Opt-Out Form - Secure My Medicare Plan

Secure My Medicare Plan

Opt-Out Form

Speak with a licensed insurance agent

1 (800) 674-6376 | TTY 711
Monday - Friday 7am - 7pm PST

Opt-Out Form / Do Not Sell My Personal Information

First Name

Last Name

Phone Number

Zip Code

State

I verify that the contact information entered is correct and is my personal information, and I request to opt-out of all marketing communications, phone calls, SMS/MMS, and emails from securemedicareplan.com. I understand that my details will be added to the internal Do Not Call list and that securemedicareplan.com will process this request within compliance guidelines.

34145 Pacific Coast Highway, Suite 757
Dana Point, California 92629

Monday – Friday
7am – 7pm PST

1 (800) 674-6376
TTY 711

IMPORTANT DISCLOSURES

TPMO Disclaimer: We do not offer every plan available in your area. Currently we represent 8 organizations which offer 15 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.

FCS Disclaimer: Participating sales agencies represent Medicare Advantage [HMO, PPO and PFFS] organizations and stand-alone PDP Prescription Drug Plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.

OEP/SEP Disclaimer: Enrollment in the described plan type may be limited to certain times of the year unless you qualify for a Special Enrollment Period.

Non-Government Disclaimer: Not affiliated with the U.S. government or Federal Medicare program. We are not an insurance carrier, licensed sales agent or broker.

Plan Availability Disclaimer: Benefits, premiums, provider networks, and plan availability vary by carrier and location.

Medicare Supplement Disclaimer: Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Acceptance may depend on medical underwriting outside of your Medigap Open Enrollment Period.