Medicare Decision Worksheet Request

This interactive workshop will help you understand Medicare basics and learn the difference between Medicare Advantage and Medicare Supplement. ⏱️ Takes about 15–20 minutes. Download the worksheet below and complete it at your own pace.

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Medicare Starting Point

I am turning 65 soon

I have Medicare Part A and Part B

I have employer group coverage

I am a veteran or spouse and use VA benefits. Champ VA, or Tricare

I have Medicaid

Other

Current Health and Coverage Needs

I take prescription medications regularly

I have doctors I want to keep

I want dental coverage

I want vision coverage

I want hearing coverage

I want help with transportation, OTC items, or extra benefits

I travel often or live in more than one state during the year

I want predictable out-of-pocket costs

I want more provider flexibility

I may need help understanding future health costs or ongoing care needs

Watch Original Medicare Video — 3-minutes

After watching the Original Medicare video, which statement stood out to you?

Original Medicare includes Part A and Part B.

Original Medicare does not usually include prescription drug coverage.

I may still have deductibles, coinsurance, or other out-of-pocket costs.

I can generally see any provider who accepts Medicare.

I would like more information about Original Medicare.

Medicare Part B Readiness

I am comfortable paying the Part B premium

I am not sure I can comfortably afford the Part B premium

I want to learn whether I may qualify for Medicaid, or MSP assistance to help pay Medicare Part B

I may consider delaying Part B , are there any penalties?

Next Watch Medicare Advantage Video — 2-minute

After watching the Medicare Advantage video, which statement stood out to you?

Medicare Advantage provides Medicare benefits through a private insurance plan.

Many plans use a network of doctors and hospitals.

Some plans include prescription drug coverage and additional benefits.

Costs, benefits, and availability can vary by plan and county.

I would like more information about Medicare Advantage.

Next Watch Medicare Part D — 2-minute video

After watching the Medicare Part D video, which statement stood out to you?

Medicare Part D helps cover prescription medications.

Drug costs can depend on the plan's formulary, drug tier, and pharmacy.

A preferred pharmacy or mail-order option may lower prescription costs.

Part D plans and costs can change from year to year.

Next Watch Medicare Supplement — 3-minute video

After watching the Medicare Supplement video, which statement stood out to you?

Medicare Supplement works with Original Medicare.

It may help pay 20% of costs that Original Medicare does not cover.

I can generally see any provider who accepts Medicare.

Medicare Supplement usually does not include prescription drug coverage.

Which tradeoff feels easier for you to live with?

Pay Part B premium + Medigap premium+ Part D premium, pay for additional benefits when needed

Pay Part B premium + Medicare Advantage $0/low premium with Part D and additional benefits included (All in one)

I need both options compared side by side

Do you have any upcoming procedures?Type N/A if it don't apply to you.

Any pending treatments or surgeries?Type N/A if it don't apply to you.

Do you currently have a primary care doctor / PCP?

Yes

Do you currently see any specialists?

Yes

Step 5: Doctors, Travel, and Upcoming Treatment

I travel often enough that provider flexibility matters

I already use doctors or hospitals outside my local area and I want to keep them

I have specialist visits, tests, or treatment that may continue throughout the year

I don't go to the doctor

I am ok with seeing any doctor close to me.

I want to keep all my doctors as long as they are in the network its fine.

Do you travel frequently or receive care outside your local area?

Yes

My doctor / travel / treatment notesType N/A if it don't apply to you.

Medicare Advantage (MAPD) if...

I prefer a lower monthly premium

I am comfortable using a provider network: HMO, HMO-POS, PPO etc...

I like the idea of medical + drug coverage bundled into one plan

Extra benefits like dental, vision, hearing, OTC, or transportation matter to me

I do not mind checking copays, provider networks, and prior authorization rules

Most of my care happens locally

I want to compare my monthly premium against possible copays as I use care

I like having medical and drug coverage in one package

Medigap + Part D if...

I travel often or spend time in more than one state during the year

I sometimes see doctors or specialists out of town

I want the freedom to use providers nationwide who accept Medicare

I have ongoing treatment, specialist care, or heavier medical usage

I want fewer network restrictions and fewer referral worries

I care more about provider flexibility and peace of mind than extra benefits

I understand I may pay for Part B + Medigap + Part D

I am okay if I may also need separate dental, vision, or hearing coverage

Other

Based on your answers, a review can help compare your doctors, prescriptions, budget, travel needs, and whether Medicare Advantage, Medicare Supplement plus Part D, or savings programs may need a closer look.

Do you want to request a Medicare review appointment?* This field is required.

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Text message

Any of these

Preferred appointment date* This field is required.Monday - Friday only

Date

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Communication Permission* This field is required.

By checking this box and submitting this form, I agree that Sunrise Benefit Advisors and licensed insurance agent Rosequertha Lorfils may contact me by phone, text message, and email regarding my Medicare workshop answers, appointment request, and related Medicare insurance information. I understand that my consent is not required to enroll in a plan or purchase any product. Message and data rates may apply. I can ask not to be contacted at any time. This is a solicitation for insurance.

Thank you for completing the Medicare 101 Decision Workshop. We hope it helped you better understand your Medicare choices. If you need help in the future, you can contact Sunrise Benefit Advisors at 754-777-0931. Click Submit