* By submitting this form, you agree that a licensed sales agent may contact you to discuss the specific types of products listed above. The sales agent that will be discussing plan options with you is either employed or contracted by a Medicare Health plan or prescription drug plan that is not the Federal government, and they may be compensated based on your enrollment in a plan. 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. A Medicare Advantage plan is a health insurance plan provided through a private insurer and delivers Medicare Part A and Part B benefits. A Part D Drug plan is a prescription drug insurance plan provided through a private insurer and delivering Medicare Part D benefits. A Medicare Supplement plan is a health insurance plan provided by a private company that fills in the "gaps" in original Medicare coverage. By submitting this form, you acknowledge that you have read and understand our Terms and Conditions.