Disclaimer:

• Filling out this form is optional.
• This is a solicitation of insurance.
• By calling this number, you agree to be directed to a licensed insurance sales agent.
• By providing this information, you agree that an authorized representative or licensed insurance agent may contact you by phone, email, or US Postal mail to answer any questions or provide additional information about Medicare Advantage, Part D, or Medicare Supplement Insurance plans.
• We do not offer every plan available in your area. The number of organizations represented and the number of plans offered may vary depending on state and plan availability.
• Enrollment depends on the plan’s contract renewal.
• Limitations and exclusions may apply.
• Medicare Supplement plans may require underwriting, and enrollment is not guaranteed.
• Enrollment in a plan may be limited to certain times of the year unless you qualify for a Special Enrollment Period or you are in your Medicare Initial Enrollment Period/if you are turning 65, new to Medicare plans, moving, or losing coverage. For example, during the fall Annual Enrollment Period, you can join, switch or drop your Medicare plan.
• Medicare supplement plans cannot be held with Medicare Advantage plans at the same time.
• To protect your privacy, please do not send us confidential personal information by unprotected e-mail. Instead, discuss that personal information with us by phone.
• Not connected with or endorsed by the United States government or the federal Medicare program.
• Please contact Medicare.gov 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.