Form Request

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By submitting this form you agree that a licensed insurance agent employed with one of the listed companies, CLICK HERE. may contact you to discuss Medicare Advantage, Prescription Drug and/or life insurance plans by the phone number provided (wireless/landline) or email. You expressly consent to receive autodialed and/or pre-recorded phone calls and/or email regardless of whether you are on any Federal or state DNC (“Do Not Call”) and/or DNE (“Do Not Email”) list or registry. You expressly consent to receive phone calls and email (included autodialed and/or pre-recorded calls) using automated technology (even on your wireless number) regardless of whether you are on any Federal or state DNC (“Do Not Call”) and/or DNE (“Do Not Email”) list or registry.. You expressly consent to receive phone calls and email regardless of whether you are on any Federal or state DNC (“Do Not Call”) and/or DNE (“Do Not Email”) list or registry. I understand that data and message rates may apply.

Online quotes may not be available for all plans, but the agent that will be discussing plan options with you is contracted with various Medicare health or prescription drug plans that are not under the Federal government, and the agent may be compensated based on your enrollment in a plan. Submitting this form does NOT affect your current enrollment, nor will it enroll you in a Medicare Advantage Plan, Prescription Drug Plan, or other Medicare plan. A Medicare Advantage plan is a health insurance plan provided through a private insurer and delivers Medicare Part A and Part B benefits. A Part D Drug plan is a prescription drug insurance plan provided through a private insurer and delivers Medicare Part D benefits. Receiving quotes through our website and from our agents is always free and you are under no obligation to purchase any goods or services as a result of this request. You may revoke your express consent at any time by contacting us at 877.683.0014 or email at optout@medicarepolicychoices.com so that you may placed on our do-not-call and/or our do-not-email list.

*I would like to receive additional information from third party advertisers related to my above interests. By clicking the submit button above, you acknowledge my agreement with the stated terms and conditions and the privacy policy of this website. You understand that by including your home AND/OR wireless number with the information submitted above, you are extending an express invitation to one or more of the companies listed or their agents or marketing partners (i) to contact you by telephone at the numbers you have provided so they may assist you with your transaction, and you hereby consent to any such calls even if your phone number is on any Do Not Call list, or (ii) to contact you by email at any email address you provided and understand that any such email will not be considered spam or unauthorized by any local, state or federal law or regulation. You understand you may receive additional information from third party advertisers related to my above interests. Contact methods may include phone calls via an automated telephone dialing system, prerecorded voice, text messaging and/or email and direct mail. You understand that this consent is not a condition to receive goods/services.

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