Medicare Part D Enrollment

  1. Avery Hall Insurance
  2. Medicare Part D Enrollment

Drug Plan Finder

You are allowed to change your Medicare Drug Plan between 10/15 and 12/07

Shopping for the most cost effective Medicare Drug Plan can be overwhelming, our licensed agents are happy to research all of the Drug Plans for you. Our service for this is FREE!

Please complete the form and click “Submit” on the bottom of the Form.

Thank you for sending us your Rx list; a licensed agent will contact you shortly to discuss your Medicare Part D plan options and enrollment periods.

Please select a location to send form.

First Name is required.

Last Name is required.

Please correct your Date of Birth.

Email Address is required.

Phone Number is required.

Zip Code is required.

Medication List Instructions:
  1. Type your medicine name directly from your bottle Example: Simvastatin
  2. Dosage for each medication: Example: 20mg
  3. The frequency for each medication. Select an option.
  4. The type of medication. Select an option.

Pharmacy

Pharmacy is required.

If you could save money by switching pharmacies, would you be willing to change?

Please correct your If you could save money by switching pharmacies, would you be willing to change?.

Atleast one medication is required.

Please select a type.

Atleast one dosage is required.

Atleast one refill quantity is required.

Please select a refill frequency.

Add additional medications

Please note that we do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please visit Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Get Your FREE Quote

We will direct your quote request to an experienced Avery Hall agent.
Thank you for your submission.

First Name is required.

Last Name is required.

Email Address is required.

Home Phone is required.

Street Address (Home/Business) is required.

City is required.

State is required.

Zip is required.

Please select an option.

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