Medicare Health Plans Quote

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

THIRD PARTY MARKETING ORGANIZATION DISCLAIMER:

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 to get information on all of your options.

The Part D sponsor must ensure that the disclaimer is as follows:

1. Used by any TPMI, as defined under § 42 CFR 422.2260 and 423.2260, that sells plans on behalf of more than one plan sponsor unless the TPMO sells all community available plans in a given service area.
2. Verbally conveyed within the first minute of a sales call.
3. Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication.
4. Prominently displayed on TPMO websites
5. Included in any TPMO marketing materials, including print materials and television advertising.

Personal Information

First Name *

Last Name *

Date of Birth *

Street *

City *

State *

ZIP / Postal Code *

Primary Phone Number *

E-Mail Address *

Medicare Part A effective date *

Medicare Part B effective date *

List all current medications *

Do you have a preferred pharmacy?

Submission Validation

Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

Insurance Websites Designed and Hosted by Insurance Website Builder

The website may contain concepts that have legal, accounting and tax implications. LB Benefits Inc. dba Lohman Companies does not provide tax or legal advice. Please consult your tax advisor or attorney for such guidance.

Lohman Companies Privacy Statement