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SHIBA Medicare Counseling

Please complete the following information. A SHIBA Medicare Counselor will contact you to arrange an appointment.

Appointment Information

Name

First Name

Last Name

Verify Email

Phone

Select All that Apply

Initial Medicare Enrollment

Choosing Medigap plan

Choosing Part D Prescription Plan

Understanding Benefits and Coverage

Help with claims, notices, etc.

Changing Coverage

Help with Medicare costs

Other (describe below)

Additional or Other Questions