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Submitted URL:
http://li.emergencyemail.org/click?s=705960&li=eewn&m=af1d463765e7de94ff835950e21131d9&p=WeatherAlerts3212022
Effective URL:
https://www.gomedicare.com/new-medicare-rules-form-chat?link_id=16617&src=LV_GM&source_type=DISPLAY&affiliate_id=3930&cmpn=...
Submission: On March 25 via manual (March 25th 2022, 11:02:36 pm UTC) from US — Scanned from DE

Form analysis
8 forms found in the DOM

<form class="form">
  <h1 class="vertical-form__title">Let’s see if you qualify for a <span class="vertical-form__title-highlight">$5,100<sup class="vertical-form__title-sup">1</sup> Medicare subsidy</span> and a new Medicare plan - at no extra cost!</h1>
  <div class="form__button-wrapper"><button type="submit" class="form__submit" aria-label="See If I Qualify" tabindex="0">See If I Qualify</button>
    <p class="form__press-enter">Press Enter</p>
  </div>
</form>

<form class="form form--zip" novalidate=""><label for="zip-code" class="form__label">What is your <span class="form__label--highlighted">ZIP code</span>?</label>
  <div class="form__input-wrapper">
    <div class="form-field__container"><input type="tel" aria-label="ZIP Code" autocomplete="postal-code" disabled="" id="zip-code" maxlength="5" name="zip" placeholder="Enter ZIP Code here" tabindex="1" value="" class="form-field form__input"></div>
  </div>
</form>

<form class="form form__age-gange" novalidate="" id="age_range"><label class="form__label">What's your <span class="form__label--highlighted">age range</span>?</label>
  <div class="form__input-wrapper">
    <div class="form-field__container age_range"><input type="radio" class="custom-radio__input custom-radio__input--dropdown age-range" name="custom_question_ageRange_label" id="custom_question_agerange_label-under60" required="" value="Under60"
        tabindex="1"><label class="applicant-info-section__label" for="custom_question_agerange_label-under60">Under 60</label><input type="radio" class="custom-radio__input custom-radio__input--dropdown age-range"
        name="custom_question_ageRange_label" id="custom_question_agerange_label-60-69" required="" value="60-69" tabindex="2"><label class="applicant-info-section__label" for="custom_question_agerange_label-60-69">60 - 69</label><input type="radio"
        class="custom-radio__input custom-radio__input--dropdown age-range" name="custom_question_ageRange_label" id="custom_question_agerange_label-70-79" required="" value="70-79" tabindex="3"><label class="applicant-info-section__label"
        for="custom_question_agerange_label-70-79">70 - 79</label><input type="radio" class="custom-radio__input custom-radio__input--dropdown age-range" name="custom_question_ageRange_label" id="custom_question_agerange_label-80-89" required=""
        value="80-89" tabindex="4"><label class="applicant-info-section__label" for="custom_question_agerange_label-80-89">80 - 89</label><input type="radio" class="custom-radio__input custom-radio__input--dropdown age-range"
        name="custom_question_ageRange_label" id="custom_question_agerange_label-90plus" required="" value="90plus" tabindex="5"><label class="applicant-info-section__label" for="custom_question_agerange_label-90plus">90 +</label><input type="radio"
        class="custom-radio__input custom-radio__input--dropdown age-range" name="custom_question_ageRange_label" id="custom_question_agerange_label-no_answer" required="" value="no_answer" tabindex="6"><label class="applicant-info-section__label"
        for="custom_question_agerange_label-no_answer">Prefer Not to Say</label></div>
  </div>
</form>

<form class="form form--firstname" novalidate=""><label for="first-name" class="form__label">What is your <span class="form__label--highlighted">first name</span>?</label>
  <div class="form__input-wrapper">
    <div class="form-field__container"><input type="text" aria-label="First Name" autocomplete="given-name" disabled="" id="first-name" maxlength="35" name="fname" placeholder="Enter first name here" required="" tabindex="1" value=""
        class="form-field form__input"></div>
  </div>
</form>

<form class="form form--lastname" novalidate=""><label for="last-name" class="form__label">What is your <span class="form__label--highlighted">last name</span>?</label>
  <div class="form__input-wrapper">
    <div class="form-field__container"><input type="text" aria-label="Last Name" autocomplete="family-name" disabled="" id="last-name" maxlength="35" name="lname" placeholder="Enter last name here" required="" tabindex="1" value=""
        class="form-field form__input"></div>
  </div>
</form>

<form class="form form__medicare-ab" novalidate="" id="form_medicare_ab"><label class="form__label">Have this card?</label>
  <div class="form__input-wrapper">
    <div class="form-field__container medicare-ab"><input type="radio" class="custom-radio__input custom-radio__input--dropdown" name="custom_question_medicare_label" id="custom_question_medicare_label-yes" required="" value="yes" tabindex="1"><label
        class="applicant-info-section__label" for="custom_question_medicare_label-yes">Yes</label><input type="radio" class="custom-radio__input custom-radio__input--dropdown" name="custom_question_medicare_label"
        id="custom_question_medicare_label-no" required="" value="no" tabindex="2"><label class="applicant-info-section__label" for="custom_question_medicare_label-no">No</label><input type="radio"
        class="custom-radio__input custom-radio__input--dropdown" name="custom_question_medicare_label" id="custom_question_medicare_label-not_answered" required="" value="not_answered" tabindex="3"><label class="applicant-info-section__label"
        for="custom_question_medicare_label-not_answered">Prefer not to say</label><input type="radio" class="custom-radio__input custom-radio__input--dropdown" name="custom_question_medicare_label"
        id="custom_question_medicare_label-not_answered_unsure" required="" value="not_answered_unsure" tabindex="4"><label class="applicant-info-section__label" for="custom_question_medicare_label-not_answered_unsure">Unsure</label></div>
  </div>
</form>

<form class="form form--phoneEmail" novalidate=""><label for="phone-number" class="form__label">Last step<!-- -->, <!-- -->!</label>
  <div class="form__input-wrapper">
    <div class="form-field__container"><input type="text" aria-label="Email Address (Optional)" autocomplete="email" disabled="" id="email-address" name="email" placeholder="Email Address (Optional)" tabindex="1" value=""
        class="form-field form__input form__input-email"></div>
    <div class="form-field__container"><input type="tel" aria-label="Phone Number" autocomplete="tel" disabled="" id="phone-number" maxlength="35" name="phone" placeholder="Phone Number" required="" tabindex="2" value=""
        class="form-field form__input"></div><button type="submit" class="form__submit form__submit--over-consent" aria-label="See If I Qualify" tabindex="0">See If I Qualify<small class="form__button-consent">I consent to the terms in this
        form.</small></button>
    <div class="form__consent">
      <p>By clicking the button, you consent to be contacted by a licensed insurance agent at GoHealth or GoHealth services about Medicare Advantage, PDP plans, and other related services via automatic telephone dialing system, artificial voice
        and/or pre-recorded message, or text message at the telephone number you provided. You understand that consent is not a condition of purchase, and you may also receive a quote by contacting us by phone. You may revoke this consent at any
        time.</p>
      <p>GoHealth does not charge you for sending or receiving text messages. Your carrier's message and data rates may apply. By using this form, you agree to the terms of our
        <a href="/privacy-policy?link_id=16617&amp;src=LV_GM&amp;source_type=DISPLAY&amp;affiliate_id=3930&amp;cmpn=287175&amp;ad=984983&amp;p1=29283&amp;p2=10063667&amp;p3=PC&amp;li_did=24721534-b72a-3a33-88b2-039cf75f1998" target="_blank">Privacy Policy</a>.
      </p>
    </div>
  </div>
</form>

GET https://tr.snapchat.com/cm/i

<form method="GET" action="https://tr.snapchat.com/cm/i" target="snap0978655483715763" accept-charset="utf-8" style="display: none;"><iframe id="snap0978655483715763" name="snap0978655483715763"></iframe><input name="pid"></form>

Text Content

Speak to a Licensed Insurance Agent
1-866-279-8740 TTY Users 711
Mon - Sun, 7a.m. - 10p.m. CST
Call Now


LET’S SEE IF YOU QUALIFY FOR A $5,1001 MEDICARE SUBSIDY AND A NEW MEDICARE PLAN
- AT NO EXTRA COST!

See If I Qualify

Press Enter

What is your ZIP code?


What's your age range?
Under 6060 - 6970 - 7980 - 8990 +Prefer Not to Say
What is your first name?

What is your last name?

Have this card?
YesNoPrefer not to sayUnsure
Last step, !

See If I QualifyI consent to the terms in this form.

By clicking the button, you consent to be contacted by a licensed insurance
agent at GoHealth or GoHealth services about Medicare Advantage, PDP plans, and
other related services via automatic telephone dialing system, artificial voice
and/or pre-recorded message, or text message at the telephone number you
provided. You understand that consent is not a condition of purchase, and you
may also receive a quote by contacting us by phone. You may revoke this consent
at any time.

GoHealth does not charge you for sending or receiving text messages. Your
carrier's message and data rates may apply. By using this form, you agree to the
terms of our Privacy Policy.

 * Privacy Policy
 * Terms
 * Licensing Information
 * Contact Us



GoMedicare.com is privately owned and operated by GoHealth, LLC. The purpose of
this site is the solicitation of insurance and informational purposes only.
Contact may be made by an insurance agent/producer or insurance company.
GoHealth and Medicare supplement insurance plans are not connected with or
endorsed by the U.S. government or the federal Medicare program, if you are
looking for the government’s Medicare site, it is www.medicare.gov.

1SSA.gov "Understanding the Extra Help With Your Medicare Prescription Drug
Plan" pages. https://www.ssa.gov/pubs/EN-05-10508.pdf

MULTIPLAN_GOHEALTH0012_2022_ENG

Copyright © 2022 GoMedicare.com All Rights Reserved

214 W. Huron, Chicago, IL 606541-866-279-8740

www.gomedicare.com Open in urlscan Pro 3.18.135.206 Public Scan

Form analysis 8 forms found in the DOM

GET https://tr.snapchat.com/cm/i

Text Content

www.gomedicare.com Open in urlscan Pro
3.18.135.206 Public Scan

Form analysis
8 forms found in the DOM