According to Medicare rules, we need your permission to contact you to discuss your Medicare plan option. By accepting this form, you are agreeing to a sales telephone call or an email from a licensed sales agent to discuss the specific types of product above. The person who will be discussing plan option with you is with is with or contracted by a Medicare health plan or prescription drug plan that is not the Federal Government, and they may be compensated based on your enrollment in a plan. Signing This does NOT affect your current enrollment, nor will it enroll you in a Medicare Advantage Plan, or the other Medicare Plan.