Medicare Advantage Annual Reviews
Each year, as your agent, we strive to make sure your Medicare Advantage plan is still a great fit. Please complete this form at your earliest convenience if you would like us to complete an annual plan review.
Section 1 - Base
Please enter a valid phone number.
Street Address Line 2
State / Province
Postal / Zip Code
Section 2 - Prescription Details for Medicare Advantage Plans
Optional Pharmacies if Cost Savings Are Available
Section 3 - Medical Providers to Ensure Networks of Coverage
Please list the names for any providers you’ve seen in the last 12 months
What do you currently like or dislike about your plan?
Are there any areas of benefits you would like us to focus on in our review: For example, dental, vision, hearing, over the counter etc.
Should be Empty: