If you are Medicare-eligible, our licensed insurance agents will contact you about Medicare plan options including Medicare Advantage, Medicare supplement and Prescription Drug plans by phone or email. Submitting this form does NOT affect your current Medicare Part A and Part B enrollment, nor will it enroll you in a Medicare Advantage Plan, Prescription Drug Plan, or other Medicare plan. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Participating sales agencies represent Medicare Advantage HMO,PPO, PFFS, and/or PDP organizations that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.