By clicking YES, I provide my electronic signature and express consent to be contacted by a licensed insurance agent at [Your Name/Agency Name] regarding Medicare Advantage, Group Health, or Prescription Drug Plans.

I understand that I may be contacted via telephone, email, or text message at the number and address provided above, even if I am on a State or Federal Do Not Call Registry. I acknowledge that my consent is not a condition of purchase and that I can revoke this consent at any time. Messaging and data rates may apply.

This is a solicitation for insurance. I understand that the person who will contact me is employed or contracted by a Medicare health plan or prescription drug plan that is not the Federal Government, and they may be compensated based on my enrollment in a plan."

Disclaimer: VIP Insurance Group offers a number of Medicare Advantage, stand alone prescription drug plans, supplemental plans, and hospital indemnity plan options for 2026. VIP Insurance Group does not offer every plan in your area, currently we represent the top organizations which offer the top products in your area.

Please visit medicare.gov, call 1-800-MEDICARE, or contact your local

State Health Insurance Program to get information on all of your options.

Medicare regulations require that we obtain your consent before we contact you to discuss Medicare Advantage plan(s).

PLEASE NOTE: This Consent to Contact Form is optional. Submitting this optional form does NOT obligate you to enroll in a plan, affect your current or future Medicare enrollment, or automatically enroll you in a plan.

By completing this form, your information will be provided to VIP Insurance Group, a licensed insurance agent. You may be contacted by VIP Insurance Group who is a licensed and certified representative of Medicare Advantage organizations and/or stand-alone Prescription Drug Plans. Each of the organizations they represent has a Medicare contract. 

VIP Insurance Groups is not affiliated nor endorsed by Medicare or any government agency.