At Choice Health, we take pride in helping our customers navigate a complex health
care system and find affordable coverage that meets their needs.
Complete this form and provide some basic personal information to request a
complimentary copy of “Your eGuide to Medicare Enrollment” that helps you understand important
milestones and next steps. Then, one of our licensed Care Specialists will contact you to answer any
questions and discuss your options.
What is your ZIP code?
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By completing this form and providing your phone number and/or email address, you consent to and agree
that an authorized representative or licensed insurance agent from Choice Health LLC, its service
providers, and/or affiliates may call or text (SMS) the phone number provided, or email you to answer
questions, determine eligibility, provide additional information about Medicare plans offered by one or
several Medicare-contracted carrier(s), and/or discuss other products and services. You are not
obligated to provide your consent in order to utilize our services or make a purchase and may change
your contact preferences at any time. To opt out of receiving text messages (SMS), you may reply STOP to
any text message you have received. Providing your phone number and/or email address shall serve as your
signature for consent with regard to such phone number and/or email address, respectively. Standard
phone, data, and/or text message charges may apply from your provider. Please see the “Communications
Information” link on 123medicare.com for information about text messaging (SMS), phone contact, opting
out, and more.
What is your name? (first & last)
Enter your name here
Please correct name and retry.
What is your phone number
Enter your phone number here
Please correct phone number and retry.
What is your email address? (optional)
Enter your email address here
Please correct email address and retry.
Thank you! A Care Specialist will contact you soon.
Access a complimentary copy of “Your eGuide to Medicare Enrollment”.
Choice Health LLC respects your rights and privacy interests in choosing how you wish to
communicate with us about our products and services. When you provide your cell phone number and
consent to receiving calls and texts we are permitted to contact you via phone call or text
(SMS) message using automatic telephone dialing systems (ATDS) and artificial or prerecorded
voice messages. Although we generally strive to connect you to a live agent right away, Choice
Health LLC also may use an ATDS and/or prerecorded voice to deliver certain messages and
facilitate connection to an agent. However, we are not allowed to condition buying any of our
products or services or otherwise working with us on your consent to receive text (SMS) messages
or cell phone calls. Depending on your cell phone plan, message and data rates may apply. You
also have the right to revoke your authorization and opt-out of receiving our text messages or
cell phone calls at any time. If you have received a text message and you wish to opt-out,
simply respond “STOP” to the text and you will be removed from all future texting. In some
cases, you may receive one subsequent text to confirm/inform you that you will be removed. If
used, you will be able to opt-out of receiving prerecorded voice messages using the prompts
provided and/or when you are connected to an agent.
In general, the purpose of contacting you by phone and/or text (SMS) is to provide you with
additional information about health coverage options and connect you with resources and/or a
licensed agent to assist you with questions or enrollment activities. In some cases, you may be
contacted for other marketing and promotional purposes or to provide various confirmations or in
response to your information requests. You may opt-out from receiving any and/or all future
contact to the number you provided at any time by speaking to an agent and requesting to be
removed from our contact list(s). If you are enrolled in a health plan that we are working with
you, should you decide to opt-out or remove a number you provided, we may need an alternative
phone number or other contact information in order to continue to provide you with certain
administrative information about your health plan and your enrollment and to ensure that we are
able to continue to provide you with the high standard of customer service we expect to provide
Choice Health Insurance LLC is a licensed and certified representative of Medicare Advantage HMO, HMO-POS, PPO, PFFS and SNP organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal.
The plans we represent do not discriminate on the basis of race, color, national origin, age,
disability or sex.
Medicare beneficiaries may also enroll in the plan through the CMS Medicare Online Enrollment
Center located at http://www.medicare.gov.
For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call
1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
Total annual cost is calculated by adding up the total annual cost of any monthly premiums,
applicable plan deductible(s) and estimates for all co-pay and co-insurance amounts that will be
due for the medications and health benefits used throughout the year. Costs for medications and
health benefits vary across pharmacies and health systems, so the costs provided are only
estimates. Actual costs could vary.
For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription
drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE
(1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week or consult
www.medicare.gov; the Social Security
Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should
call, 1-800-325-0778 or consult www.socialsecurity.gov; or your
You must have both Part A and B to enroll in a Medicare Advantage Plan. Members may enroll in the
plan only during specific times of the year. Contact the plan for more information.
The purpose of this communication is the solicitation of insurance. Contact will be made by an
insurance agent/producer or insurance company.
This website is operated by Choice Health Insurance LLC. Nothing contained herein constitutes nor
is intended to constitute an offer, inducement, promise, or contract of any kind, or a
recommendation to purchase insurance from any particular insurance company at any particular
level of benefits or plan design. Choice Health Insurance LLC is not an insurance company.
Choice Health Insurance LLC intends that the general and insurance specific information
contained on this web site be accurate and reliable, however, Choice Health Insurance LLC makes
no warranties or representations as to the completeness, accuracy or timeliness of the web site
materials. The company will not be liable for any damages of any kind from or relating to the
use of, or reliance upon, results obtained by users from the web site and related services.