IMPORTANT: Medicare charges a late enrollment penalty to anyone that does/did not enroll in a drug plan within their Initial Enrollment Period for Part D. For Information on the penalty, refer to Part D in the Medicare & You Handbook (click here to view) or go to Medicare.gov.

I understand that the PDP analysis and plan suggestion by Senior Health Direct will be based solely on the medications and information listed on this electronic RX Plan Profile form. I also understand that based on the drugs I take, the recommended prescription plan may have a deductable.

This is a solicitation of insurance. By providing this information, you agree that an authorized representative or licensed insurance agent/producer may contact you by phone, email, or mail to answer your questions or provide additional information about Medicare Advantage, Part D or Medicare Supplement Insurance plans.

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