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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.

New Medicare Plan finder video
The new Medicare Plan Finder was released in August of 2019. 

If you would like to watch a quick video of how to use the tool to complete your own Part D analysis, click the Video to the right.

​If you would prefer that we complete the Part D analysis for you, complete the Rx Information form below.

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 NOVEMBER 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 select "No" for "Do you currently take any medication?", skip the Drug Info fields, 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.)
The Part D Rx form is for one individual.  Do not submit information for multiple people on the same form.
For example, a husband and wife need to submit one form each with their individual information.

Please use the Correct Date format (MM/DD/YYYY) for Date of Birth, Part A Effective Date, and Part B Effective Date. Otherwise you will receive an error email that will require you to send the date information.  For example, "3/1/2010" is not an acceptable date format; it needs to be entered as "03/01/2010".

CMS released a New Medicare Plan Finder Tool in 2019 which requires us to have the myMedicare.gov information to complete and save the Part D Analysis.  You can read more here.




Part D RX Information
Plan Year* ?
First Name*
Last Name*
Phone Number*
Email*
Current Part D Plan* ?
Existing Client?* ?
Select Your Agent* ?
Pharmacy - First Choice*?
Pharmacy - Second Choice
Mail Order Drugs?* ?
Do you currently take medications?*
Drug 1?
Drug 1 - Dosage?
Drug 1 - times per day?
Drug 1 - Willing to take Generic??
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
Authorization for creation myMedicare.gov account* ?
Full Name on Medicare Card*?
Medicare Number (no dashes)*?
Part A Effective Date - MM/DD/YYYY*?
Part B Effective Date - MM/DD/YYYY*?
Date of Birth - MM/DD/YYYY*?
Street Address*
City*
State*
Zip Code*
Secret Question*
Secret Answer*
myMedicare.gov Username?
myMedicare.gov Password?
Enter the Captcha below, prove you're not a robot.
Reload
If you have more than 10 drugs to enter, put the additional drugs (Drug 11, 12, etc.) in "Additional Drugs/Info" field.

​If everything was entered correctly, after you click SUBMIT you should receive a Confirmation page and a Confirmation email.

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