bestamericanmedicare.com Open in urlscan Pro
3.161.119.100  Public Scan

Form analysis
1 forms found in the DOM

POST #

<form id="certback-form" action="#" method="POST" class="mt-9 grid grid-cols-1 gap-y-6 lg:grid-cols-2 sm:gap-x-8">
  <div><label for="first-name" class="block text-sm font-medium text-blue-800">First name (Optional)</label>
    <div class="mt-1"><input type="text" name="first-name" id="first-name" class="block w-full shadow-sm w-full pl-2 pr-3 py-2 lowercase border-2 border-gray-200 outline-none focus:border-blue-800 rounded-md" placeholder="Mia" autocomplete="false">
    </div>
  </div>
  <div><label for="last-name" class="block text-sm font-medium text-blue-800">Last name (Optional)</label>
    <div class="mt-1"><input type="text" name="last-name" id="last-name" class="block w-full shadow-sm w-full pl-2 pr-3 py-2 lowercase border-2 border-gray-200 outline-none focus:border-blue-800 rounded-md" placeholder="Smith" autocomplete="false">
    </div>
  </div>
  <div class="lg:col-span-2"><label for="email-address" class="block text-sm font-medium text-blue-800">Email (Optional)</label>
    <div class="mt-1"><input id="email-address" name="email-address" type="email" class="block w-full shadow-sm w-full pl-2 pr-3 py-2 lowercase border-2 border-gray-200 outline-none focus:border-blue-800 rounded-md"
        placeholder="miasmith@bestamerican.com" autocomplete="false"></div>
  </div>
  <div class="lg:col-span-2"><label for="address1" class="block text-sm font-medium text-blue-800">Street Address (Optional)</label>
    <div class="mt-1"><input type="text" name="address1" id="address1" class="block w-full shadow-sm w-full pl-2 pr-3 py-2 lowercase border-2 border-gray-200 outline-none focus:border-blue-800 rounded-md" placeholder="737 Walnutwood Avenue"
        autocomplete="false"></div>
  </div>
  <div class="lg:col-span-2"><label for="city" class="block text-sm font-medium text-blue-800">City (Optional)</label>
    <div class="mt-1"><input type="text" name="city" id="city" class="block w-full shadow-sm w-full pl-2 pr-3 py-2 lowercase border-2 border-gray-200 outline-none focus:border-blue-800 rounded-md" placeholder="Chelmsford" autocomplete="false"></div>
  </div>
  <div class="lg:col-span-2"><label for="state" class="block text-sm font-medium text-blue-800">State (Optional)</label>
    <div class="mt-1"><input type="text" name="state" id="state" class="block w-full shadow-sm w-full pl-2 pr-3 py-2 lowercase border-2 border-gray-200 outline-none focus:border-blue-800 rounded-md" placeholder="California" autocomplete="false">
    </div>
  </div>
  <div class="lg:col-span-2"><label for="zipcode" class="block text-sm font-medium text-blue-800">Zip Code (Optional)</label>
    <div class="mt-1"><input type="text" name="zipcode" id="zipcode" class="block w-full shadow-sm w-full pl-2 pr-3 py-2 lowercase border-2 border-gray-200 outline-none focus:border-blue-800 rounded-md" placeholder="90210" autocomplete="false"></div>
  </div>
  <div class="lg:col-span-2">
    <div class="flex justify-between"><label for="phonenumber" class="block text-sm font-medium text-blue-800">Phone Number (Optional)</label></div>
    <div class="mt-1"><input type="text" name="phonenumber" id="phonenumber" class="block w-full shadow-sm w-full pl-2 pr-3 py-2 lowercase border-2 border-gray-200 outline-none focus:border-blue-800 rounded-md" placeholder="(519) 555-0148"
        autocomplete="false"></div>
  </div>
  <div class="lg:col-span-2">
    <div class="flex justify-between"><label for="dob" class="block text-sm font-medium text-blue-800">Date of Birth (Optional)</label></div>
    <div class="mt-1"><input type="text" name="dob" id="dob" class="block w-full shadow-sm w-full pl-2 pr-3 py-2 lowercase border-2 border-gray-200 outline-none focus:border-blue-800 rounded-md" placeholder="mm/dd/yyyy" autocomplete="false"></div>
  </div>
  <div class="lg:col-span-2"><input id="leadid_tcpa_disclosure" type="hidden">
    <p id="tcpa" class="text-xs">This authorization overrides any previous registration on a federal, state or corporate Do Not Call Registry or any internal AcquireCrowd privacy or solicitation preference you have previously expressed.<br><br>By
      clicking register, I provide my express written consent via electronic signature to be contacted by a <a href="https://acquirecrowd.com/partners" target="_blank" style="text-decoration:underline">partner</a> in the AcquireCrowd Network with
      insurance marketing offers, including but not limited to Medicare Advantage, Medicare Supplement and Prescription Drug plans through the use of direct or electronic mail, phone calls to the phone number provided (including any wireless number),
      text/SMS messages, via automatic/automated dialing system(s), and pre-recorded messages. Consent is not a condition of purchase and may be revoked at any time.<br><br>Telephone company may impose additional charges on subscribers for
      messages.<br><br>This is a solicitation for insurance, products and services including Medicare Supplement, Medicare Advantage and Prescription Drug Plans.<br><br>For health and Medicare, I grant the agent permission to discuss health, Medicare
      Advantage and Prescription Drug products available in my area with me. The agent will walk through and review all the benefits available to me and determine if one meets my needs. I understand that I may revoke this consent at any time, and I
      understand that my consent is not required as a condition of purchasing any goods or services.</p>
    <div class="text-center underline text-sm my-5">
      <div class="space-x-4"><a href="https://www.reservetechinc.com/privacypolicy.php">Privacy Policy</a> <a href="https://www.reservetechinc.com/termsandconditions.php">Terms &amp; Conditions</a></div>
      <div class="space-x-4"><a href="https://www.reservetechinc.com/ccpa-do-not-sell-my-information.php">Do Not Sell My Information</a> <a href="https://www.reservetechinc.com/ccpa-your-california-privacy-rights.php">For Our California Audience</a>
      </div>
    </div>
  </div>
  <div class="text-right lg:col-span-2"><input id="ip_address" type="hidden" name="ip_address" value="45.141.152.77"> <input id="consent" type="hidden" name="consent"
      value="This authorization overrides any previous registration on a federal, state or corporate Do Not Call Registry or any internal AcquireCrowd privacy or solicitation preference you have previously expressed. By clicking register, I provide my express written consent via electronic signature to be contacted by a partner in the AcquireCrowd Network with insurance marketing offers, including but not limited to Medicare Advantage, Medicare Supplement and Prescription Drug plans through the use of direct or electronic mail, phone calls to the phone number provided (including any wireless number), text/SMS messages, via automatic/automated dialing system(s), and pre-recorded messages. Consent is not a condition of purchase and may be revoked at any time. Telephone company may impose additional charges on subscribers for messages. This is a solicitation for insurance. products and services including Medicare Supplement, Medicare Advantage and Prescription Drug Plans.">
    <input id="leadid_token" name="universal_leadid" type="hidden" value="B4096C74-4F51-8844-E6B1-774E889D82EA"> <button id="submit" type="submit"
      class="register block w-full max-w-xs mx-auto bg-red-600 hover:bg-red-700 focus:bg-red-700 text-white mt-4 mb-5 px-3 py-3 font-semibold disabled:opacity-50 disabled:cursor-not-allowed">REGISTER</button></div><input type="hidden"
    name="trusted_form" value="https://cert.trustedform.com/d260191657357aea2a6d67cab596eb3ac7b086f7" id="trusted_form_0"><input type="hidden" name="xxTrustedFormToken" value="https://cert.trustedform.com/d260191657357aea2a6d67cab596eb3ac7b086f7"
    id="xxTrustedFormToken_0"><input type="hidden" name="trusted_form_ping_url" value="https://ping.trustedform.com/0.qcF7W6rhFyoJRazccXL6SG189giKezenjJVaIB-YaQ88y_xKU7YP0HzCXy1KDUPdSJJCVR7d.hw_eTjXA6UNmzVwBUCQucg.oUNl8EnVJFtZAraq4_mxeQ"
    id="trusted_form_ping_url_0">
</form>

Text Content

Non-Government Entity

To speak to a Licensed Insurance Agent +1-866-716-3066, TTY 711

Hours of operation: 8am to 6pm ET


NEW TO MEDICARE AND WANT TO REVIEW YOUR ELIGIBILITY?


ENTER YOUR INFORMATION TO SPEAK TO A LICENSED INSURANCE AGENT



Consent is not required to use this service and providing contact information
marked optional is not required.

First name (Optional)

Last name (Optional)

Email (Optional)

Street Address (Optional)

City (Optional)

State (Optional)

Zip Code (Optional)

Phone Number (Optional)

Date of Birth (Optional)


This authorization overrides any previous registration on a federal, state or
corporate Do Not Call Registry or any internal AcquireCrowd privacy or
solicitation preference you have previously expressed.

By clicking register, I provide my express written consent via electronic
signature to be contacted by a partner in the AcquireCrowd Network with
insurance marketing offers, including but not limited to Medicare Advantage,
Medicare Supplement and Prescription Drug plans through the use of direct or
electronic mail, phone calls to the phone number provided (including any
wireless number), text/SMS messages, via automatic/automated dialing system(s),
and pre-recorded messages. Consent is not a condition of purchase and may be
revoked at any time.

Telephone company may impose additional charges on subscribers for messages.

This is a solicitation for insurance, products and services including Medicare
Supplement, Medicare Advantage and Prescription Drug Plans.

For health and Medicare, I grant the agent permission to discuss health,
Medicare Advantage and Prescription Drug products available in my area with me.
The agent will walk through and review all the benefits available to me and
determine if one meets my needs. I understand that I may revoke this consent at
any time, and I understand that my consent is not required as a condition of
purchasing any goods or services.

Privacy Policy Terms & Conditions
Do Not Sell My Information For Our California Audience
REGISTER


WHAT IS THIS ALL ABOUT?

Best American Medicare can help you find the right Medicare plan and check your
eligibility with our proprietary tools, articles, and a licensed insurance agent
is here to help you find a plan to see if you may start saving. Complete the
form above today!

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 of your plan options.

ONLY TAKES A MOMENT

We won't waste your time. Complete the short form to see if you could save!

YOUR INFORMATION IS SAFE

SAFE AND SECURE INQUIRY

Best American Medicare will not negatively affect your credit.


FIND YOUR MEDICARE OPTIONS

We are here for you in your journey to find the right Medicare plan for your
needs and to check your eligibility for enrollment

GET STARTED

To request plan information without providing personal information, please call
the phone number above. We are not affiliated with any plan or endorsed by any
government entity or agency. We connect individuals with insurance providers and
other affiliates (collectively, “partners”) to give you, the consumer, an
opportunity to get information about insurance and connect with licensed
insurance agents. By completing the quotes form or calling the number listed
above, you will be directed to a partner that can connect you to an
appropriately licensed insurance agent who can answer your questions and discuss
plan options. 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 of your plan options.
Products and services are provided exclusively by our partners, but not all
offer the same plans or options. Possible options that may be offered include,
but are not limited to, ACA-Qualified Plans, Medicare Advantage Plans, Short
Term Plans, Christian/Health Sharing Plans, and Fixed Indemnity Plans.
Descriptions are for informational purposes only and subject to change. We
encourage you to shop around and explore all of your options. We are not
affiliated with or endorsed by any government entity or agency. By using this
site, you acknowledge that you have read and agree to the Privacy Policy and
Terms & Conditions.

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. Enrollment in a plan may be
limited to certain times of the year unless you qualify for a special election
period, or you are in your Medicare Initial Election Period. Not all plans offer
all of the benefits mentioned. $0 premium plans are not available in all areas.
Enrollees must continue to pay their Medicare Part B Premium. Deductibles, copay
and coinsurance may apply.

Plans are insured or covered by a Medicare Advantage organization with a
Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the
plan depends on the plan's contract renewal with Medicare.

Privacy Policy Terms & Conditions
Do Not Sell My Information For Our California Audience

MULTI-PLAN_SQIUyOaLoQ2024_C