Fill Out Our MyMedicare Account Form

MyMedicare Account Form

Fill in our MyMedicare Account Form, and a member of our team will get back to you as soon as possible.

Next Step Insurance

First Name:
Last Name:
Username:
Password:
Security Question:
Answer:
The above information is to access your account on the MyMedicare.gov site at: https://account.mymedicare.gov Next Step Insurance and its agents use the above information to run Part D plan estimates specific to your prescription medication needs. We do not share this information and follow all Privacy and Security Rule statutes related to Protected Health Information (PHI) and Personally Identifiable Information (PII) regarding HIPAA policy regulations. Its use is strictly confidential and allows Next Step Insurance and its agents the ability to provide the most suitable Part D prescription plan recommendations. By providing us this information, you agree to allow access to this account and, if necessary, update the prescription information used to run cost estimates with the most recent list of medications you have provided to us.

I Have An Existing MyMedicare.gov Account I have an existing MyMedicare.gov account and have voluntarily provided the credentials above, giving access to Next Step Insurance and its agents for the sole purpose of prescription medication cost and plan estimates.
Signature:
Date

I Do Not Have An Existing MyMedicare.gov Account I do not have an existing MyMedicare.gov account and request Next Step Insurance and its agents to create an account for my benefit and their sole use for prescription medication cost and plan estimates.
Siganture:
Date:

I Choose Not To Provide MyMedicare.gov Account I choose not to provide MyMedicare.gov account information to Next Step Insurance and recognize and agree that Next Step Insurance and its agents may no longer be able to provide detailed Part D prescription medication cost estimates or recommendations.
Signature:
Date:

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Our clients Matter

Professional. They have products for Medicare-Medicaid supplements and advantage plans. Good people to work with.

Kris explained everything clearly, and let me decide what is best for my specific health benefits. The office is very friendly, and was efficient on scheduling and returning phone calls. I recommend Kris to everyone!

Knowledgeable personnel and they explain everything so you understand.

Very personable agents and knowledgeable.

The best service!

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We're ready to be your #1 insurance resource.

Tell us your story and we listen. Our office is conveniently located in the historic Mill Street Transfer in downtown Plymouth, WI in the heart of Sheboygan County. All consultation meetings are free for our clients.

Contact

info@nextstep-insurance.com
(920) 268-1600

Visit

435 East Mill Street Mill Street Transfer Building Plymouth, WI 53073

Fill Out Our MyMedicare Account Form

MyMedicare Account Form