Gordon Marketing

Medicare Referral Program

Medicare Referral Form

1Your Information

2Referral Information

3Next Steps

Referral Agent Name*
Who is your GM Marketer?
Referral Agent Phone*
Referral Agent Email*

Referral First Name*
Referral Last Name*
Referral Phone Number*
Referral Email
Referral Zip Code
State*
How Can We Help?*
What Should We NOT Discuss?

We will do our very best to find the right policy for your referral. Although we have contracts with most carriers, we are not contracted with every single company. Should another company be better suited for your referral, we will direct them to the carrier (which can happen on a PDP plan as not all PDP plans contract with agents).

We will keep you updated on the status of your referral. When/If we are able to enroll the referral in a qualifying plan, we coordinate payment via ACH.

If you have any questions, please contact Elisha Brewer, Referral Program Manager via email: [email protected]

Thank you, we promise to take great care of your referral!

*Guaranteed Issue Supplements are excluded

*If we do not get paid by the carrier, we cannot pay a referral payment.

© 2022 The Medicare Family All Rights Reserved.

Privacy Policy ∙ Terms of Use

Owned by: ESG Insurance d/b/a The Medicare Family. This website is not connected with the federal government or the federal Medicare program. 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 options.

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