Annual Medicare Enrollment Review 2024

The flow will go as follows:

Fill out the form below. Desktop/laptop is recommended. We will address each client in the order the form is received.
After submission of the form, we will put together a 2024 review and respond back with our findings and recommendations. We will notify you by both text and email.
If we recommend switching, we will send you our calendar so you can make an appointment to speak with us and finalize the change.

If you have not received your review packet by November 1st, please contact us at support@medicarenationwide.com

If you have a Medicare supplement in Florida, like United American, you should NOT change your Medicare supplement as you cannot do better. You would also lose your issue age!

IMPORTANT #1: If the effective date of your current Medicare supplement is within the last 12 months, it's recommended you stay with the existing carrier. You would select "Drug Plan Only" from the drop down below. We can always reshop coverage at any time through the 2024 year as you can change Medicare supplements at any time.

IMPORTANT #2: You MUST know your existing premium and modal payment method, ie monthly, quarterly or annually before continuing. Please check a bank statement or bill to ensure you have the correct information. We cannot accurately do a comparison without this information.

If you do NOT wish to receive help for 2024, please choose that option from the drop-down below so we can make a note in our system.

"*" indicates required fields

Which type Medicare plan review would you like?*

First Name*

Last Name*

Email*

Phone*

I wish to be removed from the 2024 Medicare Review list

Zip code*

Date of Birth*

Underwriting Disclaimer*

I am open to being subjected to underwriting for a new policy and welcome a discussion about switching my Medicare supplement policy.

I am concerned about being subject to a potential waiting period due to a known pre-existing health condition.

Gender*

Tobacco user*

Are you married or living with someone over the age of 60?*

Medicare Supplement Carrier (MUST KNOW)*

Medicare Supplement Plan (MUST KNOW)

Medicare Supplement Monthly Premium (MUST KNOW)*

Modal Payment Method (MUST KNOW)*

Effective Date (If known)

Your agent's name (If known)

Drug Plan

Enter your drug plan information below

Stand-alone Medicare Prescription Drug Plans (Part D)

Medicare Prescription Drug Plan (PDP) — A stand-alone drug plan that adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.

Medicare Advantage Plans (Part C) and Cost Plans - OPTIONAL

Medicare Health Maintenance Organization (HMO) —A Medicare Advantage Plan that provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. In most HMOs, you can only get your care from doctors or hospitals in the plan’s network (except in emergencies).

If you are the authorized representative acting on behalf of the beneficiary, please sign above and print below. If you are the beneficiary, leave blank.

Your Relationship to the Beneficiary. If you are the beneficiary, leave blank.

Existing Drug Plan Carrier (MUST KNOW)*

Existing Drug Plan Name (MUST KNOW)*

Existing Drug Plan Monthly Premium (If known)

Pharmacy*

Medication List*

Upload Medication List (optional)

Max. file size: 50 MB.

Hidden

Section Break

Signature*