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What's Your Legal Name?

First Name *

Last Name *

By providing the information in this form, you are granting permission for a licensed insurance agent to contact you via phone, text, or email regarding your Medicare options including Medicare Supplement, Medicare Advantage, and Prescription Drug Plans. Providing permission does not impact eligibility to enroll or the provision of services.

Avanti Insurance is a licensed health insurance agency and is not affiliated or endorsed by the government or Federal Medicare program. The submission data for this form is encrypted by AWS.

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 visit Medicare.gov or call 1-800-MEDICARE to get information on all of your options.

Avanti Insurance represents Medicare Advantage (HMO, PPO, PFFS) organizations and standalone PDP Prescription Drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal.

What's Your Date of Birth?

This helps us ensure you don't miss any important eligibility deadlines, through both Social Security and Medicare.

Date of birth *

By providing the information in this form, you are granting permission for a licensed insurance agent to contact you via phone, text, or email regarding your Medicare options including Medicare Supplement, Medicare Advantage, and Prescription Drug Plans. Providing permission does not impact eligibility to enroll or the provision of services.

Avanti Insurance is a licensed health insurance agency and is not affiliated or endorsed by the government or Federal Medicare program. The submission data for this form is encrypted by AWS.

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 visit Medicare.gov or call 1-800-MEDICARE to get information on all of your options.

Avanti Insurance represents Medicare Advantage (HMO, PPO, PFFS) organizations and standalone PDP Prescription Drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal.

What's Your Phone Number?

Disclaimer: By providing this information you may be contacted by a licensed sales agent, Rolando Arellano.

Phone *

By providing the information in this form, you are granting permission for a licensed insurance agent to contact you via phone, text, or email regarding your Medicare options including Medicare Supplement, Medicare Advantage, and Prescription Drug Plans. Providing permission does not impact eligibility to enroll or the provision of services.

Avanti Insurance is a licensed health insurance agency and is not affiliated or endorsed by the government or Federal Medicare program. The submission data for this form is encrypted by AWS.

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 visit Medicare.gov or call 1-800-MEDICARE to get information on all of your options.

Avanti Insurance represents Medicare Advantage (HMO, PPO, PFFS) organizations and standalone PDP Prescription Drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal.

What's Your Zip Code?

This helps us find the best plan options and networks in your local area. Plans are not always available state-wide.

Postal Code *

By providing the information in this form, you are granting permission for a licensed insurance agent to contact you via phone, text, or email regarding your Medicare options including Medicare Supplement, Medicare Advantage, and Prescription Drug Plans. Providing permission does not impact eligibility to enroll or the provision of services.

Avanti Insurance is a licensed health insurance agency and is not affiliated or endorsed by the government or Federal Medicare program. The submission data for this form is encrypted by AWS.

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 visit Medicare.gov or call 1-800-MEDICARE to get information on all of your options.

Avanti Insurance represents Medicare Advantage (HMO, PPO, PFFS) organizations and standalone PDP Prescription Drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal.

When Thinking About Your Doctors and Your Monthly Costs, What's Most Important to You?

*

Paying higher monthly costs and getting the flexibility to see any doctor I want.

Adding additional benefits like dental, vision, hearing, heart attack, cancer, stroke coverage, etc.

Keeping my monthly costs low and I may have a smaller network of providers.

Making sure I can use my plan anywhere since I plan to travel often or split my time between states.

By providing the information in this form, you are granting permission for a licensed insurance agent to contact you via phone, text, or email regarding your Medicare options including Medicare Supplement, Medicare Advantage, and Prescription Drug Plans. Providing permission does not impact eligibility to enroll or the provision of services.

Avanti Insurance is a licensed health insurance agency and is not affiliated or endorsed by the government or Federal Medicare program. The submission data for this form is encrypted by AWS.

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 visit Medicare.gov or call 1-800-MEDICARE to get information on all of your options.

Avanti Insurance represents Medicare Advantage (HMO, PPO, PFFS) organizations and standalone PDP Prescription Drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal.

Do Any of These Apply to You? (check all that apply)

*

I am planning on working past 65 and I don't know if I should keep my employer coverage

I need help understanding Social Security filing strategies and timing

I'm already on Medicare but I don't like my plan

I think I may have missed my initial enrollment window

I'm helping my parent or grandparent with their Medicare

I also need help with Retirement Income and/or Life Insurance

I'm interested in looking at additional coverage that would help cover Cancer, Heart Attack, Stroke, etc.

None of these apply

By providing the information in this form, you are granting permission for a licensed insurance agent to contact you via phone, text, or email regarding your Medicare options including Medicare Supplement, Medicare Advantage, and Prescription Drug Plans. Providing permission does not impact eligibility to enroll or the provision of services.

Avanti Insurance is a licensed health insurance agency and is not affiliated or endorsed by the government or Federal Medicare program. The submission data for this form is encrypted by AWS.

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 visit Medicare.gov or call 1-800-MEDICARE to get information on all of your options.

Avanti Insurance represents Medicare Advantage (HMO, PPO, PFFS) organizations and standalone PDP Prescription Drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal.

Is There Anything Else You Think May Be Important to Share With Us?

Any Additional Information You'd Like to Share?

By providing the information in this form, you are granting permission for a licensed insurance agent to contact you via phone, text, or email regarding your Medicare options including Medicare Supplement, Medicare Advantage, and Prescription Drug Plans. Providing permission does not impact eligibility to enroll or the provision of services.

Avanti Insurance is a licensed health insurance agency and is not affiliated or endorsed by the government or Federal Medicare program. The submission data for this form is encrypted by AWS.

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 visit Medicare.gov or call 1-800-MEDICARE to get information on all of your options.

Avanti Insurance represents Medicare Advantage (HMO, PPO, PFFS) organizations and standalone PDP Prescription Drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal.

Contact Us:

Phone: 972-619-6288

Email: [email protected]

Privacy Policy | Terms & Conditions

I am not connected with or endorsed by the United States government or the federal Medicare program. I do not offer every plan available in your area.

I currently represent 20+ Medicare Advantage and Prescription Drug plan organizations and have access to 100+ Medicare plans depending on service area. Plan availability, benefits, premiums, copayments, and provider networks vary by location and are subject to change.

Not all plans are available in all areas. Any information provided is for educational purposes only and does not constitute an offer of coverage. Enrollment in a Medicare Advantage or Prescription Drug Plan depends on contract renewal with Medicare and individual eligibility.

For a complete list of plans available in your area, please contact 1-800-MEDICARE (TTY: 1-877-486-2048), available 24 hours a day, 7 days a week, or visit www.medicare.gov.