Giardini Medicare
We're happy to help, but we just need a bit more information...
Name
*
First Name
Last Name
The state that you reside in:
*
Email
*
example@example.com
Best phone number
*
Please enter a valid phone number.
Date of birth:
*
If you are married, is your spouse currently eligible for Medicare?
Please Select
Yes
No
Not applicable
I am CURRENTLY collecting Social Security benefits:
*
Please Select
Yes
No
Your CURRENT insurance coverage is through:
*
Please Select
My employer that has OVER 20 employees
My spouse's employer that has OVER 20 employees
My employer that has UNDER 20 employees
My spouse's employer that has UNDER 20 employees
An employer retiree plan (through my own work history OR my spouses)
ChampVA
Christian Health Share arrangements
Cobra insurance coverage through prior employer
Medicaid
The ACA/Marketplace/Obamacare
The Federal Government
TriCare
VA coverage (I seek treatment there exclusively)
No insurance coverage at all
Other (please explain in the notes section)
Are you CURRENTLY putting money into a health savings account?
*
Please Select
Yes
No
IMPORTANT: Do you have access to any RETIREE health insurance - this will typically be a former employer's plan, FEHB, TriCare for Life, ChampVA, retired union, schoolteacher, municipalities, etc.
*
Please Select
Yes
No
Not sure - I will find out and let you know
Are you currently working?
*
Please Select
Yes
No
I've been retired - I now need Medicare at age 65
If working, when do you plan to retire? Please enter date or approximate month/year:
If you have OR are applying for Medicare Part B coverage, what is your start date?
Notes: Anything that you'd like to share. The more we know about your situation, the more we can help.
*If you have work insurance and you know how much you are paying for your coverage, please include that amount here:
I found your company from __________
*
TikTok
YouTube
Podcast
Instagram
Webinar
YouTube Shorts
My financial advisor (see below)
E-mail sent to me
Other
My advisor's name is: (OPTIONAL)
This fact sheet from CMS (i.e. Medicare) can help in your decision making as well. You can download a copy to your computer for your reference.
Since you are covered through an employer with over 20 employees, take some time to watch our video on YouTube.
Submit
Should be Empty: