Futurity First - 2020 Part D Prescription Drug Questionnaire
Presented by
Bill Kardos
Last Date to Sign Up
12PM EST - DEC. 4th, 2019
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Submitting this form will not enroll you in any particular plan. You will still need to call and enroll with the recommended plan.
About The 2020 Prescription Open Enrollment Process
As in years past, as part of the value added services we provide for our clients, we pledge to help you find the most suitable drug plan for your situation. This service was always performed by our local agency and not by any particular insurance carrier. To be eligible for this service, you must be a current Futurity First client with an active Medicare Supplement, Supplemental Health or Life policy or an investment account.
We take your most current prescription drug information and your preferred pharmacies.
We analyze the options available using our exclusive process
We will find you the plan with the lowest total out-of-pocket cost, the pharmacies with the lowest price for that plan, and give you instructions on how to enroll.
INSTRUCTIONS : In order to provide you the most accurate information, please fill out all areas as completely as possible. Selecting a drug store is not required but drug prices can vary dramatically between different drug stores.
For each Medicine - Please enter the drug NAME, DOSE and NUMBER of pills, syringes or bottles you get each month.
Example : Metformin, 500mg, 60 tabs.
If you take more than 10 medications enter the additional medications in the box below "Medicine 10". Each household member will have to fill out their own form.
If you provide incomplete information it may delay us finding your plan or result in your drug and plan costs being greater than if we had complete information.
If you provide your drug information later than 12 Noon on December 4, 2019, we will not have time to locate a drug plan for you. We will work on plans in order received.
Due to the level of work involved with plan research and the number of requests, we will not be able to preform a plan search unless you or a household member are a current Futurity First Pittsburgh client.
If you are not a current Futurity First Client but would like to see how much we can save you on your current Medicare Premiums with the 32 companies we represent, you can call me at 800-495-7874 or 412-838-9643. Then we will be able to perform your 2019 PDP research.
If you need help or additional information, please feel free to call me at 412-838-9643 or 800-495-7874. If you would like a traditional paper drug survey, please call as soon as possible.
Futurity First, Futurity First Pittsburgh, Legacy Wealth Strategies or William Kardos are not affiliated with the US Governement, Medicare or any Federal Program. The prescription drug search we perform is value added service we provide for no compensation from any Prescritption Drug Plan. We will suggest the plan that appears to have the lowest total out-of-pocket cost based on the information you provide to us. Our suggestion will only be as accurate as the information you provide and will not reflect any changes in your prescriptions in the new plan year. Your contrract is with whichever individual PDP you choose and any questions should be directed to them. We will be unable to answer any plan questions for you and can not respond to questions about plans after you have enrolled. (c) 2019