Personal coverage. Clear guidance.

Health insurance for the life you’re building.

Explore individual and family coverage with a licensed MAD Insurance advisor. We’ll help you understand your options, your priorities, and your next step.

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An insurance advisor helping a couple review health coverage options
✓ Independent Florida agency✓ Licensed insurance advisors✓ Pembroke Pines & Stuart✓ Serving clients since 2013
Explore your options

A clearer path to health coverage.

Tell us what matters to you. Our team can help review plan choices, provider networks, prescriptions, and monthly premium goals.

01 / INDIVIDUAL & FAMILY

Coverage for your household

Explore health plan options with your household, preferred doctors, and coverage needs in mind.

02 / MARKETPLACE GUIDANCE

Understand your choices

Get help reviewing ACA Marketplace options, possible premium assistance, and enrollment timing.

03 / DENTAL & VISION

Consider the extras

Ask about dental and vision options and how they may fit alongside your medical coverage.

Before you start

A few details help us guide you.

You don’t need to know which plan to choose. Start with what you know.

  • Your household: who needs coverage and where you live.
  • Your timing: desired start date and any recent coverage changes.
  • Your preferences: doctors, hospitals, prescriptions, and budget.

Do not include Social Security numbers or medical records in this quote request.

Let’s find your next health plan.

Five short steps about your household, timing, and coverage preferences. This is a request for guidance, not enrollment. No Social Security numbers or medical records are needed here.

Health — Guided Quote Request
SECTION 1

Let’s start with you

Fields marked * are required. Other questions can be left blank if you need help finding the answer.

Include your area code.
Include your time zone if outside Eastern Time.
Use MM/DD/YYYY, or write “Not sure.”
SECTION 2

Who needs coverage?

This is a preliminary quote request. Do not enter Social Security numbers, medical records, diagnoses or payment information.

List each person’s age and relationship to you. Full dates of birth are not needed here.
Include household members who do not need coverage. Your agent can help clarify the relevant household details.
SECTION 3

Current coverage and timing

Share your current situation so our team can help identify the next steps. Dates do not guarantee eligibility or an effective date.

Use MM/DD/YYYY if known.
SECTION 4

What matters in your plan?

These details help us prepare a useful conversation. You can skip anything you prefer to discuss directly.

Optional estimate; write “Please advise” if unsure.
Optional: provider or facility names and city only. Do not include diagnoses or treatment details.
SECTION 5

Questions and next steps

Submitting this questionnaire requests a conversation. It does not enroll you in a plan or replace a separate enrollment consent.

Do not include sensitive medical details or identity documents.

Ready for our team to review?

Check your contact details and answers, then send your request. Our team will follow up to discuss options and any additional information needed. This request does not bind or activate coverage.

Need help completing this form? Call 954-541-9232.

We use the information you submit to respond to your request and provide insurance services. Please review our Privacy Notice and Website Disclaimer. Submitting this form does not bind coverage or change an existing policy. An authorized representative must confirm coverage and policy changes. Contact us before submitting Social Security numbers, payment card details, or sensitive medical records.

Enrollment consent — a separate step

If your agent has asked you to authorize Marketplace enrollment assistance, review and complete the existing consent form below. You do not need to sign it just to send the questionnaire above.

Enrollment consent form

I, , give my permission to to serve as the health insurance Agent or broker for myself and my entire household if applicable, for purposes of enrollment in a Qualified Health Plan offered on the Federally Facilitated Marketplace.

By consenting to this agreement, I authorize the above-mentioned Agent to view and use the confidential information provided by me in writing, electronically, or by phone only for one or more of the following:

  • Searching for an existing Marketplace application
  • Completing an application for eligibility and enrollment in a Marketplace Qualified Health Plan or other government insurance affordability programs, such as Medicaid and CHIP or advance tax credits to help pay for Marketplace premiums
  • Providing ongoing account maintenance and enrollment assistance, as necessary
  • Responding to inquiries from the Marketplace regarding my application

I understand that the Agent will not use or share my personally identifiable information (PII) for any purposes other than those listed above. The Agent will ensure that my Pll is kept private and safe when collecting, storing, and using my Pll for the stated purposes above.

  • I confirm that the information I provide for entry on my Marketplace eligibility and enrollment application will be true to the best of my knowledge.
  • I confirm that I have reviewed my completed application and that all information is accurate.

I understand that I do not have to share additional personal information about myself or my health with my Agent beyond what is required on the application for eligibility and enrollment purposes. I understand that my consent remains in effect until I revoke it, and I may revoke or modify my consent at any time by contacting my Agent or by revoking it through my HealthSherpa dashboard.

Primary Writing Agent

Agency

Primary Applicant

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Your next step

Ready to protect your health?

Continue your guided quote request, or speak with a licensed MAD Insurance advisor for clear help comparing your health coverage options.

Continue My Quote Call 954-541-9232
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