Medicare Authority Program

Apply for your state.

We take one agency per state. Fill this in completely and we will confirm whether your state is open, then set a time to talk. Payment details come after that conversation, never before it.

We review your application. Everything we need is in this form, so there is nothing to chase afterwards.

We confirm your state. If it is already taken we tell you straight away rather than let you wait on it.

We set a time to talk. You will have read the program by then, so the call is to meet, agree the scope and get you payment details.

Full name

Mobile phone

Agency name

Your current website

Referred by

Business address

City

State

ZIP code

Your FMO or upline

Are you the decision maker?

Which state do you want to own?

Any additional states you would want

Are you licensed and appointed in that state?

Is your AHIP certification current?

Roughly how many Medicare clients on your book?

What are you doing for marketing today?

Which package are you applying for?

When would you want to start?

Best time for a call

Anything we should know?

Text message consent

I agree to receive text messages from FEX Leads Daily at the number I provided, including messages sent using automated systems and AI assistants. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help. Consent is not required to do business with us. See our Messaging Terms and Privacy Policy.