2025 Drug Plan Finder - Registration
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email Address (Optional. But, you will receive a confirmation email if you list it.)
Confirmation Email
Zip Code
*
Local County
*
Pharmacy Preferences (Select up to 3)
*
CVS
Walgreens
Brookshires
Walmart
Publix
HEB
Tom Thumb
Other - Click box to left and type in pharmacy name
Current Prescription Drug Coverage - Check ALL that apply
*
I have a Medicare Part D drug plan.
I have prescription drug coverage through the VA.
I have prescription drug coverage through my employer.
I do not have a prescription drug plan.
Other
Does the following apply to you in regards to paying for your Medicare Part D drug plan.
*
I currently pay a late-enrollment penalty for my Medicare Part D drug plan.
I am enrolled in the Medicare Extra Help program for my Medicare Part D drug plan.
I pay extra premium each month (IRMAA) for my Medicare Part D drug plan.
I don't get help from any of these programs.
I have Medicaid.
Current Medicare Health Coverage
*
I have a Medicare supplement.
I have a Medicare Advantage plan.
I have group health coverage.
I have an individual health plan.
I do not have any health coverage.
I have Medicaid.
How many prescriptions do you take?
Please Select
Ask client - do not have a list of medications
0 - I do not take any prescription medications
1 medication
2 medications
3 medications
4 medications
5 medications
6 medications
7 medications
8 medications
9 medications
10 medications
11 medications
12 medications
13 medications
14 medications
15 medications
16 medications
17 medications
18 medications
19 medications
20 medications
Back
Next
Upload List of of Medications or Your Can Enter Them Below
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Current List of Medications
Additional notes to tell Medicare Supplements Plus+ team member:
Settings - Email to Get Notification of New Submission
example@example.com
Appointment Date and Time
-
Month
-
Day
Year
Date
Team Member
Catherine
Mark
David
Mandi
Heather
Other
2024 Medicare Part D Drug Plan
Submit
Should be Empty: