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Welcome to our Medicare Annual Review Portal!

Your health and well-being are our top priorities, and we understand that making informed decisions about your Medicare plan is essential to ensuring comprehensive coverage that meets your evolving healthcare needs. Medicare plans can change from year to year, and without a careful review, you might find yourself in a plan that no longer aligns with your requirements. Our user-friendly platform is here to guide you through the process of submitting a digital Scope of Appointment, a crucial step towards assessing your current plan and exploring better options.

An annual review can make a world of difference in identifying the plan that best suits you for the upcoming year, safeguarding not only your health but also your financial security. Once you've submitted the Scope of Appointment, one of our dedicated agents will promptly reach out to you to schedule an appointment. During this appointment, we'll delve into the details of your healthcare needs, answer any questions you may have, and work together to explore the most suitable Medicare plan options for the upcoming year.

Scope of Sales Appointment Confirmation Form

The Centers for Medicare and Medicaid Services requires agents to document the scope of a marketing appointment prior to any face-to-face sales meeting to ensure understanding of what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). All information provided on this form is confidential and should be completed by each person with Medicare or his/her authorized representative.

Please check the type of product(s) you want the agent to discuss.(Required)

By signing this form, you agree to a meeting with a sales agent to discuss the types of products you indicated above. Please note, the person who will discuss the products is either employed or contracted by a Medicare plan. They do not work directly for the federal government. This individual may also be paid based on your enrollment in a plan.

Signing this form does NOT obligate you to enroll in a plan, affect your current enrollment, or enroll you in a Medicare plan.

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Beneficiary or Authorized Representative Signature and Signature Date:

MM slash DD slash YYYY
I have read the product type descriptions listed below(Required)

Beneficiary or Authorized Representative Signature and Signature Date:

*Scope of Appointment documentation is subject to CMS record retention requirements* A Coordinated Care plan with a Medicare Advantage contract and a Medicare-approved Part D sponsor.

Collection of Medical Information

Collecting both doctors' information and medication lists is vital for conducting a thorough and effective annual review of one's healthcare. Doctors' details enable us to verify and assess whether your current healthcare providers align with your medical needs and preferences. This ensures continuity of care and that any necessary referrals or consultations can be made promptly. Simultaneously, an up-to-date medication list is crucial for evaluating the appropriateness and effectiveness of your medication regimen, identifying potential drug interactions, and exploring cost-saving alternatives. By combining these two sets of information, we can provide a comprehensive annual review that helps optimize your healthcare plan, ensuring it truly meets your unique needs and circumstances.

Doctors Information:

City, State, Zip
City, State, Zip
City, State, Zip

Prescription Information:

if you have more prescriptions, doctors or just want to let us know never to call after 3pm tell us all about your needs here.
Stand-alone Medicare Prescription Drug Plans (Part D)
Medicare Prescription Drug Plan (PDP) - A stand-alone drug plan that adds prescription drug coverage to Original Medicare, some Medicare Cost plans, some Medicare Private Fee-for-Service plans, and Medicare Medical Savings Account plans.
Medicare Advantage Plans (Part C) and Cost Plans
Medicare Health Maintenance Organization (HMO) - A Medicare Advantage Plan that provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. In most HMOs, you can only get your care from doctors or hospitals in the plan’s network (except in emergencies)

Medicare Preferred Provider Organization (PPO) Plan - A Medicare Advantage Plan that provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. PPOs have network doctors and hospitals but you can also use out-of-network providers, usually at a higher cost.

Medicare Private Fee-For-Service (PFFS) Plan - A Medicare Advantage Plan in which you may go to any Medicare-approved doctor, hospital and provider that accepts the plan’s payment, terms and conditions and agrees to treat you – not all providers will. If you join a PFFS Plan that has a network, you can see any of the etwork providers who have agreed to always treat plan members. You will usually pay more to see out-of-network providers

Medicare Point of Service (POS) Plan - A type of Medicare Advantage Plan available in a local or regional area which combines the best feature of an HMO with an out-of-network benefit. Like the HMO, members are required to designate an in-network physician to be the primary health care provider. You can use doctors, hospitals, and providers outside of the network for an additional cost.

Medicare Special Needs Plan (SNP) - A Medicare Advantage Plan that has a benefit package designed for people with special health care needs. Examples of the specific groups served include people who have both Medicare and Medicaid, people who reside in nursing homes, and people who have certain chronic medical conditions.

Medicare Medical Savings Account(MSA) Plan - MSA Plans combine a high deductible health plan with a bank account. The plan deposits money from Medicare into the account. You can use it to pay your medical expenses until your deductible is met

Medicare Cost Plan - In a Medicare Cost Plan, you can go to providers both in and out of network. If you get services outside of the plan's network, your Medicare-covered services will be paid for under Original Medicare but you will be responsible for Medicare coinsurance and deductibles.
Dental/Vision/Hearing Products
Plans offering additional benefits for consumers who are looking to cover needs for dental, vision or hearing. These plans are not affiliated or connected to Medicare.
Hospital Indemnity Products
Plans offering additional benefits; payable to consumers based upon their medical utilization; sometimes used to defray copays/coinsurance. These plans are not affiliated or connected to Medicare.
Medicare Supplement(Medigap) Product
Plans offering a supplemental policy to fill “gaps” in Original Medicare coverage. A Medigap policy typically pays some or all of the deductible and coinsurance amounts applicable to Medicare-covered services, and sometimes covers items and services that are not covered by Medicare, such as care outside of the country. These plans are not affiliated or connected to Medicare.