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Medicare Plan Review

Review Your Coverage by Email

Complete the questionnaire below so our team can review your current coverage and determine whether other options may be available.

After you submit the form, HTA will review your information and email your options within a few business days.

Because changing Medicare Supplement plans may require medical underwriting, the health questions below help us determine which options you may qualify for.

First Name (as on Medicare ID Card)(Required)

Last Name(Required)

Email Address(Required)

Phone Number(Required)

State(Required)

Zip(Required)

Would you like to also shop for a spouse/partner?(Required)

Yes

Spouse/Partner Information

First Name (as on Medicare ID Card)(Required)

Last Name(Required)

Email Address(Required)

Phone Number(Required)

YOUR Medical Info

In most states, changing Medicare Supplement plans requires medical underwriting. Please answer the health questions below so we can better determine whether you may qualify to change plans and potentially lower your premium.

Change Preference (check all that apply)(Required)

I want to see if there is a lower premium for the same benefits i have now

I would be willing to consider lower benefits to save money

Current Plan(Required)

Current Premium(Required)

Frequency(Required)

Monthly

Quarterly

SemiAnnual

Annual

Have you recently received a rate increase notice?(Required)

Yes

Date of Increase(Required)

Premium after Increase(Required)

Tobacco Use In the last 12 months(Required)

Yes

Height(Required)

Weight(Required)

Congestive Heart Failure(Required)

Yes

Heart Attack, Stroke or TIA(Required)

Yes

Date of Diagnosis (Month/Year)

Details on CHF, Heart Attack, Stroke or TIA including date of diagnosis, treatment, ongoing meds needed, degree of recovery, etc.(Required)

Internal Cancer or Melanoma(Required)

Yes

Atrial Fibrillation(Required)

Yes

Diabetes(Required)

Yes

Date of Diagnosis (Month/Year)

Details on Cancer or A-Fib including date of diagnosis, treatment, ongoing meds needed, degree of recovery, etc.(Required)

Diabetes with insulin use(Required)

Yes

Diabetes with complications (Retinopathy, Neuropathy, Peripheral Vascular or Arterial Disease)(Required)

Yes

Please provide any additional details about diabetes including how long you have had it, have your medications changed in the last 12 months, A1C levels, etc(Required)

Kidney or Liver Disease(Required)

Yes

Osteoporosis and have fractured a bone in last 5 years (regardless of if related to osteoporosis)(Required)

Yes

Parkinson's Disease, Rheumatoid Arthritis or Multiple Sclerosis(Required)

Yes

Date of Diagnosis (Month/Year)

Details on Kidney, Liver, Osteoporosis, Parkinsons, Arthritis or MS including date of diagnosis, treatment, ongoing meds needed, degree of recovery, etc.(Required)

Any physical, occupational or speech therapy- in past 6 months, current, or recommended?(Required)

Yes

Any scheduled or recommended surgery or treatment in next 12 months?(Required)

Yes

Details on PT, OT or any upcoming surgeries or treatment including reason for treatment, anticipated recovery time, etc(Required)

SPOUSE/PARTNER'S Medical Info

Change Preference (check all that apply)(Required)

I want to see if there is a lower premium for the same benefits i have now

I would be willing to consider lower benefits to save money

Current Plan(Required)

Current Premium(Required)

Frequency(Required)

Monthly

Quarterly

SemiAnnual

Annual

Has your spouse/partner recently received a rate increase notice?(Required)

Yes

Date of Increase(Required)

Premium after Increase(Required)

Tobacco Use(Required)

Yes

Height(Required)

Weight(Required)

Congestive Heart Failure(Required)

Yes

Heart Attack, Stroke or TIA(Required)

Yes

Date of Diagnosis (Month/Year)

Details on CHF, Heart Attack, Stroke or TIA including date of diagnosis, treatment, ongoing meds needed, degree of recovery, etc.(Required)

Internal Cancer or Melanoma(Required)

Yes

Atrial Fibrillation(Required)

Yes

Diabetes(Required)

Yes

Date of Diagnosis (Month/Year)

Details on Cancer or A-Fib including date of diagnosis, treatment, ongoing meds needed, degree of recovery, etc.(Required)

Diabetes with insulin use(Required)

Yes

Diabetes with complications (Retinopathy, Neuropathy, Peripheral Vascular or Arterial Disease)(Required)

Yes

Please provide any additional details about diabetes including how long you have had it, have your medications changed in the last 12 months, A1C levels, etc(Required)

Kidney or Liver Disease(Required)

Yes

Osteoporosis and have fractured a bone in last 5 years (regardless of if related to osteoporosis)(Required)

Yes

Parkinson's Disease, Rheumatoid Arthritis or Multiple Sclerosis(Required)

Yes

Date of Diagnosis (Month/Year)

Details on Kidney, Liver, Osteoporosis, Parkinsons, Arthritis or MS including date of diagnosis, treatment, ongoing meds needed, degree of recovery, etc.(Required)

Any physical, occupational or speech therapy- in past 6 months, current, or recommended?(Required)

Yes

Any scheduled or recommended surgery or treatment in next 12 months?(Required)

Yes

Details on PT, OT or any upcoming surgeries or treatment including reason for treatment, anticipated recovery time, etc(Required)

Other Coverages

Do you have interest in any other types of benefits (check all that apply)

Dental

Vision

Auto Insurance

Home Insurance

“By submitting the information above, you are agreeing to be contacted by a Licensed Sales Agent by email or phone call to discuss information about Medicare Insurance Plans. This is a solicitation for insurance.”

Medicare Plan Review

Review Your Coverage by Email

Spouse/Partner Information

YOUR Medical Info

SPOUSE/PARTNER'S Medical Info

Other Coverages

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