Filling out this form is optional. By filling out this form you agree that a sales representative of Franklin Benefits Group LLC may contact you by email or phone to discuss Medicare Advantage, Medicare Supplement and Prescription Drug plans.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.

*Not connected with or endorsed by the United States government or the federal Medicare program.