Request for Information - MedicareOnDemand Request for Information

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Getting Ready for Medicare?

You are a VIP (Very Important Patient)

To assist you with your Medicare plan needs, offers the services of MedicareOnDemand, a non-government platform serviced by the MCUSA Holding family of companies. By completing this optional form, you authorize a licensed insurance agent from MedicareOnDemand to contact you.

Getting Ready for Medicare?

Use the services of MedicareOnDemand, a Medicare plan insurance resource offered in conjunction with MedicareOnDemand, a non-government platform serviced by the MCUSA Holding family of companies. By completing this optional form, you authorize a licensed insurance agent from MedicareOnDemand to contact you.

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Please tell us how we can help you.

Check all that apply:

Schedule your Medicare Orientation

Information about activating or postponing your Medicare benefits

Compare Medicare Supplement (Medigap) and Medicare Advantage plans accepted by your physicians and hospital

Find a Medicare Prescription Drug plan that covers my medications

I am conducting Medicare insurance research and want to speak with a licensed insurance agent before making my final decision

TCPA Consent

MedicareCompareUSA

Senior Choice Plans LLC

My phone number where these companies may contact me is:

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MCUSA_1017_MODProvMedReqFrm_C

(866) 391-7763

M-F 9am-5pm

TTY 711

MedicareOnDemand is a non-government platform provided by the MCUSA Holding family of companies including: MedicareCompareUSA, MCUSA Insurance Services, MCUSA Insurance Center, Fairhaven Insurance Solutions, and Insurance Helpline Services. All MCUSA Holding insurance agencies are independent and not affiliated with the federal Medicare program. All services are provided at no cost and without obligation; MedicareOnDemand and our affiliated agents are paid directly by the Medicare plan when enrollment occurs. Healthcare providers receive no financial benefit when patients use the service. We do not offer every plan available in your area. Currently we represent 6 organizations which offer 24 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.