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FREE Prescription Drug Plan Analysis

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Each year between October 15 and December 7, individuals have an opportunity to change their Prescription Drug Coverage with Medicare Part D.


Other than initial enrollment in Part D of Medicare, this is the only time throughout the year that you can change Part D (Prescription Drug Plan) of Medicare.


During each Annual Enrollment, it is critical to review your drug card to make sure you have the best drug card based on your specific drug lists.  There are about 30 different drug cards to choose from and the coverages, premiums, deductibles, change each year.


For all of our Medicare supplement customers, we offer a FREE Annual review of their drug coverage to make sure they have the best drug cards available.

Example of Medicare.gov RX analysis tool



​If you are curious, here is a short video on how to use the Medicare.gov tool to enter your drug information and complete the Part D Prescription Analysis.

Online RX Entry Form

​​Submit the form below to have your drugs analyzed to identify the right drug card for your specific needs. 
  • FOR FORMS SUBMITTED AFTER 11/15, THERE IS NO GUARANTEE WE WILL HAVE A CHANCE TO REVIEW & RESPOND BY DECEMBER 7 DEADLINE.  WE WILL GIVE BEST EFFORTS, BUT WE CANNOT GUARANTEE A RESPONSE BY DECEMBER 7 DUE TO THE VOLUME OF REQUESTS.
  • ​Do NOT include Vitamins, Supplements, or OTC drugs since these are not covered by Part D.   Please ONLY list Prescribed Medications in the form.  

  • Also do NOT include diabetic supplies (e.g. test strips, needles, etc.) since these are covered by Part B of Medicare under Durable Medical Equipment not under Part D of Medicare.  The exception to this rule is the Omnipod "pods" since these are covered under Part D (not Part B).
  • If you are not taking any medications, complete the fields below and check the box "I do not currently any medications" and click Submit.
  • If you drug list has not changed from the prior year, we still need you to complete the RX form to make sure we have all the correct RX information.
  • If you are taking prescribed medications that are NOT pill form (e.g. Insulin, Eye Drops, Creams, Lotions, Inhalers), in the "times per day" field below please just enter the amount per month that you fill (e.g. 5 pens per month, 1 bottle per month, 1 inhaler per month, etc.)
Part D RX Information
Plan Year*
Name*
Phone Number*
Zip Code*
Email*
County*What County do you live in?
State*
Current Part D Plan* Select 'I don't have one', if you don't have a Part D Plan.
Existing Client?* Are you an existing client?
Select Your Agent* If you're a new client, select 'I don't have an agent yet.' For existing clients, select your agent.
Pharmacy - First Choice*Enter the name of your preferred pharmacy.
Pharmacy - Second Choice
Mail Order Drugs?* Are you willing to obtain your drugs via mail order if it is cost-effective?
I do not currently take any medications. If you do not currently take any regular medications, check this box.
Drug 1Enter the name of the Drug.
Drug 1 - DosageEnter the dosage (e.g. 500mg)
Drug 1 - times per dayEnter the number of times per day this drug is taken.
Drug 1 - Willing to take Generic?If this is a brand name drug, are you willing to take a generic instead?
Drug 2
Drug 2 - Dosage
Drug 2 - times per day
Drug 2 - Willing to take generic?
Drug 3
Drug 3 - Dosage
Drug 3 - times per day
Drug 3 - Willing to take generic?
Drug 4
Drug 4 - Dosage
Drug 4 - times per day
Drug 4 - Willing to take generic?
Drug 5
Drug 5 - Dosage
Drug 5 - times per day
Drug 5 - Willing to take generic?
Drug 6
Drug 6 - Dosage
Drug 6 - times per day
Drug 6 - Willing to take generic?
Drug 7
Drug 7 - Dosage
Drug 7 - times per day
Drug 7 - Willing to take generic?
Drug 8
Drug 8 - Dosage
Drug 8 - times per day
Drug 8 - Willing to take generic?
Drug 9
Drug 9 - Dosage
Drug 9 - times per day
Drug 9 - Willing to take generic?
Drug 10
Drug 10 - Dosage
Drug 10 - times per day
Drug 10 - Willing to take generic?
Additional Drugs/Info
If you have more than 10 drugs to enter, put the additional drugs (Drug 11, 12, etc.) in "Additional Drugs/Info" field.

Please do not click the SUBMIT button more than one time - since this will create duplicate submissions.

Data Entry Trick for Husband & Wife - After you click SUBMIT this will take you to the Confirmation Page.  Then, click Back button on the Browser which will take you back to the pre-filled form.  This will save you some time with some of the data entry for the basic information at the top of the form.  Please remember to update the correct drug information for the second individual.