Opt-Out - medicaresinfo.com

Opt-Out Form

We regret that you are considering opting out of Medicare, but we understand that healthcare needs can vary from person to person. If you’ve made the decision to opt out, we are here to guide you through the process. Please fill out the form below to let us know your reasons and begin the opt-out procedure. Our team is ready to provide the support you need to make an informed decision about your healthcare options.

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TPMO Disclaimer: We do not offer every plan available in your area. Currently, we represent 6 organizations which offer [insert number of plans] 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, PFFS] and/or Prescription Drug Plan organizations that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.

OEP/SEP Disclaimer: Enrollment in a plan may be limited to certain times of the year unless you qualify for a special enrollment period.

General Benefits Disclaimer: Not all plans offer all available benefits. Benefits vary by carrier, plan, and location. Deductibles, copays, coinsurance may apply. Allowance amounts cannot be combined with other benefit allowances. Limitations and exclusions may apply. Enrollment in a plan may be limited to certain times of the year unless you qualify for a special enrollment period.

Aetna Disclaimer: To send a complaint to Aetna, call the Plan or the number on your member ID card. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048, 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.