By submitting this form, You are agreeing by your electronic signature to the Terms and Conditions and Privacy Policy that Seniormedicarebenefit and /or it's Partners, 100Insure and/or a licensed insurance agent at GoHealth LLC may contact you regarding health and life insurance products and services including Medicare Advantage with a Prescription Drug plan, Medicare Supplement and Prescription Drug, insurance plans by phone or email. You provide your express written consent to receive phone calls (including autodialed and /or pre-recorded/artificial voice calls) and email using automated dialing system 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 you are over 18 years of age and your consent is not required as a condition of purchase. Your consent can be revoked through any reasonable means. Your telephone company may impose additional charges on subscriber for messages (required for SMS)and there is no obligation to enroll. (Please note the Licensed sales agents are not connected with or endorsed by the U.S. government or the federal Medicare program)

"Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan's contract renewel with Medicare." "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 (24 hours a day/7 days a week) to get inforamtion on all of your options."
My agreement does not affect my current or future Medicare enrollment status. This is effective as of [] and grants permission to discuss the above plan types.