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📋 Medicare Callback Consent & Disclaimer

I agree and request to receive a phone call, text, or email from a licensed insurance agent or broker for the purpose of discussing Medicare Advantage (Part C), Medicare Prescription Drug (Part D), and/or Medicare Supplement (Medigap).

I am agreeing to be contacted by a licensed insurance broker who partners with Humana, UnitedHealthcare, Blue Cross Blue Shield, Aetna, Anthem, and other Medicare-approved carriers.
This request is for informational purposes only and does not obligate me to enroll in any plan.
I may be contacted by phone, text, or email at the number or address I provide, even if my number is on a state or federal Do Not Call registry.
I may revoke my consent at any time by requesting no further contact.
A licensed agent or broker may be compensated based on my enrollment in a plan although Broker WILL NOT CHANGE YOUR PLAN IF YOU ARE ALREADY ON THE PLAN THAT GIVES YOU THE MOST BENEFITS> WE WILL TELL YOU

CMS Disclaimer: “By submitting this form, you are requesting to be contacted by a licensed insurance agent.This request for information is not a contract for insurance and does not affect your current Medicare enrollment, nor does it obligate you to enroll in a plan.”

First name

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Preferred Time to Call