Skip to content
  • Quote
  • Call
  • Service
    • Login
    • Policy Changes
    • Report a Claim
    • My Profile
Casanas Insurance Agency
  • For Individuals
    Personal Insurance
    We offer insurance for individuals and families, including customized coverage, to fit your lifestyle.
    View All
    Personal Insurance QuotePersonal Insurance Quote
    Homeowners
    Auto
    Life Insurance
    High Net Worth
    Umbrella
    Flood
    Boats / Watercraft
    Classic & Exotic Cars
    Motorcycle
    RV/Trailer
    Powersports
    Earthquake
    Jewelry
    Landlords
    Condo
    Course of Construction
    Renters
    • Autos, Cars & Trucks
    • Homeowners
    • High Net Worth
    • Umbrella
    • Motorcycle
    • Boat
    • Flood
    • Golf Cart
  • For Business
    Business Insurance
    We provide small businesses with a variety of different coverage & policy options that fit their needs.
    View All
    Business Insurance QuoteBusiness Insurance Quote
    Builders Risk
    Business Interruption
    Business Owners Policy
    Commercial Auto
    Commercial Property
    Commercial Trucking
    Contractor’s Tools and Equipment
    Cyber Liability
    Directors & Officers
    Employment Practices Liability
    Equipment Breakdown
    Excess / Umbrella
    Garage Keepers Insurance
    General Liability
    Hired & Non-Owned Auto
    Inland Marine
    Liquor Liability
    Package Policy
    Product Liability
    Professional Liability E&O
    Real Estate Investments
    Special Events
    Surety Bonds
    Workers Compensation
    • General Liability
    • Workers’ Compensation
    • Commercial Auto
    • Commercial Property
    • Cyber Liability
    • Professional Liability
    • Employment Practices Liability
    • Business Owners Policy
  • About
    • About Us
    • Meet The Owner
    • Testimonials
    • Blog
    • FAQs
    • Refer Friends & Family
    • Join Our Team
  • Office
  • Contact
Casanas Insurance Agency
  • Login
  • For Clients
    Business Account Review
    Business
    Account Review

    Keep your business and employees protected as your business grows.

    Business ReviewBusiness Review
    Personal Account Review
    Personal
    Account Review

    Submit your updated information so we can make sure your family stays properly protected.

    Personal ReviewPersonal Review
    For Clients
    • Policy Service
    • Certificate of Insurance
    • Report a Claim
    • Schedule Appointment
    • Contact Us
    • Opt Into SMS
    • Policy Changes
    • Certificate of Insurance
    • Report a Claim
    • Account Review: Personal
    • Account Review: Business
  • For Individuals
    Personal Insurance
    We offer insurance for individuals and families, including customized coverage, to fit your lifestyle.
    View All
    Personal Insurance QuotePersonal Insurance Quote
    Homeowners
    Auto
    Life Insurance
    High Net Worth
    Umbrella
    Flood
    Boats / Watercraft
    Classic & Exotic Cars
    Motorcycle
    RV/Trailer
    Powersports
    Earthquake
    Jewelry
    Landlords
    Condo
    Course of Construction
    Renters
    • Autos, Cars & Trucks
    • Homeowners
    • High Net Worth
    • Umbrella
    • Motorcycle
    • Boat
    • Flood
    • Golf Cart
  • For Business
    Business Insurance
    We provide small businesses with a variety of different coverage & policy options that fit their needs.
    View All
    Business Insurance QuoteBusiness Insurance Quote
    Builders Risk
    Business Interruption
    Business Owners Policy
    Commercial Auto
    Commercial Property
    Commercial Trucking
    Contractor’s Tools and Equipment
    Cyber Liability
    Directors & Officers
    Employment Practices Liability
    Equipment Breakdown
    Excess / Umbrella
    Garage Keepers Insurance
    General Liability
    Hired & Non-Owned Auto
    Inland Marine
    Liquor Liability
    Package Policy
    Product Liability
    Professional Liability E&O
    Real Estate Investments
    Special Events
    Surety Bonds
    Workers Compensation
    • General Liability
    • Workers’ Compensation
    • Commercial Auto
    • Commercial Property
    • Cyber Liability
    • Professional Liability
    • Employment Practices Liability
    • Business Owners Policy
  • About
    • About Us
    • Meet The Owner
    • Testimonials
    • Blog
    • FAQs
    • Refer Friends & Family
    • Join Our Team
  • Office
  • Contact
817-592-5388
Get Insurance

Medicare Insurance Quote

  1. Home
  2. Medicare Insurance Quote
Medicare Insurance QuoteGravity Certs2026-01-06T11:18:01-07:00
This field is for validation purposes and should be left unchanged.
MM slash DD slash YYYY
I consent to contact(Required)

Client Information

Name(Required)
SMS Consent
Date of Birth(Required)
Gender(Required)
Mailing Address(Required)
For household discount purposes
Spouse Date of Birth

Current Medicare Plan (if available)

Please skip to the next section if you do not currently have a medicare plan.
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY
Are you a smoker?

Coverage Information

Do you have a medicate.gov account?(Required)
Do you give us permission to create a medicare.gov account on your behalf?(Required)
Coverage Interests(Required)
Select all that apply

Physicians

Primary Care

Specialist

Name
Add Specialist 2

Specialist 2

Name
Add Specialist 3

Specialist 3

Name
Add Specialist 4

Specialist 4

Name

Hospital & Pharmacy

Current Prescriptions

DO NOT list over the counter (OTC) vitamins, supplements, and/or prescriptions not purchased.
DO NOT state "as needed". Instead, provide an estimate based on the frequency you use the drug.
For inhalers, eye drops, creams, lotions, or ointments, provide size of bottle/tube and frequency of refills.
For insulin or injectables, provide units per day or pens per month.
Drug Name Dosage Package Generic Actions
       
There are no Medications.

Maximum number of medications reached.

Additional Information

By responding to this request, I understand that I am not required to provide any private, protected health information (PHI). This information is only for use by Casanas Insurance Agency to help make an informed plan decision and will not be shared with any third party. I agree that an Casanas Insurance Agency representative may contact me by telephone, e-mail or US mail to discuss Medicare Advantage Plans, Prescription Drug Plans and Medicare Supplement Insurance Plans.
Clear Signature
Casanas Insurance Agency
1560 E Southlake Blvd, Suite 100
Southlake, Texas 76092
Phone: 817-592-5388

Hours: Mon-Fri 8:30am-5:30pm

Get Insurance
  • Personal Quote
  • Business Quote
  • Trucking Quote
  • Contractors Quote
  • Course of Construction
  • All Quote Options
Resources
  • About
  • Contact
  • Blog
  • Refer Friends & Family
  • Frequently Asked Questions
  • Join Our Team
For Clients
  • Policy Service
  • Schedule Appointment
  • Opt Into SMS
  • Report a Claim
  • Certificate of Insurance
  • My Profile

Proudly offering insurance services, home insurance, auto insurance, life insurance, and commercial insurance for businesses in all of Texas, including Amarillo, Arlington, Austin, Bedford, Brownsville, Colleyville, Coppell, Corpus Christi, Dallas, Decatur, Denton, El Paso, Flower Mound, Fort Worth, Frisco, Garland, Grand Prairie, Grapevine, Haltom City, Houston, Irving, Keller, Killeen, Laredo, Lewisville, Lubbock, McAllen, McKinney, Plano, Richland Hills, Roanoke, Saginaw, San Antonio, Southlake, Waco, Watauga, and the surrounding areas. View all service areas.

Accessibility  |  Privacy Policy  |  Cookie Policy  |  Terms of Service  |  Sitemap

DISCLAIMER: Informational statements regarding insurance coverage are for general description purposes only. These statements do not amend, modify or supplement any insurance policy. Read your policy or consult with your agent for details. Your eligibility for particular products and services is subject to final underwriting and acceptance by the insurance company providing such products or services.

This website does not make any representations that coverage does or does not exist for any particular claim or loss, or type of claim or loss, under any policy. Be sure to read the policy, including all endorsements, or prospectus, if applicable.

Copyright © Casanas Insurance Agency  |  Website hosted by GravityCerts
Page load link
Start Your Quotes
Select an Insurance Type
Start Personal Insurance Quote for Individuals and Families
Personal Insurance
Start Insurance Quote
Start Business Insurance Quote
Business Insurance
Start Insurance Quote
Additional Quote Options
  • Quick General Liability

  • Contractors & Trades

  • Course of Construction

  • Commercial Trucking

  • Farm Insurance

  • Medicare

  • Golf Cart

  • Jewelry & Valuables

  • Equine & Animals

  • Vacant Land

Need a Policy Recommendation?
  • Contact Us

  • Call: 817-592-5388

Login

Lost password

Don’t have an account?

Create AccountCreate Account
Insurance Fraud Statement

Fraud is a crime

If your application contains purposefully misleading, absent, or inaccurate information, you could be charged with fraud. Your insurance carrier could potentially void your policy, or you could face civil or criminal charges or penalties.

Any person who knowingly and with intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act, which is a crime.

We use cookies to offer you a better browsing experience, analyze site traffic and personalize content. Read about our Cookie Policy. Ok