Navigating your Medicare Coverage options does not need to be an intimidating experience.

We use easy-to-understand language to help clients better comprehend their choices. Additionally, we will help guide you through an easy process of selecting a Medicare Supplement Plan that makes sense for you.

Affordable, competitive rates. No hype, no obligation.

You can enroll in a Medicare supplement plan without medical underwriting -- IF you apply during your six-month open enrollment period that begins when your Medicare Part B becomes effective. Don't miss it!

Request your Medicare Supplement Insurance quote here! Whether you are a new Medicare beneficiary or purchased a supplement plan years ago, we are here to help you explore your plan options. We are pleased to offer you supplement insurance quotes without any obligation to apply.

Strategic Estate Planning Services is an independent agency. Therefore, we work closely with several insurance carriers and plans so we can help customize a solution that fits your needs.

Note: The information gathered from the form below is for Medicare Supplement (Medigap) quotes only. This site is not designed to assist Medicare beneficiaries with enrollment in advantage or prescription drug plans.

Medicare Coverage Form

Name*
First Last
Spouse's First and Last Name (if applicable)
First Last
Email*
Street Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
(Indicate primary use, i.e., cell, home, work)
Current Age*
Spouse's Current Age*
Medicare Part B Effective Date*
MM slash DD slash YYYY
Spouse's Part B Effective Date*
MM slash DD slash YYYY
Medicare Supplement Plan?
- Click this box if you currently do NOT have a Medicare Supplement Plan
Medicare Supplement Plan insurance carrier (if applicable)
Spouse's insurance carrier (if applicable)
What plan letter? (For Example, Plan F, or Plan N)
Spouse's plan letter? (For Example, Plan F, or Plan N)
By clicking “SUBMIT” you are agreeing to the following three statements:

1. I acknowledge that Strategic Estate Planning Services is not affiliated with Medicare, CMS or any government agencies.

2. I give my written consent for a Strategic Estate Planning Services staff member or agent to contact me through the contact information I have provided in this form.

3. I hereby request a Medicare Supplement quote from Strategic Estate Planning Services. I acknowledge and understand that I will be contacted by a licensed sales agent regarding the purchase of a Medicare Supplement plan.
Lastly, are you aware that submitting this form does not enroll you into Medicare or a Medicare-related product?*
- Yes
- No

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For more information about any of the products and services listed here, schedule a meeting today.

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Or give us a call at 800.381.8870

Navigating your Medicare Coverage options does not need to be an intimidating experience.

Affordable, competitive rates. No hype, no obligation.

Medicare Coverage Form

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