Gold Plan — In-Depth Review (60-minute session)

Next Step: Sign Your Service Agreement & Secure Your Spot

Thank you for choosing the Gold Plan — In-Depth Review (60-minute session). You’re almost there!


Please complete the form below to finalize your service agreement and confirm your appointment.

What to expect next:

Step 1: Review and sign the agreement, which outlines what’s included and your responsibilities.
Step 2: Submit the signed agreement, and you’ll receive a link to schedule your one-on-one session at a convenient time.
Step 3: Complete payment for your session through our secure system. Once payment is confirmed, you’ll receive a confirmation email.

This form ensures everything is clear and agreed upon so we can provide you with seamless, personalized Medicare guidance.

Gold Level Service Agreement & Payment

Medicare Plan Advocates Inc. – Gold Contract

Beneficiary Information (Required):

POA or Personal Legal Representative (if applicable):

Tier Level: Gold Plan ($75)

By selecting this plan, I agree to the following:

  • I understand this service does not guarantee specific outcomes or exact medication costs; it provides an estimate using Medicare.gov Plan Finder.
  • Before my session, I will have or create a Medicare.gov account and ensure I know my login information (MPA can help create this if needed).
  • I will provide a current list of all prescription medications and dosages, including creams, eye drops, inhalers, and occasional medications. (I will not include vitamins, OTC items, or medications covered under Part B.)

Scope of Services

  • 60-minute Medicare.gov Part D analysis and consultation.
  • Assistance with creating or accessing my Medicare.gov account.
  • Research and recommendations for potential cost-saving options (e.g., GoodRx, SingleCare, Cost Plus, Pharmacy Checker).
  • Help enrolling into the selected drug plan through Medicare.gov.
  • There is no ongoing support after this session; this is considered a Self-Enrolled Plan.

General Disclaimer

  • MPA is an independent consultant and not an agent of Medicare.
  • Information provided to MPA is used solely for this analysis and will not be kept or shared.
  • I retain full responsibility for my final Medicare Part D plan selection.

Digital Signature

By typing my name below, I confirm this serves as my legal digital signature.

Payment Section

Once signed, you will be directed to complete secure payment for $75 to finalize your booking

Need Extra Support Before You Sign?

Our team is here to walk you through the process and make sure you feel fully confident before you move forward. Whether you want help understanding the agreement, choosing the right plan, or just need a friendly voice to talk it through — we're here for you.