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Medicare intake form

ASAP Benefits believes that Medicare Beneficiaries deserve efficient answers from their broker/agent who has done their research for you. There has never been a simpler way to achieve just that.

With just a few simple secure questions, the Medicare maze is now a delightful transition! By completing this intake form, your Medicare Agent will be able to research initial plan options that match up with a list of your Prescriptions, Doctors, Hospitals, and Pharmacies and more.

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We do not offer every plan available in your area. Currently, we represent 8 organizations which offer 70 - 100 plans in your area.

Please contact medicare.gov, 1-800-MEDICARE, to get all of your options.

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