Palffy Insurance Group

Medicare Prescription Drug Plan Quote Request

Prescription Plan Quote Form
*Required Fields

First Name*

Last Name*

Phone Number*

Email Address*

Zip Code*

Do you have Medicare Parts A & B?*

Are you new to Medicare?*

Did you recently turn 65 or will you turn 65 in the near future?*

Will you be losing or did you recently lose employer group insurance?*

Additional Comments:

A sales agent may call you as a result of submitting this form. We may need to clarify some information while completing your quote request. We may call you to discuss your options after you receive your quote.

The information you provide will only be used to satisfy your quote request. Certain information will be shared with insurance companies for quoting purposes only. No insurance company and no other insurance agency will market to you as a result of submitting this form. We do not share your information with outside organizations for marketing purposes.

Prescription Drug Plans

With only a few exceptions, Original Medicare does not cover outpatient prescription drugs. Medicare Part A covers medications administered in the hospital and Part B covers some medications that are administered in outpatient treatment facilities or doctor's offices.

Medicare Part D Prescription Drug Plans cover medications that are prescribed by your doctor for outpatient medical treatment (e.g. prescriptions that you take on your own).

Medicare Prescription Drug Plans are run by private insurance companies that are approved by Medicare. These plans are highly regulated by the federal government and must adhere to strict guidelines.