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By completing this form, you agree that Ms. Xavier Scott a licensed Insurance Sales Agent, may contact you by phone or email to answer any questions you have regarding Medicare Advantage Plans, Part D Prescription Drug Plans or Medicare Supplement Plans. This is a solicitation for insurance. The communications consented to above including marketing of insurance products. Licensed insurance agents are not connected with or endorsed by the U.S. government or the federal Medicare program. Submitting this form does NOT affect your current enrollment, nor will it enroll you in a Medicare Advantage Plan, or Prescription Drug Plan. A Medicare Advantage Plan is a health insurance plan provided through a private insurer and delivers Medicare Part A and Part B benefits. A Part D Drug Plan is a prescription drug insurance plan provided through a private insurer and delivers Medicare Part D benefits.

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