Disability (with disability age 40-63 for medicare/medicaid)

Do you have Medicare part A and B? (Must be Yes to continue)
YesNo

Are you the descision maker?
YesNo

Do you have Medicare / Medicaid?
YesNo

By clicking submitting Medicare or Medicaid or Yes, I provide my express written consent via this webform to initiate a chat interaction for a licensed sales agent associated with Medi Fortify to contact me via chat, text, or call at the number I provided, even if the phone number provided is on the National Do Not Call registry, regarding products or services, including Medicare Supplement, Medicare Advantage, Prescription Drug insurance plans, and other health-related services. I consent to being contacted via chat, a live, automated dialing system telephone call, SMS text, or email. I understand this request has been initiated by me and that this is an unscheduled contact request where I am requesting information immediately. I understand my telephone company may impose charges on me for these contacts and am not required to enter into this agreement as a condition of any purchase or service. I further understand that this request, initiated by me, is my affirmative consent to be contacted which is in compliance with all federal and state telemarketing and Do-Not-Call laws. Licensed Sales Agents are not connected with or endorsed by the U.S. government or the federal Medicare program. I agree to the Privacy Policy and Terms and Conditions. Please note this is a solicitation for insurance. There is no obligation to enroll.

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