Submitting the form is only a contact request
- Submitting the form does not enroll you in any health coverage.
- It does not change or cancel any existing coverage.
- No application is submitted from this form, and no application will be submitted without your review, confirmation, and consent.
How a licensed agent may contact you
With your consent, a licensed agent with Jake's Healthcare Options may contact you by phone, text message, or email using the contact details you provide, to discuss individual and family health insurance options, including ACA Marketplace coverage and other available plans. Message and data rates may apply. Consent is not a condition of purchase.
The consent you provide on the form
When you submit the form, you check the following boxes (consent version 2026-05-27.v2):
- I request to be contacted by Jake's Healthcare Options and its licensed agents at the phone number and email I provided regarding individual/family health insurance options, including ACA Marketplace coverage and other available health insurance options. Contact may be made by phone, text message, or email. Message and data rates may apply. Consent is not a condition of purchase.
- I understand that submitting this form does not enroll me in health coverage, does not change my existing coverage, and does not authorize an application to be submitted. I understand I will have the opportunity to review and confirm any application information before anything is submitted.
- I understand I may revoke consent or request no further contact at any time.
Revoking consent or stopping contact
You may revoke your consent or request no further contact at any time. To do so, contact us at jakemanson5@yahoo.com or (844) 264-8353. If you receive text messages, you may also reply with the opt-out keyword provided in those messages (for example, STOP). We will honor opt-out requests as required by law.
Please don’t send sensitive information
Please do not submit Social Security numbers, immigration documents, banking information, or sensitive medical information through this form.
Placeholder: TCPA-compliant language
[Placeholder for final TCPA-compliant consent language to be drafted and approved by counsel, including any required disclosures about the use of automatic telephone dialing systems or prerecorded/artificial voice messages, the parties authorized to contact you, frequency, and applicable state-specific requirements.]
Not a government website
Jake's Healthcare Options is an independent, licensed health insurance agency. This website is not affiliated with or endorsed by the U.S. government, CMS, or HealthCare.gov.