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Submit medicare needs analysis

Now for Step 2: Complete your Medicare Needs Analysis

To help me recommend a Medicare plan that fits your unique needs, please complete the Medicare Needs Analysis Form.

This form will gather three important pieces of information:
1. Your Doctors & Specialists

• This helps me confirm that your providers are in-network with the plan you’re enrolled in — or considering enrolling in.

2. Your Prescription Medications

• Medication coverage can change each year.
• Just because a drug was covered this year does not guarantee it will be covered next year.
• By listing your prescriptions, we can double-check that they are included in the plan’s formulary.

3. Scope of Appointment (Required by Medicare)

• This form is a Medicare requirement and gives me permission to discuss specific plan types with you.
• Without this completed form, we cannot meet.

To proceed, please click here.