Are you inquiring on behalf of yourself or someone else? * Myself Someone else First name * Last name * Phone number * Email * Zip code * Age - None -64 or younger65-7475-8485 or older Your first name * Your last name * Your phone number Your email address Your relationship to the person for whom you're making this inquiry - None -friendneighborrelative Their first name * Their last name * Their zip code Their age - None -64 or younger65-7475-8485 or older What is the ethnicity of the person seeking Medicare? - None -American Indian or Alaska nativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or other Pacific IslanderWhitePrefer not to specify How would you prefer to be contacted by a SHIP counselor? - None -EmailPhoneEither What is the main reason you are contacting us today? You can select as many choices as apply. Original Medicare (Parts A and B) Medicare Advantage Help with Medicare Cost Medigap Medicaid New to Medicare Medicare Claims & Billing Issues Other Health Insurance Suspected Medicare Fraud None of these categories apply/I am not sure CAPTCHA Checking this box helps us avoid spam. Submit
DRCOG ON Twitter