FILL OUT THE FORM BELOW

We require your consent before contacting you to go over your Medicare plan alternatives, given Medicare regulations. By filling out the form below , you consent to a licensed insurance agent from Benefits & Care, to contact you by mail, phone, sms or email to discuss particular products for marketing purposes regarding Medicare Advantage, Medicare Supplement and Prescription Drug Plan. The person who will talk to you about your plan alternatives is contracted by a Medicare health plan or a prescription drug plan that is not a Federally-sponsored program, and they might receive payment based on your participation in a plan. Your current enrollment in a Medicare Advantage Plan, Prescription Drug Plan, or other Medicare plan will not be impacted by signing this form, nor will it enroll you in one.