
Are you new to Medicare, recently moved, or losing your health insurance coverage?
- Review your current benefits
- Explore additional benefits
- Explain your coverage options

- To speak with a licensed insurance agent, call 910-555-1212 (TTY 711) Monday - Friday, 9 am - 5 pm EST
- info@yourcompany.com
- # NC: 123456
- 313 Your Company Address, Suite 1 City, State, Zip Code
Licensed insurance agents are available to answer all your questions. the form below and a licensed insurance agent will reach out to you.
* Optional Question
SCHEDULE AN APPOINTMENT
This is a solicitation for insurance. [Action), you understand that your contact information will be provided to a licensed sales agent who can enroll you into a Medicare Advantage, Prescription Drug (Part D), and Medicare Supplement Insurance plans and you agree to receive automated marketing messages via email, autodialer, text, or robocalls. Cellular charges may apply. Your consent to connect with a licensed insurance agent(s) does not impact eligibility to enroll or the provision of services. Call [Agency) at [1-888-###-####] to unsubscribe from this offer.
SMID: Here
This is a solicitation for insurance. [Action), you understand that your contact information will be provided to a licensed sales agent who can enroll you into a Medicare Advantage, Prescription Drug (Part D), and Medicare Supplement Insurance plans and you agree to receive automated marketing messages via email, autodialer, text, or robocalls. Cellular charges may apply. Your consent to connect with a licensed insurance agent(s) does not impact eligibility to enroll or the provision of services. Call [Agency) at [1-888-###-####] to unsubscribe from this offer. We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. **[Partner/Agency] represents Medicare Advantage [HMO, PPO, and PFFS] organizations that have a Medicare contract. Enrollment depends on the plan's contract renewal. **Extra benefits require enrollment in an MA plan and depend on whether you are eligible to enroll in an MA plan in your area. Benefits are available only in select areas. **Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease.