Request an orientation

If you would like to receive an orientation about our health care plan options, by phone or in the comfort of your own home, complete the following form and one of MMM Medicare and Much More licensed Sales Representatives will contact you soon:

Medicare Health Maintenance Organization (HMO)

A Medicare Advantage Plan that provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. In most HMOs, you can only get your care from physicians or hospitals in the plan’s network, except in emergencies.

Medicare Special Needs Plan (SNP)

A Medicare Advantage Plan that provides focused and specialized health care for a specific group of people with special needs. For example, they include people who have both Medicare and Medicaid, who reside in nursing homes, and people who have certain chronic medical conditions.

The Centers for Medicare and Medicaid Services (CMS) require agents to document the scope of a marketing appointment prior to any face-to-face sales meeting to ensure understanding of what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). All information provided on this form is confidential and should be completed by each person with Medicare or their authorized representative. 

By signing this form, you are agreeing to a sales meeting or receiving a call from a sales representative to discuss the specific types of products you initialed above. The person who will be discussing plan options with you is employed or contracted by a Medicare Health Plan that is not the Federal government, and they may be compensated based on your enrollment in a plan.

This is not an application. Signing this form does NOT affect your current enrollment, nor will it enroll you in a Medicare Advantage or other Medicare plan.