Welcome to MARS Enterprises Inc.

General Insurance & Financial Intake

Use this intake to help us understand your needs and guide you toward the right insurance or financial solution. If you’re unsure which service fits you best, our licensed professionals are here to provide clear, personalized guidance.

To provide accurate guidance, we begin with a short, secure intake form. This helps us understand your needs before scheduling a consultation.

Completing this form:

  • Does not obligate you to enroll in any plan
  • Does not require a purchase
  • Helps us prepare for a personalized discussion

Who This Is For

Medicare & Health Insurance

  • Medicare Advantage (MAPD)
  • Dual-Eligible Special Needs Plans (D-SNP)
  • ACA / Marketplace coverage

Life Insurance Planning

  • Family protection
  • Final expense or legacy planning
  • Supplemental retirement funding

Annuities & Retirement Income

  • Guaranteed income strategies
  • Existing annuity reviews
  • 401(k) rollovers

Not Sure Where to Start

If you’re unsure which service fits your needs, we’ll help guide you.

Your Information is Protected

We use bank-level security and comply with federal HIPAA privacy laws

256-bit Encryption

Bank-level security for all data

HIPAA Compliant

Meets federal health privacy laws

Never Sold

Your data stays completely private

Secure Access

Only authorized staff can view

Read our completePrivacy Policy &Notice Of Privacy Practices

Basic Contact Information

Your primary contact details for follow-up and communication.

Service Selection

Select the services you are interested in or choose guidance if you're unsure.

Consent & Acknowledgments

Review the disclosures and provide your consent to proceed with this request.

Submitting this form does not obligate you to enroll in any plan and does not guarantee plan availability.

MARS Enterprises Inc. is an independent agency and is not connected with or endorsed by the U.S. government or the federal Medicare program.

Information provided will be used solely to respond to your request and provide insurance or financial planning assistance.

Do not include medical records or detailed diagnosis information in this intake form.

Consent Signature Agreement

By typing your name above, you electronically sign acknowledging the disclosures above. Date and time will be automatically recorded when you sign.

Consumer Written Consent – Marketplace & Medicare

CMS-required authorization to assist with coverage shopping

By signing below, you authorize MARS Enterprises Inc. and its licensed representatives to serve as your health insurance agency for Marketplace and Medicare shopping purposes.

You authorize MARS Enterprises Inc. to access, use, and securely store your confidential information, including personally identifiable information (PII), solely for the purposes of:

  1. Searching for or creating a Marketplace or Medicare application;
  2. Completing applications for eligibility and enrollment;
  3. Providing ongoing account maintenance and enrollment assistance;
  4. Responding to inquiries from CMS, Marketplaces, or carriers;
  5. Validating eligibility information (MBI, LIS, Medicaid, providers, formularies).

MARS Enterprises Inc. will not use or share your information for purposes beyond those listed above. You may revoke or modify this consent at any time by written or electronic notice.

Only fill this if someone other than yourself will be the primary contact

What Happens Next

After you submit the form:

  1. A licensed representative will review your information
  2. We’ll contact you using your preferred method
  3. A one-on-one consultation will be scheduled (phone, video, or in person)

There is no obligation to enroll in any plan.

Important Information

MARS Enterprises Inc. is an independent agency and is not connected with or endorsed by the U.S. government or the federal Medicare program.

Submitting this form does not guarantee plan availability and does not obligate enrollment or purchase.

Please do not include medical records or detailed diagnosis information in this form.

Need help completing the form?

Contact us directly and we’ll be happy to assist.

Confidential & Secure

Your information is protected and handled responsibly

CMS-Compliant Disclosures

Transparent, compliant, and regulatory-safe

No Obligation

You’re always in control of your choices

Prefer to Talk Instead?

(814) 844-3511
info@marsenterprisesinc.com