Medicare Information Request

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Medicare Information

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Disclosure Statement

By submitting this form, you are consenting to receive phone calls from one of our licensed insurance agents who represent various health insurance companies such as Humana, Aetna, Mutual of Omaha, Coventry, Anthem, and Blue Cross Blue Shield, amongst others. This is not an application for insurance and does not replace any coverage you may currently have.

By completing this form, you authorizing a licensed insurance agent to contact you to provide information regarding Medicare related products such as Medicare Supplements, Medicare Advantage Plans, and Medicare Prescription Drug Plans, even if you are on the Do Not Call Registry.

The sales representative discussing the plan options with you is either employed by or contracted with a Medicare Health Plan or Medicare Prescription Drug Plan, and may be compensated based on your enrollment into a plan.

Note: Calls from AMAC appear on your phone as coming from the number: (631) 729-7319, or sometimes as potential SPAM (depending on your cell phone settings). Please keep this in mind if you made an inquiry or asked for a call from AMAC recently, as we will be trying to reach you.

AMAC, Inc. is neither endorsed by nor contracted with the US Government, or any federal/ state programs.

AMAC does not recommend health related products, services, or insurance plans. You are strongly encouraged to evaluate your needs.

By submitting this form, you acknowledge understanding and agreement to the above terms and conditions.

Medicare Part C

A Medicare Advantage Plan that provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. In most HMOs, you can only get your care from doctors or hospitals in the plan’s network (except in emergencies).

A Medicare Advantage Plan that provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. PPOs have network doctors and hospitals, but you can also use out-of-network providers, usually at a higher cost.

A Medicare Advantage Plan in which you may go to any Medicare-approved doctor, hospital and provider that accepts the plan’s payment, terms and conditions and agrees to treat you – not all providers will. If you join a PFFS Plan that has a network, you can see any of the network providers who have agreed to always treat plan members. You will usually pay more to see out-of-network providers.

A type of Medicare Advantage Plan available in a local or regional area which combines the best feature of an HMO with an out-of-network benefit. Like the HMO, members are required to designate an in-network physician to be the primary health care provider. You can use doctors, hospitals, and providers outside of the network for an additional cost.

A Medicare Advantage Plan that has a benefit package designed for people with special health care needs. Examples of the specific groups served include people who have both Medicare and Medicaid, people who reside in nursing homes, and people who have certain chronic medical conditions.

Medicare Part D

A stand-alone drug plan that adds prescription drug coverage to Original Medicare, some Medicare Cost plans, some Medicare Private Fee-for-Service plans, and Medicare Medical Savings Account plans. Medicare Advantage Plans (Part C) and Cost Plans

Medicare Supplement

Plans offering a supplemental policy to fill “gaps” in Original Medicare coverage. A Medigap policy typically pays some or all of the deductible and coinsurance amounts applicable to Medicare-covered services, and sometimes covers items and services that are not covered by Medicare, such as care outside of the country. These plans are not affiliated or connected to Medicare.

Cancer, Heart and Stroke

Plans offering additional benefits; payable to consumers based upon their medical utilization; sometimes used to defray copays/coinsurance. These plans are not affiliated or connected to Medicare.

The Association of Mature American Citizens (AMAC) is a licensed and certified representative of Medicare Advantage HMO, PPO and PFFS organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal.

The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. To learn more about a plan’s nondiscrimination policy, please click any of the Nondiscrimination links above in the Health plan disclaimers section.

This information is not a complete description of benefits. Call 1-800-334-9330 (TTY: 711) for more information.

Medicare beneficiaries may also enroll in the plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Every year, Medicare evaluates plans based on a 5-star rating system.

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call the Plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Total annual cost is calculated by adding up the total annual cost of any monthly premiums, applicable plan deductible(s) and estimates for all co-pay and co-insurance amounts that will be due for the medications and health benefits used throughout the year. Costs for medications and health benefits vary across pharmacies and health systems, so the costs provided are only estimates. Actual costs could vary.

For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778 or consult www.socialsecurity.gov; or your Medicaid Office.

You must have both Part A and B to enroll in a Medicare Advantage plan. Members may enroll in the plan only during specific times of the year. Contact the plan for more information.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.