Take the confusion out of "Medicare"

know for sure!

If you are turning 65 or losing your employers Insurance Coverage, Or you have a SEP (Special Election Period) You may not have to wait until,

Medicare AEP is back to enroll in a different plan.

(Medicare Annual Enrollment Period)

Oct 15th through Dec 7th

Complete the form below ASAP, so you will KNOW how to make your next move!

General questions to discover the best plan for you?

Check All That Apply?

There are no two individuals needs that are the same we will find the best one for you!

Are you new to Medicare?

Yes

I have Medicare Parts A and B (check all that apply)

Part A

Part B

Part A only

Medicaid / Limited Income Subsidy (check as many as applies)

Medicaid

Limited Income Subsidy

I am interested in (check all that apply)

Advantage Plan

Medigap or Medicare Supplement

Drug Plan or Part D

Benefits

Large Network

Ease of Use

Cost

I am a veteran

Benefits I am most interested in: (check as many as applies)

Dental

Vision

Part B Payback

Food Card

Transportation

Gym Membership

OTC Benefits

Mail Order Meds

Tele-med

Veteran (Check as many as apply)

Yes

I get my Meds from VA

I use VA and local Dr

Comments or Questions?

Primary Doctor

Specialist

#1-Medication - Name - Dosage - Frequency (Don't Forget Dosage and Frequencies)

Continue - Add Up to 10 More Medications (Place a comma between Medications, see example)

Drug Store

Contact Information

Full Name - As it is on your Medicare Card (if you have received it)

Date of birth

Email *

Phone *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

City

Primary State

Primary Zip

Complete Form and Click Submit Button Below!

My Direct Line 606-224-2406

Medicare Advantage Plan Name and Company

Please text a picture of your id card to 606-224-2406 (if it has been issued)

If you do not know how to text, please give me a call on my direct line >>>>> 606-224-2406

You are "Special" and this is a very special time in your life. Let us help you take the confusion out of Medicare and make the best choice for you!