If you live in the Eastern Region, including in Atlanta, Chicago, Minneapolis, Nashville, New Orleans and New York City, choose AHIRC Eastern.

If you live in California, choose EHIS.

If you live in the Western Region, including Dallas, Houston, Las Vegas, Portland, and Seattle, choose AHIRC Western

If you have previously submitted a request for assistance through Submittable please use the Change of Information/Update form. This form is for those returning for assistance with insurance enrollment/renewal, a change in circumstances like change of household, income, and insurance status, or a new issue that has affected you or your household members.

If you live in AL, AR, CT, DE, FL, GA, IA, IL, IN, KY, LA, MA, ME, MD, MI, MN, MO, MS, NC, OH, NH, NY, NJ, PA, RI, SC, TN, VA, VT, WI, WV, and Washington DC, please use this form.

If you are requesting Medicare counseling, we regret that our Medicare Specialists have reached capacity at this time. If you are a SAG-AFTRA senior performer, please contact VIA Benefits: https://my.viabenefits.com/. For all others, please contact your State Health Insurance Assistance Program for enrollment assistance at https://www.shiptacenter.org/. You can also contact Medicare directly at 800-633-4227; the average wait to speak to someone is 15 minutes, and they can help you enroll in Part D and Medicare Advantage plans. Again, this is for Medicare counseling only. If you are requesting assistance with an ACA/Marketplace plan, please fill out this form. We appreciate your understanding during this very busy time.



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If you live in AK, AZ, CO, HI, ID, KS, MT, ND, NE, NM, NV, OK, OR, SD, TX, UT, WA, WY, please use this form. If you live in California, please click on the form below





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If you live in California, please use this form

Use this form if you’ve previously submitted a request for assistance through Submittable. This form is for those returning for assistance with insurance enrollment/renewal, a change in circumstances like change of household, income, and insurance status, or a new issue that has affected you or your household members.

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