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plus By submitting this form, you agree that a licensed insurance agent employed with e-TeleQuote Insurance, Inc., may contact you regarding health and life insurance products and services including Medicare Advantage, Medicare Advantage with a Prescription Drug plan, Medicare Supplement and Prescription Drug plans or Life Insurance plans by phone, text message or email. You expressly consent to receive telemarketing calls (including autodialed and/or pre-recorded calls) text messages and email using automated technology at the phone number and email address you provided, even if it is a wireless number, regardless of whether you are on any Federal or state DNC (“Do Not Call”) and/or DNE (“Do Not Email”) list or registry. In addition, you understand and acknowledge that data and message rates may apply. Furthermore, you acknowledge that you are over 18 years of age.

Receiving quotes through our website and from our licensed insurance agents is always free and you are under no obligation to purchase any goods or services as a result of this request. You agree that we may share your information with third parties, and you may receive surveys of service, account updates or other special offers via email, phone or text message sent by e-TeleQuote Insurance, Inc. and/or our partners. You may revoke your express consent at any time, including by contacting us via 1-877-461-1585 so that you may be placed on our do-not-call list and/or clicking the unsubscribe link at the bottom of any of our emails to be added to our do-not-email list.

Online quotes may not be available for all Medicare Advantage, Medicare Supplement and Prescription Drug plans, but the agency that will be discussing these plan options with you is contracted with various Medicare health or prescription drug plans, which may include Medicare Advantage and/or Prescription Drug plans under the Federal government Medicare program and/or Medicare Supplement plans that are not under the Federal government Medicare program. The licensed agent may be compensated based on your enrollment in such a plan. Medicare Supplement plans are not connected with or endorsed by the U.S. Government or the Federal Medicare program. 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.

plus Medicare Online is a non-government site powered by e-TeleQuote Insurance, Inc., a duly licensed insurance agency appointed by Medicare Advantage HMO, PPO and PFFS plans and stand-alone prescription drug plans and insurance companies holding Medicare contracts approved by The Centers for Medicare & Medicaid Services (CMS). e-TeleQuote is not connected with or endorsed by the U.S. Government or the Federal Medicare Program. Enrollment in any plan for coverage is subject to insurance company approval. Enrollment in the plan depends on the plan’s contract renewal with Medicare. Sales agents/producers may be compensated based on your enrollment in a health plan. Medicare Supplement plans are not connected with or endorsed by the U.S. Government or the Federal Medicare program. e-TeleQuote complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. Not all plans offer all benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply. 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. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.


Last Updated: 4/11/23 12:01:00 AM PENDING – TBD < YYYYY_MULTIPLAN_GHHJXXXXX >

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plus Medicare Online is a non-government site powered by e-TeleQuote Insurance, Inc., a duly licensed insurance agency appointed by Medicare Advantage HMO, PPO and PFFS plans and stand-alone prescription drug plans and insurance companies holding Medicare contracts approved by The Centers for Medicare & Medicaid Services (CMS). e-TeleQuote is not connected with or endorsed by the U.S. Government or the Federal Medicare Program. Enrollment in any plan for coverage is subject to insurance company approval. Enrollment in the plan depends on the plan’s contract renewal with Medicare. Sales agents/producers may be compensated based on your enrollment in a health plan. Medicare Supplement plans are not connected with or endorsed by the U.S. Government or the Federal Medicare program. e-TeleQuote complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. Not all plans offer all benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply. 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. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.