Portal Life and Health

Healthcare coverage across the nation — click a highlighted state to explore

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Health Insurance Pre-Qualification

Complete this form to see if you qualify for health insurance coverage

1
Personal Info
2
Financial Info
3
Insurance Status
4
Health Info

Personal Information

Financial Information

Enter your total household income for the year (e.g., 50,000)
Total number of people in your household

Current Insurance Status

Health Information

Feet
Inches
Enter your current weight in pounds
This information helps us provide accurate qualification results
Include prescription and over-the-counter medications
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ACA / Marketplace Disclosure

Portal Life and Health Insurance is an independent, licensed insurance agency. We are not affiliated with, endorsed by, or acting on behalf of the federal or state Health Insurance Marketplace (Healthcare.gov), the Centers for Medicare & Medicaid Services (CMS), or any government agency. Plans shown may be Affordable Care Act (ACA)-compliant or non-ACA plans. Benefits, premiums, and availability vary by state and are subject to underwriting, policy terms, limitations, and exclusions. Enrollment in coverage is not guaranteed.

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Health Information Privacy Notice (HIPAA)

The health information you provide is collected solely to evaluate your eligibility for health and life insurance products and will be shared with licensed insurance professionals at Portal Life and Health. Your information is protected under applicable federal and state privacy laws. We do not sell your personal health data to third parties. By submitting this form you acknowledge that you have read and agree to our Privacy Policy.