In order for us to process your enrollment thru the Health Insurance Marketplace, please sign the authorization form below. Once we received your signed form, we’ll call you right away.

Information Needed for Quote and/or Enrollment

  • Immigration documentation (i.e. residence card)
  • Social Security numbers & Birth dates for all household members
  • To qualify for financial assistance(tax credits) we need income, expenses, and deductions of everyone in your household, even those not applying for coverage.
  • Employer and household income information (i.e. tax return)
  • Anyone you include on your tax return as a dependent, even if they don’t live with you.

We’re happy to help you compare and enroll on insurance plans that fit your needs. 

FREE HELP via phone, office or home visit appointment.



At Health Plans In Oregon, our goal is to make sure you have all the information you need about health coverage. 

Talk to us for a one-on-one consultation at no cost. We make the complex and hard to understand policies, simple and easy; giving you peace of mind. If you have any questions at all we can help you. Call: 503-928-6918

Get free enrollment assistance from your local, licensed, certified, 5 star reviews and well experienced licensed insurance agent.

*By completing this form, you agree that an authorized representative or licensed insurance agent may contact you by phone, email, text, mail or face to face to answer your questions or provide additional information about your Medicare plan options. Not affiliated or endorsed by Medicare or any state or federal governmental agency. 

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