MEDICARE CHECKLIST

Items to bring with for your Medicare Review Appointment

Medicare Checklist ( Internal Office Use Only)
Clients Name
Date

MonthDayYear
Date
Agents Name
Date

MonthDayYear
Date
1 Primary Dr
2 Secondary Dr
Check to make sure you have 2024 income
A
Social Security Statement (2024)
B
Addt'l income. Pension, 2nd Job, etc
C
D
E
4.Social Security Statement (Income/2024)

5.Driver's License Valid 6. Medicare Card

for $30.00 ONE TIME DONATION (free internet)

7. Insurance Card (IF ARE ALREADY ON PLAN)

Atena, United Healthcare, CIGNA, Humana, Devoted
8.Social Security Card (If you have it)

Affordable Health Insurance (Family Member)Getting on the Christmas Gifting ListWe can laminate your cards for FREEDriver’sLicense Valid (Check Expiration Date)Check to make sure you have 2024 incomeSocial Security Statement (2024)Addt’lincome. Pension, 2nd Job, etcSS CardInsurance Card (Front & Back)Medicare CardAsk about tablet $250 value for $30.00 ONE TIME DONATION (Free Internet)Life Insurance (ask if the client would like a Life Insurance Quote)
Should be Empty: