Use your browser’s Print menu to print or save this resource as a PDF. Keep completed worksheets privately. Do not put policy numbers, Medicare numbers, medical records or Social Security numbers in our general quote form.
Get ready for a Medicare conversation
Keep a private list of the following so your discussion can focus on your needs:
- Your current coverage and the date you expect it to change.
- Doctors, hospitals and preferred pharmacies you want checked.
- Prescription names, doses and how often you refill them.
- Travel needs and the coverage questions you want answered.
- Premium and out-of-pocket costs you want to understand.
Keep Medicare identification numbers and medical documents out of the general quote form. Use the dedicated intake process when you are ready to share the information it requests.
Prepare with RetireFlo Medicare intakeUse RetireFlo for Part D onlyRetireFlo intake collects information for review; it does not enroll you in a plan or reserve an appointment. You can also use Medicare.gov’s official plan comparison.
