Medicare Enrollment Information

Please fill out the form below so that we can present

accurate information pertaining to your Medicare options.

Tip: Click the Year first, then month lastly, the day

I consent to receive marketing communications from Health Wealth Simplified DBA Mere as described in our Privacy Policy. I understand that I can unsubscribe at any time.I consent to receive communications from Health Wealth Simplified LLC, DBA Mere, including but not limited to SMS notifications, emails, ringless voicemails, and phone calls. These communications may include information about health insurance plans, updates, and promotional offers. Some communications may be automated or managed by an AI bot. Message frequency may vary. Message and data rates may apply. You can opt out of these communications at any time by replying STOP to any message.

I acknowledge that some virtual meetings may be recorded and transcribed using Fathom AI Notetaker, a HIPAA-compliant tool used by Mere to support accurate documentation. This platform operates under a Business Associate Agreement and stores data securely. I understand that meeting summaries or transcripts may be retained and used only for service-related purposes.

*IF YOU PUT "YES" TO MEDICAID, PLEASE PROVIDE YOUR SOCIAL SECURITY NUMBER
Please add Drug Name - Reason for Med, Dosage and Frequency. (ex. Lisinopril 20mg 1x day)
Please provide Full Name with correct spelling.

Please take note: Each individual looking for coverage needs their own form completed. Thank you!