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    Medicare Prescription Drug Plans (Part D)Medicare Advantage Plans (Part C)Medicare Supplement (Medigap) ProductsDental/VisionNot Sure/Other (Explain Below)

    By clicking submit on this form, you agree to having a sales agent call to discuss the types of products you selected above. Please note, the person who will discuss the products is either employed or contracted by a Medicare plan. They do not work directly for the Federal government. Sandra Chiarello works with various Medicare health plans. Each one has a Medicare contract. Enrollment in a Plan depends on their contract renewal. This individual may also be paid based on your enrollment in a plan. Submitting this form does NOT obligate you to enroll in a plan, affect your current or future enrollment, or enroll you in a Medicare plan.

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    We do not offer every plan available in your area. Currently we represent 5 organizations which offer 15 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.