Medicare Comparison Request | First Insurance Agency of the Hill Country

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General Info

Select Your State

Please Note: We only write insurance for these states.

Name*

First Last

Phone*

Email Address*

Part B effective date:

Date of Birth

Zip Code:

Do you currently have Retiree Medical and/or Prescription Drug coverage (e.g., from a former employer or union)?

Yes – If yes, you need to find out how current coverage will work with Medicare
No

What kind of Medicare coverage are you looking for? Check all that apply

Medicare Advantage Plans – Prescription drugs are sometimes included
Supplement/Gap Plan
Prescription Drug coverage
Not sure

Coverage Needs:

I live in a Nursing Home, LTC/Long Term Care Facility, or Assisted Living Facility
I am eligible for Medicaid
None of the above

Coverage Preferences – Which do you prefer when budgeting for health care costs?

Higher monthly premiums and lower out-of-pocket expenses
Lower monthly premium and higher out-of-pocket expenses

Which Medical Coverage do you prefer?

A plan with few limitations regarding which hospital and doctors you can see
A plan with a pre-approved list of doctors and hospitals

Do you need local only coverage or national coverage?

Local coverage – We don’t travel much or have extended trips out of the local area
National coverage – We travel and/or have extended stays and trips away from home

Drug coverage

I need prescription drug coverage
I don’t need prescription drug coverage
Not sure

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