Refer A Friend

Referrers Name

Your First Name

Your Last Name

Referral's Name

Friend's First Name

Friend's Last Name

Referral's Email

Referral's Birthdate

Providing your friend’s information on this form will allow RetireMed to communicate with them to help guide them through their Medicare journey.

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RetireMed operates under the legal name RetireMED IQ LLC and is licensed to sell health insurance plans in Ohio, Kentucky, and Indiana. 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.