Individual Coverage What is needed for Individual Coverage? Gather details about your household, income, health status, and coverage preferences Review and comparison of Marketplace/ACA, private insurance, and healthshare options Helps match plans to your budget, preferred doctors, and prescription needs Addresses unique health factors for you and your family All personal information is confidential and used only for personalized recommendations Individual Coverage Questionnaire Contact First NameLast NameEmailPhoneZip CodeCounty– Select –Anderson CountyAndrews CountyAngelina CountyAransas CountyArcher CountyArmstrong CountyAtascosa CountyAustin CountyBailey CountyBandera CountyBastrop CountyBaylor CountyBee CountyBell CountyBexar CountyBlanco CountyBorden CountyBosque CountyBowie CountyBrazoria CountyBrazos CountyBrewster CountyBriscoe CountyBrooks CountyBrown CountyBurleson CountyBurnet CountyCaldwell CountyCalhoun CountyCallahan CountyCameron CountyCamp CountyCarson CountyCass CountyCastro CountyChambers CountyCherokee CountyChildress CountyClay CountyCochran CountyCoke CountyColeman CountyCollin CountyCollingsworth CountyColorado CountyComal CountyComanche CountyConcho CountyCooke CountyCoryell CountyCottle CountyCrane CountyCrockett CountyCrosby CountyCulberson CountyDallam CountyDallas CountyDawson CountyDeaf Smith CountyDelta CountyDenton CountyDeWitt CountyDickens CountyDimmit CountyDonley CountyDuval CountyEastland CountyEctor CountyEdwards CountyEl Paso CountyEllis CountyErath CountyFalls CountyFannin CountyFayette CountyFisher CountyFloyd CountyFoard CountyFort Bend CountyFranklin CountyFreestone CountyFrio CountyGaines CountyGalveston CountyGarza CountyGillespie CountyGlasscock CountyGoliad CountyGonzales CountyGray CountyGrayson CountyGregg CountyGrimes CountyGuadalupe CountyHale CountyHall CountyHamilton CountyHansford CountyHardeman CountyHardin CountyHarris CountyHarrison CountyHartley CountyHaskell CountyHays CountyHemphill CountyHenderson CountyHidalgo CountyHill CountyHockley CountyHood CountyHopkins CountyHouston CountyHoward CountyHudspeth CountyHunt CountyHutchinson CountyIrion CountyJack CountyJackson CountyJasper CountyJeff Davis CountyJefferson CountyJim Hogg CountyJim Wells CountyJohnson CountyJones CountyKarnes CountyKaufman CountyKendall CountyKenedy CountyKent CountyKerr CountyKimble CountyKing CountyKinney CountyKleberg CountyKnox CountyLa Salle CountyLamar CountyLamb CountyLampasas CountyLavaca CountyLee CountyLeon CountyLiberty CountyLimestone CountyLipscomb CountyLive Oak CountyLlano CountyLoving CountyLubbock CountyLynn CountyMadison CountyMarion CountyMartin CountyMason CountyMatagorda CountyMaverick CountyMcCulloch CountyMcLennan CountyMcMullen CountyMedina CountyMenard CountyMidland CountyMilam CountyMills CountyMitchell CountyMontague CountyMontgomery CountyMoore CountyMorris CountyMotley CountyNacogdoches CountyNavarro CountyNewton CountyNolan CountyNueces CountyOchiltree CountyOldham CountyOrange CountyPalo Pinto CountyPanola CountyParker CountyParmer CountyPecos CountyPolk CountyPotter CountyPresidio CountyRains CountyRandall CountyReagan CountyReal CountyRed River CountyReeves CountyRefugio CountyRoberts CountyRobertson CountyRockwall CountyRunnels CountyRusk CountySabine CountySan Augustine CountySan Jacinto CountySan Patricio CountySan Saba CountySchleicher CountyScurry CountyShackelford CountyShelby CountySherman CountySmith CountySomervell CountyStarr CountyStephens CountySterling CountyStonewall CountySutton CountySwisher CountyTarrant CountyTaylor CountyTerrell CountyTerry CountyThrockmorton CountyTitus CountyTom Green CountyTravis CountyTrinity CountyTyler CountyUpshur CountyUpton CountyUvalde CountyVal Verde CountyVan Zandt CountyVictoria CountyWalker CountyWaller CountyWard CountyWashington CountyWebb CountyWharton CountyWheeler CountyWichita CountyWilbarger CountyWillacy CountyWilliamson CountyWilson CountyWinkler CountyWise CountyWood CountyYoakum CountyYoung CountyZapata CountyZavala CountyDate of BirthAre you a tabacco user? Yes NoHow many people are in your tax household? Estimated household income for 2026 before taxes.Do you claim any dependents on your taxes? Yes NoPlease enter each dependents gender (M/F) and DOB.Does anyone claim you as a dependent on their taxes? Yes NoPlease list the doctors that you want to make sure are in-network:Please list any prescriptions you’re taking that you want to make sure are covered:Save & ResumeSubmit
