Request C&D Plan Review

Plan Review requests will not be processed until the 2023 information is released by Medicare.  We expect the information to be available after October 15, 2022.  Thank you for your patience as we hurry to provide the most up to date information available.

C&D Plan Review

Medicare Part C/D Review Request

Check Medicare Insurance Choices for the upcoming year. Medicare Advantage & Prescription Drug Plans will be changing their premiums, deductibles, co-pays and formularies for next year.  October 15 through December 7 is your opportunity to make changes to your plan selections for the upcoming year.  Submit a complete prescription medication list and you will receive personalized information about the plans by mail or email.  Next year's plan information should be available October 15th at 

Open to Washington County residents only.

Contact Info


Insurance Coverage

Medicare Part A Start Date: 
Medicare Part B Start Date: 
Current Prescription or Advantage Plan - SELECT ONE PLAN
(Select insurance company then select your plan in the corresponding dropdown box) 
* If you are not sure what plan you have please check the contract ID number on your plan card.
 Anthem BCBS
 Clear Spring 

Community Care




 Mutual of Omaha

 My Choice Wisconsin Health Plan

 Network Health


 United Healthcare / AARP

 Wellcare by Allwell

 Other (Employer Group Plan, Retiree coverage, WI SeniorCare, Veterans Benefits)

Pharmacy Selection

Plan reviews include mail order pricing and the pricing for up to 4 local pharmacies. 
Local Pharmacy Preference Select up to 4 pharmacies. 
*Note: if no pharmacy is selected we will default to Walgreens
Mail Order 

Drug List

Please provide complete medication list including NAME, DOSAGE and HOW OFTEN TAKEN for each drug.  Additional drugs can be included in the comments section below.  

(If prescription is taken "as needed" advise how often script is filled ie: every 3 months, once per year, etc.)


Example: Lisinopril - 10MG - 1 per day

Prescription 1: 
Prescription 2:  
Prescription 3: 
Prescription 4: 
Prescription 5: 
Prescription 6: 
Prescription 7: 
Prescription 8: 
Prescription 9: 
Prescription 10: 
Prescription 11: 
Prescription 12: 
Prescription 13: 
Prescription 14: 
Prescription 15: 


Please provide any special instructions or additional medications in the comments section.  Please feel free to also include any specific questions or comments you may have in the comment box below.  
Thank you for taking the time to complete this form!

Security Measure