MEDICARE INSURANCE IN GEORGIA, SOUTH CAROLINA, AND TENNESSEE

Any messages you receive will be from the licensed insurance agent you have selected above. We won't sell your information. This is a solicitation of insurance.

By submitting this form, I expressly consent by electronic signature to sharing of my personal beneficiary information and to being contacted by the licensed insurance agent you selected above for the marketing of Medicare Insurance products (i.e., Medicare Advantage Plans (Part C), Prescription Drug Plans (Part D), and/or Medicare Supplement (Medigap) Products) and services. I'm aware the person who will discuss the products is a licensed and certified representative of Medicare Advantage organizations and/or stand-alone Prescription Drug Plans. Each of the organizations they represent has a Medicare contract. This licensed insurance agent may also be paid based on my enrollment in a plan. Enrollment in any plan depends on contract renewal. I am aware that the person who will contact me is not affiliated with or works directly for the Federal government. 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.

I understand that I may be contacted via telephone, email, text messaging, artificial or prerecorded voice messages, or automatic dialing at the contact information provided above (even if my number is currently listed on any state, federal, local, or corporate Do Not Call list). Carrier data use charges and rates may apply. I understand that my consent is voluntary and is not a condition of purchasing any goods or services, and that I may change my preferences at any time.