Let's Get Started

Enter your ZIP code and county to continue.

ZIP Code

County

Your Information

Please provide your contact information.

First Name*

Last Name*

Phone Number*

Email Address*

Address

City

State

Scope of Appointment

Place a check next to the type of product(s) you want the agent to discuss: *

Medicare Advantage Plans (Part C)

Stand-alone Medicare Prescription Drug Plans (Part D)

Medicare Supplement (Medigap) Products

Ancillary Products (Dental/Vision/Hearing Products)

Beneficiary or Authorized Representative Information:

By signing this form, you agree to a meeting with a sales agent to discuss the types of products you indicated above. Please note, the person who will discuss the products is either employed or contracted by a Medicare plan. They do not work directly for the Federal government. This individual may also be paid based on your enrollment in a plan.

There is no obligation to enroll. Current or future Medicare enrollment status will not be impacted, and automatic enrollment will not occur.

Name of Signatory *

Meet Your Agent

You're almost done. Schedule your appointment with your assigned agent.

👤

John Smith

Your assigned agent

The purpose of this website is the solicitation of insurance and is not connected with or endorsed by the U.S. Government or the Federal Medicare Program. We do not offer every plan available in your area.
Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information of all of your options.

MULTI-PLAN_myMA40_M

Contact

+1 (843) 492-0940
office@myma.net
597 Old Mount Holly Rd Suite 204 Goose Creek SC 29445
Monday to Friday, 9 AM to 5 PM EST