Medicare Advantage Plan Review

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856.866.8900 (Moorestown, NJ), 908.272.1970 (Cranford, NJ), 602.996.1549 (Phoenix, AZ)

This short video explains how to submit the Medicare Advantage Plan Review form and why the information is needed to complete the Review.

Medicare Advantage Plan Review

Depending on where you live, there could be ten (10) to fifty (50) different Medicare Advantage Plan options available.

If you would like some assistance reviewing these options to find the most appropriate plan option(s), you can complete the form below.

FOR ANNUAL REVIEW 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.

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.)
If your drug is "as needed" or "PRN" please put an estimate in the "times per day" fields below (e.g. refill inhaler twice per year).

The form below is for existing clients, or new clients that have already set an appointment or phone appointment.

MAPD Review

Plan Year*

First Name*

Last Name*

Phone Number*

Email*

Click here if you have BOTH Medicaid and Medicare

Current Medicare Advantage Plan*

Existing Client*

Select Your Agent's Name*

What's Most Important to You?*

Primary Doctor and Town Located*

Specialists and Town Located*

Pharmacy - First Choice*

Pharmacy - Second Choice

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 to use your myMedicare.gov account*

Full Name on Medicare Card*

Medicare Number (no dashes)*

Part A - Effective Month*

Part A - Effective Year*

Part B - Effective Month*

Part B - Effective Year*

Date of Birth - Month*

Date of Birth - Day of Month*

Date of Birth - Year*

Street Address*

City*

State*

Zip Code*

County*

Mailing Address (if different)

Secret Question*

Secret Answer*

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.

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Moorestown Office |  214 W. Main Street, Suite 101, Moorestown, NJ 08057 | Tel:856-866-8900
Servicing Moorestown, Cherry Hill, Mount Laurel, Haddonfield, Voorhees, Medford, Marlton, Philadelphia, surrounding towns, and licensed in 30+ other states as well.

Cranford Office |  15 Alden Street, Suite 8, Cranford, NJ 07016      | Tel: 908-272-1970
Servicing Cranford, Westfield, Summit, Scotch Plains, Mountainside, Berkeley Heights, New Providence, Basking Ridge, surrounding towns, and licensed in 30+ other states as well.

Phoenix Office | P.O. Box 71283. Phoenix, AZ 85050. | Tel:  602- 996-1549
Servicing Phoenix, Scottsdale, Peoria, Sun City, Sun City West, Paradise Valley, Fountain Hills, Cave Creek, surrounding towns and licensed in 30+ other states as well.

Email: info@senior-advisors.com (Se Habla Español -Tel: 908.481.5678)