MEDICARE CHECKLIST

Items to bring with for your Medicare Review Appointment
Clients Name
Date

MonthDayYear
Date
Agents Name
Date

MonthDayYear
Date
1 Primary Doctor
2 Secondary Doctor
1. Drug List
2. Drug List
3. Drug List
4. Drug List
5. Drug List, if more than 5 please let agent know so they can be listed
Bring your current year income statements

4.Social Security Statement for the current year or any additional income, Pension, 2nd Income, etc...

5.Driver's License Valid

6. Medicare Card

7. Insurance Card (IF ARE ALREADY ON PLAN)

Atena, United Healthcare, CIGNA, Humana, Devoted

8.Social Security Card (If you have it)
If you need any additional services, please check the box

Affordable Health Insurance (Family Member)Getting on the Christmas Gifting ListWe can laminate your cards for FREEOther
File Upload, Social Security Statement, Drivers License, Medicare & or Medicaid card any additional Income source documents.

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