULLY BEFORE PROCEEDING.

The government has come down hard on states that have allowed enrollments outside of open enrollment. While the rule has always been that you can only enroll during open enrollment, it has not been heavily enforced. That is changing. We have had many people who lost their insurance or never enrolled be denied enrollment because it was outside of open enrollment.

If you do not enroll, you will likely have no insurance in 2027. Your existing plan will end on December 31. There are some rare instances in which the state itself will re-enroll you. Again, this is rare. The insurance company should not be re-enrolling you without your agent. Some do, but technically they are not allowed to do so. They do not have access to your updated information.

People often lose their insurance during the first three months of the year because the state (Marketplace) sent them a letter requesting income verification, verification of immigration status, or other information and never received a response. We have previously been able to resolve these situations, but we most likely will not be able to do so in the future if you do not respond by the deadline provided. They typically give you 90 days. Please open your mail and keep us informed so we can provide the state with the requested information by the deadline.

You are responsible for ensuring that the income you provide is correct. This is your estimated gross income for 2027, NOT 2026. Gross income is your income before taxes. Enter your estimated ANNUAL income, not your monthly income. Please review your answers carefully. If you complete the form incorrectly, you will need to complete it again. New regulations now require all information to come from the form.

I confirm that I have read and understand all the information above.

Please check the box to continue.

Your quote request

Required fields are marked with an asterisk (*).

Complete the form below. Your agent will follow up after submission.

Your answers, including any health notes you choose to provide, are sent through an encrypted system to your agent for review.

Contact details

Enter the primary account holder’s contact information below, even if you are completing this form on their behalf. For example, if you manage the account but your spouse is the primary account holder, enter your spouse’s information here.

Person Managing the Account and Completing This Form

Your household

You must show everyone who will be on your tax return for tax year 2027, whether they are on the insurance or not. The return you filed this year—April 2026—was for 2025. Your 2027 return will be filed in April 2028. This is income you expect to earn, not income you have already earned.

Please list everyone on your 2027 tax return, starting with yourself.

Health notes Optional

Does anyone requesting coverage have major health issues, such as diabetes, high blood pressure, heart issues, or cancer?

Marketplace plans cover preexisting conditions. They cannot deny you coverage or charge more because of a preexisting condition.

Health Notes (optional)

Other policies

2027 income estimate

Estimate income for all of 2027, not 2026, before taxes. Include your spouse’s income even if your spouse is not requesting coverage.

If you are self-employed, use your net business income: for example, $150,000 in business revenue minus $100,000 in business expenses leaves $50,000 of personal self-employment income. Business revenue is not the same as personal income.

Total estimated 2027 household income$0

Doctors you’d like to keep

If you have doctors you would like to keep, select the number below. We can check up to four doctors. The more doctors you have, the harder it may be to find a plan that all of them accept.

Before submitting, please look over this carefully to ensure all information is correct.

Your information is for your agent’s quote review. Please keep this page open until your submission is confirmed.

Let’s update your information.