Access to your Medicare.gov account allows us to save medication lists and compare your options. 

Security Question for Future Password Reset Purposes (answer only one)

Reminder: You will receive a one-page letter from Centers for Medicare and Medicaid regarding account access if we set up an account for you.

Please list all of your current prescription medications as they are written on your medication bottles (list generic name if used). List only medications prescribed by your doctor and do not include over-the-counter items.

Medicare Advantage plans have HMO or PPO networks that you must use. If you are interested in Medicare Advantage Plans, please list all providers you currently use. 

Specialists (Doctors, Dentists, Durable Medical Equipment providers, etc.)

I have voluntarily provided the information on this sheet to BIFS, LLC, dba Baker Insurance & Financial Services to aid in the choice of individual health plan(s). I am pursuing their advice for health plan(s) that will best service my needs. I agree to receive my personal, no cost, no obligation recommendation, and I further authorize a licensed sales agent to contact me by phone, text, email, or mail, if needed. This information, provided to Baker Insurance, is not to be used for any purpose other than for my health plan(s) selection. I understand I am not bound to accept their recommendation.